Eyeworld

EW CATARACT September 2011 79 cant difference in patient outcomes between ECCE vs. phaco in the hands of a novice surgeon. We are pleased to see that they found the rate of vitreous loss to be the same in the two groups. But what would ultimately be more important to know is the final visual acuity in order to show that it is ethical for patients to receive ECCE. Dr. Chang: How important is it for phaco surgeons to know how to do a manual ECCE? Dr. Braga-Mele: It is important for phaco surgeons to feel comfortable with ECCE to be able to convert a difficult or challenging case. How- ever, unless one keeps the skills in tune, even some of the best phaco surgeons (that may have been ECCE trained) have a difficult time feeling comfortable with conversion to ECCE. Luckily, there are not many cases in this day and age, in the U.S. or Canada, that require conversion to ECCE. Many of these cases get re- ferred to surgeons who tend to do the more challenging cases and be- cause of this, these surgeons keep their skills honed. It is also difficult to say at what point in one's career that ECCE needs to be taught or whether it should be in a wet lab sit- uation or on live patients. Dr. Gattey: A previous paper by Dr. Naseri's group noted that the two highest risk factors for a major intra- operative complication during resi- dent-performed phacoemulsification cataract surgery were mature 4+ nu- clear sclerosis cataract and zonular pathology. These cases are often "converted" to ECCE after complica- tions ensue, necessitating that ex- pert surgeons eventually acquire the skill to perform an ECCE under chal- lenging circumstances. Planned ECCE is often the best choice for these cataracts. Manual small inci- sion cataract extraction (MSICS) is a variation of ECCE that is even better suited for these potentially compli- cated surgeries. Its benefits include the possibility of a sutureless proce- dure and the induction of less astig- matism than traditional ECCE. Used extensively in South Asia, this proce- dure has a proven track record for routine and difficult cataracts and, in experienced hands, can be per- formed as quickly as phaco. Drs. Park and Dodick: We believe it is still critical to teach ECCE as a technique and for cataract surgeons to feel comfortable handling an open eye. In our training program at NYU, which includes a Level 1 Trauma Center and coverage of the New York correctional system, we often encounter cases necessitating conversion to ECCE or ICCE. Addi- continued on page 80 76-83 Cataract_EW October 2011-DL2_Layout 1 9/29/11 5:26 PM Page 79

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