Eyeworld

October 2011 Dr. Chang: What is your opinion of and take-home conclusion from the UCSF study data? Dr. Braga-Mele: The UCSF study is a very interesting study that looks at complication rates of residents per- forming ECCE or phacoemulsifica- tion. The data revealed that the complication rates were about the same with respect to vitreous loss and similar with respect to reopera- tion rates (but perhaps for different reasons). However, the study failed to look at post-op outcomes such as visual acuity, astigmatism, and corneal endothelial stability. It also showed that there was a lower rate of PCIOL implantation in the ECCE group, which makes one assume that ACIOLs were used, and they in- herently have a longer-term compli- cation issue. The conclusion that the author states of further studies need- ing to be done to weigh the educa- tional benefits of teaching ECCE is a valid one; however, one must question the ethics of subjecting live patients to ECCE when phacoemul- sification can likely be performed with relatively good results. Dr. Gattey: I applaud Dr. Naseri and his group for their thoughtful analy- sis of this dilemma. The primary outcome of vitreous loss rate is an important one, but more germane to the patients receiving the procedures is final uncorrected and best cor- rected visual acuity. ECCE induces substantially more astigmatism than phacoemulsification, leading, pre- sumably, to worse uncorrected visual acuity. This alone makes ECCE less ethical in my mind even if all other outcomes are equal. Another inter- esting result was the high rate of vit- reous loss (17% for ECCE and 16.9% for phaco) for beginning surgeons. This points to a need for better cataract surgery training models, perhaps with more time spent on wet lab practice or the use of surgery simulators. Drs. Park and Dodick: We agree with the overall conclusion that it is acceptable to teach phaco first as a primary cataract extraction tech- nique. When we trained, residents were required to perform 10 ECCEs before moving to phaco. We don't believe this is necessary or desirable, and this policy is no longer the case in our training program. The tech- niques are not dependent on one another, and with the judicious use of the wet lab and surgical simula- tion as introductory exercises, we feel comfortable starting a novice surgeon with phaco techniques. It would appear that the take- home conclusion from the UCSF study data is that there is no signifi- A Perfect Balance of Performance, Convenience, and Simplicity. • Rapid Bilateral Measurements • IOP Correction Calculation • Powered by (2) AAA Batteries • Ret ractable Probe • Lightweight at 3.6 oz • Only 6.9" Long • Rel iable • Durable • Proven Accuracy Available in BLack, Burgundy, Royal Blue, White and Teal. Serving Eye Care Professionals since 1982 CALL TODAY! (800) 722-3883 • www.pachymeter.com Enhance your practice's diagnostic capabilities. Many eye care professionals find the B-Scan essential in a myriad of cases. CPT 76512 (Ophthalmic Ultrasound, Diagnostic B-Scan). Multiple ICD-9 codes for reimbursement. The Scanmate is a compact, high-tech and affordable system. The Scanmate merits careful review by eye care professionals. *Computer not included. F A S T • P O R T A B L E • E A S Y • A F F O R D A B L E USB Computer Based B-Scan* The Pachmate DGH 55 ALSO ask about our economical Pachette 3. Experience The Benefits of Excellence The Scanmate DGH 8000 dghbpC booth 4.860x13 ASCRS:Layout 1 5/20/11 5:10 PM Page 1 Part II: Will ECCE become a vanishing art? Rosa Braga-Mele, M.D. Devin Gattey, M.D. Lisa Park, M.D. Jack Dodick, M.D. 76-83 Cataract_EW October 2011-DL2_Layout 1 9/29/11 5:26 PM Page 78

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