Comparison of Posterior Capsule Rupture Rate during Phacoemulsification by Novice Ophthalmologists: Microscope vs. Intracameral Illumination

Yu Jeong Kim; Hyejin Seo; Jong Hwan Lee; Seong-Woo Kim; Tae-Young Chung; Sung Jin Lee; Kyu Hyung Park; Dong Heun Nam

doi:10.3341/jkos.2019.60.7.654

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Kim, Seo, Lee, Kim, Chung, Lee, Park, and Nam: Comparison of Posterior Capsule Rupture Rate during Phacoemulsification by Novice Ophthalmologists: Microscope vs. Intracameral Illumination

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(7): 654-660.

Published online: 15 July 2019

DOI: https://doi.org/10.3341/jkos.2019.60.7.654

Comparison of Posterior Capsule Rupture Rate during Phacoemulsification by Novice Ophthalmologists: Microscope vs. Intracameral Illumination

Yu Jeong Kim, MD¹, Hyejin Seo, MD², Jong Hwan Lee, MD¹, Seong-Woo Kim, MD, PhD³, Tae-Young Chung, MD, PhD⁴, Sung Jin Lee, MD, PhD⁵, Kyu Hyung Park, MD, PhD⁶, Dong Heun Nam, MD, PhD¹

¹Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea.

²DMC Good Eye Clinic, Seoul, Korea.

³Department of Ophthalmology, Korea University Guro Hospital, Seoul, Korea.

⁴Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

⁵Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Seoul, Korea.

⁶Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.

Address reprint requests to Dong Heun Nam, MD, PhD. Department of Ophthalmology, Gachon University Gil Hospital, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: 82-32-460-3684, Fax: 82-32-460-3358, eyedawns@gilhospital.com

Received 27 December 2018 Revised 24 February 2019 Accepted 25 June 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared the posterior capsule rupture (PCR) rate between microscope versus intracameral illumination in phacoemulsification surgery performed by novice ophthalmologists.

Methods

We conducted a retrospective chart review of 300 eyes of 211 patients who underwent phacoemulsification by novice ophthalmologists from March 2012 to October 2017. Novice ophthalmologists (n = 6) were divided into those using microscope illumination (n = 4) and intracameral illumination users (n = 2). The first 50 cataract surgery cases of each novice ophthalmologist were reviewed. The results using a phacoemulsification machine and microscopy were the same. The intraoperative complications and learning curve in each case were evaluated.

Results

Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in PCR rate between the microscope illumination (19.0%, 38/200) and intracameral illumination (4.0%, 4/100) groups (p = 0.001). The incidence of PCR was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while it was 15% in the first 10 cases and 0% in 50 cases thereafter in the intracameral illumination group.

Conclusions

Novice surgeons had a lower PCR rate during cataract surgery using intracameral illumination than using microscope illumination. Both groups showed a tendency for the PCR to decrease with increasing surgical cases, but the intracameral illumination group showed a shorter learning curve.

Keywords: Intracameral illumination, Learning curve, Novice ophthalmologist, Phacoemulsification, Posterior capsule rupture

Figures and Tables

Figure 1

Phacoemulsification learning curve of each illumination. The incidence of posterior capsule rupture was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while 15% in the first 10 cases and 0% in 40 cases thereafter in the intracameral illumination group. PCR = posterior capsule rupture.

Figure 2

Microscope illumination (A) vs. intracameral illumination (B). In microscope illumination, a red reflex is produced by reflection of bright coaxial light from the macula back to the observer (the ocular of an operating microscope). In Intracameral illumination, on the other hand, a side light of intracameral illumination is shining into not macula but peripheral retina. Therefore, the light reflection from the macula back to the observer is decreased. Furthermore, intracameral illumination improved visibility of the lens and enhanced depth perception of the surgical field.

Table 1

Patient demographics

Values are presented as mean ± standard deviation (range) or number (%).

DM = diabetes mellitus.

^*Independent t-test; ^†chi-square test.

Table 2

Posterior capsule rupture of each surgeon

Values are presented as number (%).

PCR = posterior capsule rupture.

^*Chi-square test.

Table 3

Comparison of PCR rate

Values are presented as number (%).

PCR = posterior capsule rupture.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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