Ergebnisse der Phakoemulsifikation in der Lernphase

Background The subjective and objective results during the training phase of phacoemulsification using a 6 mm sclero-corneal tunnel incision at 12 h were evaluated. Patients and methods In a prospective study we evaluated the first 221 cases of phacoemulsification by a cataract surgeon during his training phase. Objective parameters which were analyzed included intraoperative complications, preoperative, early postoperative (p. o.) (1 - 13 days) and late p. o. (to the third month) assessment of refraction, visual acuity and corneal astigmatism. Calculation of the induced astigmatism was performed using the subtraction method and the vector analysis according to Jaffe. For evaluation of subjective results we used a questionnaire in the late p. o. phase. The questionnaire contained questions concerning satisfaction with the explanation of the surgical procedure, the medical personnel, the procedure itself and the result of the operation. Results During surgery, 6 posterior capsular ruptures (2.7 %) and 3 zonular dialyses (1.4 %) occurred. In 6 cases (2.7 %) an anterior vitrectomy was necessary, in two cases (0.9 %) an anterior-chamber lenses had to be implanted. Preoperatively, the average visual acuity was 0.5 +/- 0.14 (n = 221), the early p. o. visual acuity was 0.49 +/- 0.23 (n = 220) and the late p. o. visual acuity was 0.73 +/- 0.31 (n = 121). The average spheric equivalent was early p. o. 0.04 D +/- 1.18 D (n = 208) and late p. o. 0.11 D +/- 1.08 D (n = 118). The difference to the planned refraction was early p. o. 0.68 D +/- 1.13 D, and late p. o. 1.39 D +/- 1.18 D. The mean induced astigmatism early p. o. was 0.55 D +/- 0.97 D (n = 166) and late p. o. 0.37 D +/- 0.87 D (n = 121) (subtraction method). Utilizing vector analysis for calculation of the induced astigmatism we obtained 1.43 D +/- 0.86 D (n = 121) for the early p. o. situation and 1.22D +/- 0.88 D (n = 121) for the late p. o. situation, respectively. 80 % of the patients (n = 119) were satisfied with the results (highest rating), 3 % were unhappy (lowest rating). Conclusion The results of this study reveal that phacoemulsification is a safe and satisfactory procedure for patient, even during the training phase of a cataract surgeon.