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Moustafa GA, Borkar DS, McKay KM, Eton EA, Koulisis N, Lorch AC, Kloek CE. Outcomes in resident-performed cataract surgeries with iris challenges: Results from the Perioperative Care for Intraocular Lens study. J Cataract Refract Surg 2018; 44:1469-1477. [PMID: 30391157 DOI: 10.1016/j.jcrs.2018.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/16/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the outcomes of resident-performed cataract surgeries with iris challenges and to compare these outcomes with similar surgeries performed by attending surgeons. SETTING Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. DESIGN Retrospective chart review. METHODS All cases of cataract extraction by phacoemulsification with intraocular lens implantation, performed by comprehensive ophthalmologists between January 1 and December 31, 2014, were reviewed. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome, were included for analysis. Visual outcomes and the rate of perioperative adverse events were compared between resident and attending surgeon cases. Factors predicting adverse events were also assessed. RESULTS In total, 1931 eye cases of 1434 patients were reviewed, and 65 resident cases and 168 attending surgeon cases were included. The mean logarithm of the minimum angle of resolution corrected distance visual acuity was better in the resident group 1 month after surgery (0.051 ± 0.10 [SD] versus 0.132 ± 0.30, P = .03); however, the difference was eliminated when controlling for macular disease. The mean operative time was 43.8 ± 26.5 minutes and 30.9 ± 12.6 minutes for cases performed by resident surgeons and attending surgeons, respectively (P .0001). Residents utilized supplemental pharmacologic dilation or retraction more frequently than attending surgeons (98% versus 87% of cases, P = .008). The overall rate of adverse events was no different between residents and attending surgeons (P = 0.16). Dense nuclear sclerosis predicted adverse events in cataract cases with iris challenges (adjusted odds ratio, 1.86; 95% confidence interval, 1.17-2.94; P = .001). CONCLUSION Although requiring longer operative times and more surgical manipulation, residents who performed cataract surgeries with iris challenges achieved outcomes comparable to those performed by attending surgeons, and residents should be given the opportunity to operate on these eyes.
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Affiliation(s)
- Giannis A Moustafa
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Durga S Borkar
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - K Matthew McKay
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Emily A Eton
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Nicole Koulisis
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Alice C Lorch
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Carolyn E Kloek
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA.
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- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
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Hargitai J, Vezendi L, Vigstrup J, Eisgart F, Lundbye-Christensen S, Hargitai B, Vorum H. Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin - a randomized controlled trial. BMC Ophthalmol 2013; 13:83. [PMID: 24359572 PMCID: PMC3878506 DOI: 10.1186/1471-2415-13-83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/16/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A strong association exists between the use of tamsulosin and the occurance of intraoperative floppy iris syndrome. Several methods were advocated to overcome the progressive intraopertive miosis.Our purpose was to investigate the effect of a mydriatic-cocktail soaked cellulose sponge on perioperative pupil diameter in tamsulosin-treated patients undergoing elective cataract surgery. METHODS Patients using tamsulosin were dilated either with mydriatic-cocktail soaked sponge (group 1) or with conventional eyedrop regimen (group 2). Control patients not taking any α1 adrenergic receptor inhibtors were also dilated with mydriatic sponge (group 3).In all groups oxybuprocain 0.4%, cocain 4%, tropicamide 1%, phenylephrine 10%, diclophenac 0.1% along with chloramphenicol 0.5% were used preoperatively.Pupil diameter (mm) was measured preoperatively, after nucleus delivery, and before IOL implantation. Adverse effects associated with the use of sponge, minor and major intraoperative complications, the use of iris retractors and operation time were recorded.Differences in general between groups were analyzed with a one way analysis of variance (ANOVA); differences between groups in proportions were assessed by Fisher's exact test. RESULTS Mean pupil diameter (mm) was preopertively: 7.52 ± 1.21, 7.30 ± 1.55 and 7.99 ± 0.96 (ANOVA: p = 0.079); after nucleus delivery: 6 ± 1.20, 6.29 ± 1.12 and 6.52 ± 0.81 (ANOVA: p = 0.123); before IOL implantation: 5.46 ± 1.06, 5.83 ± 1.09 and 6.17 ± 0.89 (ANOVA: p = 0.0291).No adverse effect related to sponge use was detected. Frequency of minor complications, and iris hook use was similar in the two tamsulosin treated group. Operation time did not differ significantly in the three groups. CONCLUSION We have found that using a mydriatic cocktail-soaked wick - an alternative way to achieve intraoperative mydriasis for cataract surgery - was as effective and safe as the conventional repeated eyedrops regiment for tamsulosin treated patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN37834752.
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Affiliation(s)
- János Hargitai
- Department of Ophthalmology, Thy-Mors Hospital, Højtoftevej 2, Thisted 7700, Denmark
| | - László Vezendi
- Department of Ophthalmology, Thy-Mors Hospital, Højtoftevej 2, Thisted 7700, Denmark
| | - Jørgen Vigstrup
- Department of Ophthalmology, Thy-Mors Hospital, Højtoftevej 2, Thisted 7700, Denmark
| | - Finn Eisgart
- Department of Ophthalmology, Thy-Mors Hospital, Højtoftevej 2, Thisted 7700, Denmark
| | | | - Bálint Hargitai
- UK Specialist Hospitals, Emersons Green NHS Treatment Center, Bristol, UK
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University, Aalborg, Denmark
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