Eyeworld

OCT 2011

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Precision Controlled Dry Heat Sterilizers Microprocessor controlled units for all metal and steam sensitive instruments. www.sterisure.com • www.coxrapidheat.com 2364 Leicester Road • PO Box 175 • Leicester, NY 14481 Phone: 1-800-828-6011 • (585) 382-3223 • Fax (585) 382-9481 Model 2100 - 2 Trays Advantages of SteriSURE Dry Heat Sterilization • Kills bacteria and spores without moisture. • Does not dull, pit, or rust sharp instruments. • Does not require a dry cycle that adds to the sterilization cycle time. • Economical, little to no maintenance, low operating costs and requires no distilled water. Model 3100 - 3 Trays One Touch Automatic Controls and Digital Display See You at the AAO Show! October 22-25 • Orlando, FL Booth #3275 COX Rapid Dry Heat Sterilizer Utilizes dry heat to sterilize rather than steam and pressure. Focus On the Quality Products from CPAC Used by Refractive Surgeons Worldwide Fast 6 Minute Cycle Time, Easy to Use and Convenient! Made in USA Made in USA NEW! Part I: Complication rates of phaco vs. manual ECCE among initial surgical trainees at UCSF phacoemulsification in these pa- tients. Another potential difficulty is that temporally in each resident's experience, the ECCE surgeries oc- curred before the phacoemulsifica- tions, as is standard practice in the UCSF residency program, thus im- parting an experiential advantage to the phacoemulsification cases. Fi- nally, since the surgeries occurred in three different hospitals, one or more of the sites may have been more likely to employ a certain pro- cedure based on the pathology in- herent to its patient population. Nonetheless, we believed it was im- portant to have some outcomes data to compare the two procedures from a patient safety perspective. We retrospectively reviewed first-year ECCEs and the first 10 pha- coemulsifications performed by the same residents between 2002 and 2008, looking specifically at vitreous loss, posterior chamber intraocular lens (PCIOL) placement, and reoper- ation within 90 days of the initial surgery. Because ECCEs were per- formed prior to phacoemulsifica- tions and because ECCE patients often have dense cataracts, we hy- pothesized that the rate of complica- tions would be higher in ECCE cases. 5 We identified 171 eyes of 160 patients who underwent ECCE and 255 eyes of 242 patients who under- went phacoemulsification. Vitreous loss occurred in 29 (17.0%) of 171 eyes that underwent ECCE and in 43 (16.9%) of 255 eyes that underwent phacoemulsification (P=0.95). A PCIOL was initially placed in 153 (89.5%) ECCE cases as compared to 248 (97.3%) phacoemulsification cases (P=0.002). Reoperation within 90 days of cataract surgery took place in 5 (2.9%) ECCE cases and in 13 (5.1%) phacoemulsification cases (P=0.31). When pre-op BCVA, hospi- tal, and age were controlled for in a multivariate analysis, there was no evidence of a relationship between type of cataract extraction and vitre- ous loss rate (P=0.86), placement of a PCIOL (P=0.10), or reoperation rate (P=0.10). Although the vitreous loss rates in our study were uncomfortably high in both groups, we felt reas- sured that there was no ethical dilemma posed by training our resi- dents in ECCE when comparing out- comes between the two groups. We had already studied our complica- tion rate for resident-performed cataract surgery over the course of our 3-year program and found the vitreous loss rate to be 3.1%. But be- cause of the high rates we found in this study, we have been working diligently to decrease the complica- tion rate for both techniques. Other issues that we have iden- tified in the course of looking at teaching ECCE in our residency pro- gram include the adoption of small incision ECCE techniques and the decreasing numbers of experienced ECCE educators over time. Many of our current teaching faculty trained in the "phaco" era and are therefore less comfortable teaching ECCE. At the same time, we are impressed by the advances in small incision ECCE popularized by our international col- leagues, and we have begun to train our residents in these methods as well. EW References 1. Smith JH. Teaching phacoemulsification in US ophthalmology residencies: can the quality be maintained? Curr Opin Ophthalmol 2005;16:27-32. 2. Stewart JM. Phacoemulsification performed by residents [letter]. J Cataract Refract Surg 2007;33:755. 3. Bhagat N, Nissirios N, Potdevin L, et al. Complications in resident-performed pha- coemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol 2007;91:1315-7. 4. Rowden A, Krishna R. Resident cataract sur- gical training in United States residency pro- grams. J Cataract Refract Surg 2002;28:2202-5. 5. De Niro J, Biebesheimer J, Porco TC, Naseri A. Early resident-performed cataract surgery. Ophthalmology. 2011 Jun;118(6):1215-1215. 76-83 Cataract_EW October 2011-DL2_Layout 1 9/29/11 5:26 PM Page 77

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