Aravind Eye Hospital, Madurai, India.
J Cataract Refract Surg. 2012 Aug;38(8):1360-9. doi: 10.1016/j.jcrs.2012.04.025.
To analyze the rate of intraoperative complications, reoperations, and endophthalmitis with phacoemulsification, manual small-incision cataract surgery (SICS), and large-incision extracapsular cataract extraction (ECCE).
Aravind Eye Hospital, Madurai, India.
Retrospective cohort study.
This study comprised consecutive cataract surgeries performed during a 12-month period. All surgical complications and endophthalmitis cases were tabulated and analyzed for each of 4 surgeon groups (staff, fellows, residents, visiting trainees). Within each surgeon group, complication rates with phacoemulsification, manual SICS, and ECCE were compared.
The surgical distribution was 20,438 (26%) phacoemulsification, 53,603 (67%) manual SICS, and 5736 (7%) ECCE. The overall intraoperative complication rate was 0.79% for staff, 1.19% for fellows, 2.06% for residents, and 5% for visiting trainees. Extracapsular cataract extraction had the highest overall rate of surgical complications (2.6%). The overall complication rate was 1.01% for manual SICS and 1.11% for phacoemulsification. However, the combined complication rate for trainees was significantly higher with phacoemulsification (4.8%) than with manual SICS (1.46%) (P<.001). The corrected distance visual acuity was better than 6/12 in 96% after phacoemulsification complications and 89% after manual SICS complications (P<.001). There were 27 cases (0.04%) of endophthalmitis but no statistical differences between surgical methods or surgeon groups.
For staff surgeons experienced with both phacoemulsification and manual SICS, intraoperative complication rates were comparably low. However, for trainee surgeons, the complication rate was significantly higher with phacoemulsification, suggesting that manual SICS may be a safer initial procedure to learn for inexperienced cataract surgeons in the developing world.
No author has a financial or proprietary interest in any material or method mentioned.
分析超声乳化白内障吸除术、小切口手法白内障囊外摘出术（ECCE）和传统白内障囊外摘出术（SICS）的术中并发症、翻修率和眼内炎的发生率。
印度马杜赖的 Aravind 眼科医院。
回顾性队列研究。
本研究纳入了在 12 个月期间连续进行的白内障手术。对所有手术并发症和眼内炎病例进行了制表和分析，共分为 4 组外科医生（主治医生、进修医生、住院医生、访问学员）。在每组外科医生中，比较了超声乳化白内障吸除术、小切口手法白内障囊外摘出术和传统白内障囊外摘出术的并发症发生率。
手术分布为：超声乳化白内障吸除术 20438 例（26%）、小切口手法白内障囊外摘出术 53603 例（67%）和传统白内障囊外摘出术 5736 例（7%）。主治医生的术中并发症发生率为 0.79%，进修医生为 1.19%，住院医生为 2.06%，访问学员为 5%。ECCE 的总体手术并发症发生率最高（2.6%）。小切口手法白内障囊外摘出术和超声乳化白内障吸除术的总体并发症发生率分别为 1.01%和 1.11%。然而，住院医生和进修医生的联合并发症发生率，超声乳化白内障吸除术（4.8%）显著高于小切口手法白内障囊外摘出术（1.46%）（P<.001）。在超声乳化白内障吸除术并发症和小切口手法白内障囊外摘出术并发症后，矫正视力优于 6/12 的比例分别为 96%和 89%（P<.001）。有 27 例（0.04%）眼内炎，但手术方法或外科医生组之间无统计学差异。
对于经验丰富的超声乳化白内障吸除术和小切口手法白内障囊外摘出术的主治医生，术中并发症发生率相当低。然而，对于进修医生来说，超声乳化白内障吸除术的并发症发生率显著更高，这表明在发展中国家，对于没有经验的白内障外科医生来说，小切口手法白内障囊外摘出术可能是一种更安全的初始手术方法。
无作者存在任何与材料或方法相关的经济利益。
