Cataract surgery risk stratification in phacoemulsification and manual small incision cataract surgery in a teaching
Madhu Shekhar1, Payal Choudhury1, Gomati Ramya1
1Aravind Eye Hospital, Madurai, India.
Purpose:
To evaluate a system that objectively assesses the risk of cataract surgery complications performed with phacoemulsification and manual small incision cataract surgery (MSICS) techniques.
Methods:
The study was a retrospective comparative interventional case series. Electronic medical records of consecutive eyes that underwent cataract surgery from January 2019 to December 2019 were evaluated. Patient's demographic data and preoperative risk factors were identified, and cataract was categorized as per Lens Opacities Classification System (III). Cataract eyes were grouped into normal cataract cases (G1) and complex cataract cases (G2 and G3), based on the risk factors. The rate of complications in each group and the rate of each complication were calculated and compared.
Results:
The overall rate of anyone complication was 2.2% with 2.3% in G1, 1.0% in G2 and 3.9% in G3 (p < 0.001). MSICS technique, mostly used for complex cases (54.2%), reported a higher complication rate than the phacoemulsification technique (2.9% vs 1.4%, p < 0.001). However, the complication rates among the normal and complex cases were similar (2.3% vs 2.2%, p = 0.376). The total posterior capsular tear rate was 1.1% with no vitreous loss in nearly 1 in eight eyes.
Conclusion:
A preoperative risk stratification system is crucial for obtaining informed consent and better allocation of cases to surgeons based on their expertise to minimize intraoperative complications.
