Hong Kong Eye Hospital

Acknowledgement  OT nursing staff  MRO staff Unplanned AV rate

Introduction  Importance of auditing cataract surgery outcomes Most commonly performed surgery Surgeons at different levels of training The Royal College of Ophthalmologists – cataract surgery guidelines recommendations  Especially important this year with increase in cataract surgery load Unplanned AV rate

Posterior capsule rupture  One of the most common adverse surgical events  Incidence varies from 0.7% to 16%*  Acceptable range around 2-4%  Associated with a poor visual outcome Cystoid macular edema Retinal detachment Unplanned AV rate Surv Ophth 2001

Methods  Cataract surgeries performed in HKEH between 1 April 2010 to 31 Jan 2011 Phacoemulsification Extracapsular cataract extraction  No of AV________ No of surgeries performed Unplanned AV rate Mechanical vitrectomy Planned AV excluded Information from nursing record Confirmed with patient record Both as surgeon and supervisor Information from CDARS Combine surgery excluded

Primary outcome  Unplanned AV rate Hospital Phaco versus ECCE Specialist versus non-specialist Individual surgeon  Individual surgeon information confidential Feedback to surgeon Unplanned AV rate

Results  Phacoemulsification 40 phaco surgeons 4094 phaco 60 unplanned AV cases Rate 1.5%  ECCE 35 ECCE surgeons 650 ECCE 18 unplanned AV cases Rate 2.8% Unplanned AV rate

Comparison of results 2007/82009/102010/11 Phacoemulsification AV rate (%) ECCE AV rate (%) Unplanned AV rate

Specialist vs non-specialist Unplanned AV rate SpecialistNon-specialistOverall Phacoemulsification AV rate (%) ECCE AV rate (%)

Unplanned AV rate Phacoemulsification No serious outliers Variation in surgical load

Unplanned AV rate ECCE Lesser ECCE Less surgical experience Smaller denominator

Secondary outcomes  Mean final visual outcomes  Stage when PCR occurred  Lens status  Other major complications Unplanned AV rate

Final visual outcomes Unplanned AV rate Mean Snellen VA (range)* Phacoemulsification0.40 ( ) ECCE0.41 ( ) *Cases with other accountable cause of poor visual acuity excluded

Stage of phaco when PCR occurred Unplanned AV rate More than half after nucleus removed

Lens status Unplanned AV rate Aphakia (%)Pseudophakia Sulcus (%)SFIOL (%)ACIOL (%) Phacoemulsification ECCE

Other complications PhacoemulsificationECCE Dropped nucleus61 Retained cortical matter71 Vitreous hemorrhage53 Suprachoroidal hemorrhage01 (limited) Choroidal detachment20 Retinal break40 Retinal detachment10 Unplanned AV rate

Conclusions  Unplanned AV rates of cataract surgeries in acceptable compared with International data Previous annual rates  Increasing the surgical load did not adversely affect the surgical outcomes Unplanned AV rate