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EW RESIDENTS 91 I n the October issue of JCRS, the article, "Decreasing rate of capsule complications in cataract surgery," Lundström et al., evaluates the frequency of capsule complications during cataract surgery over the 8-year pe- riod from 2002-09 and identifies risk factors using prospectively collected data from the Swedish National Cataract Register (NCR). Capsular complications occurred in 2.09% of cases. Possible risk factors included poor pre-op corrected visual acuity, glaucoma, diabetic retinopathy, older age, first eye surgery, clinic vol- ume, and clinic location. We applaud Lundström et al. for the multiple merits of this publica- tion. By using the Swedish NCR as the data source, they were able to perform a true population study, representing more than 97% of the cataract surgery done in the country D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: +1 800-75-DUTCH or +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutch ophthalmicusa.com MEMBRANEBLUE TM 0.15% Trypan Blue Ophthalmic Solution INDICATIONS FOR USE MembraneBlue ™ is indicated for use as an aid in ophthalmic surgery by staining the epiretinal membranes during ophthalmic surgical vitrectomy procedures, facilitating removal of the tissue and reducing the risk of retinal damage. Staining also reduces the chance of incomplete peeling of the membrane, which could lead to persisting metamorphopsia. The application of MembraneBlue ™ onto the ILM or the ERM resulted in a useful bluish staining, facilitating the identification, delineation, and removal of the membranes in all surgeries. No residual staining or adverse effects related to MembraneBlue ™ were observed. 1 MembraneBlue ™ staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal. 2 SPECIAL CONSIDERATIONS It is recommended that after injection all excess MembraneBlue ™ is immediately removed from the posterior chamber of the eye. MembraneBlue ™ is contraindicated when a non-hydrated, hydrophilic acrylic lens is planned to be inserted into the eye. Adverse reactions reported following use of MembraneBlue ™ include discoloration of high water content hydrogen IOLs and inadvertent staining of the posterior lens and vitreous face, which is generally self-limited, lasting up to one week. NOW AVAILABLE TO US SURGEONS Please see adjacent page for brief prescribing information. 1. Teba FA, Mohr A, Eckardt C, Wong D, Kusaka S, Joondeph BC, Feron EJ, Stalmans P, Van Overdam K, Melles GRJ. Trypan blue staining in vitreoretinal surgery. Ophthalmology 2003; 110(12):2409-12. 2. Vote BJ, Russell MK, Joondeph BC, Trypan Blue-Assisted Vitrectomy, Retina 2004; 24(5):736-8. D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: +1 800-75-DUTCH or +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutch ophthalmicusa.com ERGONOMICALLY DESIGNED, PRECISION ENGINEERED TO GIVE YOU AN ADVANTAGE. See what other advantages D.O.R.C. can offer you! INNOVATION WITH AN ADVANTAGE... THE D.O.R.C. ADVANTAGE Until now, disposable microforceps and scissors have fallen short of achieving the same level of action and performance as reusable instruments. The Dutch Ophthalmic Research Center, the first to develop disposable instruments, now offers you a distinct advantage in disposable instrumentation. The D.O.R.C. Advantage line has been clinically engineered to overcome the functional limitations of existing disposable instruments while delivering maximum performance and functionality. by Afshan A. Nanji, J. Peter Campbell, Connie J. Chen, Christina S. Moon, Wilmer residents; James P. Dunn, residency program director; and Shameema Sikder, chief resident Wilmer residents' review of "Decreasing rate of capsule complications" continued on page 92 October 2011 James P. Dunn, M.D., residency program director, WIlmer Institute Shameema Sikder, M.D., chief resident, Wilmer Institute Decreasing rate of capsule complications in cataract surgery J Cataract Refract Surg (October) 2011; 37: 1762-1767 Mats Lundström, M.D., Ph.D., Anders Behndig, M.D., Ph.D., Maria Kugelberg, M.D., Ph.D., Per Montan, M.D., Ph.D., Ulf Stenevi, M.D., Ph.D., William Thorburn, M.D., Ph.D. Eight-year study of incidence, risk factors, and data validity by the Swedish National Cataract Register Purpose: To define the incidence of capsule complication and its risk factors in Sweden over an 8-year period Setting: Fifty-two ophthalmic surgery units in Sweden Design: Database study Methods: Data were collected prospectively in the Swedish National Cataract Register (NCR) from 2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Sweden over the 8-year study period. One mandatory variable in the register is capsule complications during surgery. As a means to validate the accuracy of register data on capsule complications, a randomly selected sample of 2,400 registrations was compared with corre- sponding medical records. Results: The analyses were based on 602,553 cataract extractions reported to the NCR. A capsule complication was reported in 12,574 cataract extrac- tions, corresponding to a frequency of 2.09%. The incidence of this complica- tion consistently decreased each year from 2002 to 2006, after which it stabilized. Poor corrected distance visual acuity in the surgical eye (≤0.1), the occurrence of glaucoma, diabetic retinopathy, and age were among the pa- rameters significantly related to a capsule complication. Some of these param- eters also decreased over time. However, even after adjusting for this, there was an obvious decrease in capsule complications over time. The validity test showed a certain underreporting of capsule complications to the registry, but it was not significant and did not change over time. Conclusion: The incidence of capsule complications decreased over time. This may be partly the result of fewer risk factors and of better surgical quality. EyeWorld journal club This month we asked the Wilmer residents to review an article from the October JCRS on decreasing capsule complications during cataract surgery. –David F. Chang Visit us at AAO Booth 2746 89-93 Resident_EW October 2011-DL32_Layout 1 9/29/11 4:35 PM Page 91

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