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Second instrument tip breaks during phacoemulsification.

Fariba Nazemi1, Silvia Odorcic, Rosa Braga-Mele

  • 1Department of Ophthalmology, University of Toronto, Toronto, Ont. fariba.nazemi@utoronto.ca

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|November 21, 2008
PubMed
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Approximately one-third of cataract surgeons experience second instrument tip breaks. Most breaks are managed during surgery, but improved tracking and inspection are needed for quality control.

Area of Science:

  • Ophthalmology
  • Surgical Complications
  • Medical Device Analysis

Background:

  • Second instrument tip breaks during phacoemulsification are anecdotally reported but poorly understood.
  • The frequency, tracking, and management of these complications are not well-documented.
  • These events may represent an underreported, serious complication of cataract surgery.

Purpose of the Study:

  • To determine the incidence of second instrument tip breaks during phacoemulsification.
  • To investigate the management and presumed causes of these breaks.
  • To assess the condition of surgical instruments through SEM analysis.

Main Methods:

  • Survey of 114 cataract surgeons in Ontario regarding tip break experiences.
  • Review of incident reports, sterilization processes, and purchase histories at 4 Toronto cataract centers.

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  • Scanning electron microscopy (SEM) comparison of broken, new, and used second instrument tips.

    • Main Results:

    • 34% of surveyed surgeons reported experiencing a second instrument tip break.
    • Most breaks (73%) were managed intraoperatively; others required imaging or vitrectomy.
    • Frequent replacement of specific instruments (Sweeney hook) suggests potential material fatigue, confirmed by SEM in both new and used instruments.

    Conclusions:

    • Despite a lack of quality control for surgical instruments, about one-third of surgeons face tip breaks.
    • While most cases are managed during surgery, standardized inspection and tracking are crucial.
    • Further investigation is needed to understand the etiology and establish protocols for reporting and managing these complications.