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Displaced nuclear fragments into the vitreous complicating phacoemulsification surgery in the United Kingdom: incidence and risk factors
  1. Sajjad Mahmood (saj{at}eyebase.co.uk),
  2. Hirut von Lany (vonlanyhirut10{at}hotmail.com),
  3. Michael Cole (mick.cole{at}nhs.net),
  4. Stephen Charles (steve.charles{at}cmmc.nhs.uk),
  5. Charles James (charles.james{at}nhs.net),
  6. Barnaby Foot (bosu{at}msn.com),
  7. Pieter Gouws (pieter.gouws{at}esht.nhs.uk),
  8. Steve Shaw (sshaw{at}plymouth.ac.uk)
  1. Manchester Royal Eye Hospital, United Kingdom
  2. Torbay Hospital, United Kingdom
  3. Torbay Hospital, United Kingdom
  4. Manchester Royal Eye Hospital, United Kingdom
  5. Torbay Hospital, United Kingdom
  6. Royal College of Ophthalmologists, United Kingdom
  7. Conquest Hospital, St Leonards-on-Sea, United Kingdom
  8. University of Plymouth, United Kingdom

    Abstract

    Aims: To study the epidemiology and risk factors contributing to displacement of nuclear fragments into the vitreous (DNFV) complicating phacoemulsification in the United Kingdom.

    Methods: Cases were collected prospectively between March 2003- March 2004 by active surveillance through the British Ophthalmological Surveillance Unit (BOSU). Case control analysis of risk factors was performed by visiting 10 randomly selected centres using a total of 521 cases of uncomplicated phacoemulsification. Validation analysis to assess under-reporting was performed in a total of 13 randomly selected units.

    Results: 610 cases of DNFV were confirmed during the reporting period. The estimated incidence of DNFV was 0.19-0.28%. The complications group was significantly older than the control group (mean 76.8 versus 74.3 years: p<0.001). Significant pre-operative risk factors were posterior synechiae (5.1% versus 2.2%), incomplete pupil dilation (59.5% versus 8.8%), pseudoexfoliation (5.6% versus 1.4%) and previous vitrectomy (7.8% versus 2.2%). Significant operative variables related to surgical experience, topical (14.3% versus 3.1%) and subtenon’s anaesthesia (51.4% versus 37.2%) and requirement for vision blue (trypan blue ophthalmic solution) (13.7% versus 2.4%).

    Conclusions: The estimated incidence of DNFV during phacoemulsification surgery in the UK is 2 to 3 per 1000 operations. Risk factors have been identified which should help guide case selection for phacoemulsification surgery and modify techniques.

    • Cataract
    • Complications
    • Phacoemulsification
    • Surveillance
    • Vitrectomy

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