Evolution of cataract surgery: Smaller incision - less complications

Abstract

Background/Aim. Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. Methods. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. The used surgical techniques were: extracapsular cataract extraction, phacoemulsification/ forceps IOL implantation, phacoemulsification/ injector IOL implantation, microincision cataract surgery (MICS). Patient follow up was 6 months. Patients were evaluated for: visual aquity, corneal astigmatism, cellular reaction in the anterior chamber, IOL position. Results. Uncorrected visual aquity 30 days postoperatively was ? 0.5 in 30% of the eyes - ECCE; 54.7% of the eyes - phacoemulsification/forceps IOL implantation; 63.0% of the eyes - phacoemulsification/injector IOL implantation; 5/8 of the eyes - MICS. Endophthalmitis was detected in 0.15% of the eyes - ECCE and 0.1% of the eyes - phacoemulsification/forceps IOL implantation. In eyes with phacoemulsification/injector IOL implantation or microincision cataract surgery (MICS) there were no cases of endophthalmitis. After a 6-month period intraocular lens were dislocated in 7.2% of the eyes - ECCE, and 0.6% of the eyes - phacoemulsification/PMMA IOL. There was no IOL dislocation in other surgical techniques. Conclusion. Shorter corneal incision implies less complications, less operative trauma, faster visual rehabilitation and better visual outcome.Uvod/Cilj. Operacija katarakte sa razvojem tehnologije i hirurske tehnike postala je jedna od ?najbezbednijih? operacija u medicini. Iako svedene gotovo na minimum, komplikacije, ipak, i dalje postoje. Cilj ovog rada bio je da uporedi vidni ishod i ucestalost pojedinih komplikacija kod razlicitih hirurskih tehnika hirurgije katarakte, odnosno operacija katarakte sa razlicitom sirinom kornealne incizije. Metode. U istrazivanje je bilo ukljuceno 3 457 bolesnika, odnosno 4 670 ociju operisanih od katarakte. Koriscene hirurske tehnike bile su: ekstrakapsularna ekstrakcija katarakte (ECCE), fakoemulzifikacija sa implantacijom intraokularnog sociva implantacionom pincetom (FAKO/IOL), fakoemulzifikacija sa implantacijom intraokularnog sociva injektorom i mikroinciziona hirurgija katarakte (MICS). Bolesnici su bili praceni sest meseci. Pri pregledu odredjivani su: vidna ostrina, kornealni astigmatizam, celularna reakcija u prednjoj komori, pozicija intraokularnog sociva. Rezultati. U zavisnosti od primenjene hirurske tehnike nekorigovana vidna ostrina 30. postoperativnog dana bila je ? 0,5: kod 30% ociju - ECCE; 33,1% ociju - FAKO/ IOL PMMA; 54,7% ociju - FAKO/IOL implantacija pincetom; 63,0% ociju - FAKO/IOL implantacija injektorom; 5/8 ociju - MICS. Endoftalmitis je registrovan kod 0,15% ociju - ECCE; 0,3% ociju - FAKO/IOL PMMA; 0,1% ociju - FAKO/IOL implantacija pincetom. Kod ociju operisanih tehnikama FAKO/IOL implantacija injektorom i MICS nije bilo zabelezenih slucajeva endoftalmitisa. Intraokularno socivo nakon sest meseci bilo je dislocirano kod 7,2% ociju - ECCE i 0,6% ociju - FAKO/PMMA. Kod drugih hirurskih metoda nije bilo dislokacije IOL-a. Zakljucak. Manja kornealna incizija daje manju operativnu traumu, manje komplikacija, kracu vidnu rehabilitaciju i bolji vidni ishod.