article envoyé par fedia

7/28/2019 article envoy par fedia

1/6

Decreasing rate of capsule complicationsin cataract surgery

Eight-year study of incidence, risk factors, and datavalidity by the Swedish National Cataract Register

Mats Lundstrom, MD, PhD, Anders Behndig, MD, PhD, Maria Kugelberg, MD, PhD,Per Montan, MD, PhD, Ulf Stenevi, MD, PhD, William Thorburn, MD, PhD

PURPOSE: To define the incidence of capsule complication and its risk factors in Sweden over an8-year period.

SETTING: Fifty-two ophthalmic surgery units in Sweden.

DESIGN: Database study.

METHODS: Data were collected prospectively in the Swedish National Cataract Register (NCR) from2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Swedenover the 8-year study period. One mandatory variable in the register is capsule complications duringsurgery. As a means to validate the accuracy of register data on capsule complications, a randomlyselected sample of 2400 registrations was compared with corresponding medical records.

RESULTS: The analyses were based on 602 553 cataract extractions reported to the NCR. A capsulecomplication was reported in 12 574 cataract extractions, corresponding to a frequency of 2.09%.The incidence of this complication consistently decreased each year from 2002 to 2006, after whichit stabilized. Poor corrected distance visual acuity in the surgical eye (% 0.1), the occurrence ofglaucoma, diabetic retinopathy, and age were among the parameters significantly related to a cap-

sule complication. Some of these parameters also decreased over time. However, even after adjust-ing for this, there was an obvious decrease in capsule complications over time. The validity testshowed a certain underreporting of capsule complications to the registry, but it was not significantand did not change over time.

CONCLUSION: The incidence of capsule complications decreased over time. This may be partly theresult of fewer risk factors and of better surgical quality.

Financial Disclosure: No author has a financial or proprietary interest in any material or methodmentioned.

J Cataract Refract Surg 2011; 37:17621767Q 2011 ASCRS and ESCRS

The evolvement of cataract surgery has been as closeas can be to a success story. Still, various complica-tions keep recurring, and some events do not endhappily.

A much feared perioperative complication is disrup-tion of the barrier between the anterior chamber andthe vitreous. In some cases, there is a rupture of theposterior capsule only, or zonulysis. In others, vitreousprolapse will occur through the wound and in theworst scenario, lens material will drop into the vitre-

ous body. A literature search limited to reports

describing more than 1000 surgeries performed byseveral surgeons showed that a posterior capsule rup-ture occurs in1.9% to 5.2% of all phacoemulsificationprocedures17 and vitreous loss occurs in 1.1% to5.0%.18 Vitreous loss is defined in different ways;mostly, the term implies that vitreous material hasbeen removed from the wound by use of instruments.

Uneventful cataract extraction is generallya straightforward and quick procedure. Even so,extractions with capsule complications can be very

difficult to handle and late complications, such as

Q 2011 ASCRS and ESCRS 0886-3350/$ - see front matter

Published by Elsevier Inc. doi:10.1016/j.jcrs.2011.05.022

1762

ARTICLE
http://dx.doi.org/10.1016/j.jcrs.2011.05.022http://dx.doi.org/10.1016/j.jcrs.2011.05.022


2/6

endophthalmitis or retinal detachment, may follow,with devastating consequences.910

The Swedish National Cataract Register (NCR)11 be-gan including posterior capsule complication as a com-plication variable with mandatory registration in theregistry form starting in January 2002. The aim of thepresent investigation was to define the incidence ofcapsule complication in Sweden and its risk factorsover an 8-year period (2002 through 2009).

MATERIALS AND METHODS

Almost all units performing cataract surgery in Sweden wereassociated with the NCR from 2002 through 2009. Thismeans that the surgical units were committed to report tothe database of the NCR every cataract extraction performedduring this period. Through comparison with another regis-ter source for intraocular procedures, which is run by theSwedish Ophthalmological Society, NCR-reported cataractoperations were found to cover97.3% of the total cataract ex-tractions in Sweden during the 8-year study period.

The present database study was based on NCR data col-lected prospectively from 2002 through 2009. The parame-ters collected for each cataract extraction were clinic, yearof surgery, surgical procedure number (clinic specific),same-day bilateral surgery, age, sex, first- or second-eye sur-gery, preoperative corrected distance visual acuity (CDVA)in surgical eye, preoperative CDVA in fellow eye, ocular co-morbidity (sight threatening) in the surgical eye (specified asglaucoma, macular degeneration, diabetic retinopathy, andother), date on waiting list, date of surgery, type of surgery,type of intraocular lens (IOL), and communication with vit-reous body during surgery.

Communication with the vitreous body was defined as

zonulysis or posterior capsule rupture with or withoutvitreous loss and also covered loss of lens material into thevitreous cavity. If a communication is present before sur-gery, the finding should have been reported; however, theoverwhelming number of cases occurred during surgery.Thus, for practical reasons, the term capsule complication isused instead of communication with the vitreous body in thepresent report.

To validate the accuracy of registerdata on a capsule com-plication, a representative sample of operations was furtherrandomly selected and the corresponding medical records

for 2400 cases were retrieved. The period to study was estab-lished as 2002 through 2006. With reference to statistical con-siderations, it was decided that 50 randomly chosenprocedures for each year and clinic would produce a suffi-ciently large sample. Thirty clinics had a sufficient annualvolume to qualify for the study; of these, 17 clinics were ran-domly selected and invited to participate. The volume crite-

rion was based on the probability of detecting a reasonablenumber of cases with a capsule complication, given its gen-erally reported incidence. Twelve clinics accepted the invita-tion, but it appeared as though 2 clinics had lost theirregistration numbers and had no way to track the patient re-cords; in the end, 10 clinics participated. With the help of theprocedure number used by the registry, cases were identifiedat the respective eye clinics and the medical records werecopied and sent to an impartial observer (W.T.), who com-pared register data and the actual patient record. No infor-mation on the recorded capsule complications wasprovided to the participating clinics. Apart from capsulecomplication, the patients sex, age, date of surgery, andkind of procedure were also validated.

Statistical Analysis

Multivariate analysis was performed as a logistic regres-sion analysis. A P value less than 0.01 was considered statis-tically significant. For confidence intervals (CIs), thesignificance level was set at less than 0.05. All analyseswere performed using SPSS software (version 16.0, SPSS,Inc.).

RESULTS

Altogether, 603 881 cataract extractions were reported

during the period and were stored in the NCRdatabase. In 1328 cases, important parameters weremissing; therefore, the analysis in this study is basedon 602 553 cataract extractions.

Sixty-three surgical units reported their data duringthe study period. Eleven units did not perform cataractsurgery each year; the remaining 52 units providedcataract surgery every study year. Twelve units re-ported more than 16 000 cataract extractions duringthe period, and 16 units reported between 8000 and15 999 cataract extractions.

Table 1 shows the number of cataract extractions

and demographic data each year. The surgical tech-nique was phacoemulsification in 594 744 cases(98.9% [707 missing]), and a foldable IOL was usedin 596 817 cases (99.2% [896 missing]). The cataractsurgery rate in Sweden from 2000 through 2009 variedbetween 8000 and 9000 surgeries per 1 millioninhabitants.

Capsule complications were reported in 12 574 cata-ract extractions, corresponding to a frequency of2.09%. Table 2 shows the frequency of capsule compli-cation over time. The incidence of this complicationdecreased consistently each year from 2002 to 2006,

after which the frequency stabilized.

Submitted: November 5, 2010.

Final revision submitted: March 14, 2011.Accepted: May 11, 2011.

From EyeNet Sweden (Lundstrom), Blekinge Hospital, Karlskrona;the Departments of Ophthalmology, Umea University Hospital(Behndig, Thorburn), Umea, and Sahlgrens University Hospital(Stenevi), Molndal; and St. Erik Eye Hospital (Kugelberg, Montan),Stockholm, Sweden.

Supported by the Swedish Association of Local Authorities andRegions and the Swedish National Board of Health and Welfare.

Corresponding author: Mats Lundstrom,MD, PhD, EyeNet Sweden,Blekinge Hospital, SE-371 85 Karlskrona, Sweden. E-mail: [email protected].

1763DECREASING RATE OF CAPSULE COMPLICATIONS

J CATARACT REFRACT SURG - VOL 37, OCTOBER 2011
mailto:[email protected]:[email protected]:[email protected]:[email protected]


3/6

Table 3 shows the results of the logistic regressionanalysis of the relationship between a capsule compli-cation and other parameters. Poor CDVA (%0.1) in thesurgical eye; the occurrence of glaucoma, diabetic ret-

inopathy, and other eye disease; first-eye surgery; andage were significantly related to a capsule complica-tion. Some of these risk factors changed in frequencyover the study period; the mean age and the percent-age of surgery in eyes with poor vision decreased(Table 4). To compensate for the change in these riskfactors over time, Table 5 shows the incidence of a cap-sule complication for patients in 2 age groups and witha CDVA worse than 0.1 (20/200) in the surgery eye.The decrease in the incidence of capsule complicationwas greater in the most risky eyes. The complicationalso consistently decreased over time in these groups.

Between reporting clinics, there was a statisticallysignificant difference in the incidence of a capsule com-plication. Fifty-two clinics participated each year, andthe mean and median values of complication incidenceat the clinics were 2.09% and 1.85%, respectively. Theclinics were separated into 3 groups: high volume,with more than 16 000 surgeries during the studyperiod (Group 1); medium volume, with 8000 to15 999 surgeries (Group 2); and low volume, withfewer than 8000 surgeries (Group 3). The incidence

in Group 1, Group 2, and Group 3 during the studyperiod was 1.89% (95% CI, 1.84-1.95), 1.95% (95% CI,1.89-2.01), and 2.94% (95% CI, 2.83-3.04), respectively.Thus, there is a significantly higher incidence in the

low-volume group than in the high-volume groups.Figure 1 shows the mean change over time in the3 groups. For the whole period, the mean incidencewas 2.3% at university clinics and 2.0% at other clinics.A regression analysis that included the type of clinic,patient age, and patient sex showed a significantrelationship between university clinic and a higherrate of capsule complications. When ocular comorbid-ity was added to the list of independent variables, therelationship was still present but was weaker (data notshown).

Validation

The total number of examined registrations shouldhave been 2400 because 1 clinic could not providedata for 2002 and 2003. Of this sample, 2276 (94.8%)were found and 124 (5.2%) were missing. Theincidence of posterior capsule complications in the

Table 1. Number of cataract extractions and demographic data for each year of the study.

Year Surgeries in the NCR (n)Surgeries in Allof Sweden (n) Coverage (%) Mean Age (Y) Women (%) Ocular Comorbidity (%)

2002 76 172 80 127 95.1 76.15 65.2 35.2

2003 74 698 78 638 95.0 75.90 65.1 34.02004 75 730 77 194 98.1 75.72 64.2 33.0

2005 77 594 78 901 98.3 75.55 63.6 32.0

2006 72 568 74 739 97.1 75.12 62.2 31.5

2007 72 306 73 997 97.7 74.93 62.0 30.6

2008 72 443 73 591 98.4 74.84 60.9 32.7

2009 82 370 83 705 98.4 74.86 60.9 33.2

Table 2. Capsule complication during cataract extraction.

Year Number Incidence (%) 95% CI

2002 2121 2.80 2.68, 2.92

2003 1902 2.57 2.46, 2.68

2004 1767 2.33 2.23, 2.44

2005 1594 2.05 1.95, 2.15

2006 1284 1.77 1.68, 1.87

2007 1364 1.89 1.79, 1.99

2008 1215 1.68 1.58, 1.77

2009 1327 1.61 1.53, 1.70

CIZ confidence interval

Table 3. Logistic regression with capsule complication asdependent variable.

Parameter B P Value Exp(B)

95% CI

for Exp(B)

CDVA%0.1, surgical eye 0.823 !.001 2.28 2.19, 2.36

Glaucoma, surgical eye 0.429 !.001 1.54 1.46, 1.62

Other eye disease,

surgical eye

0.409 !.001 1.51 1.42, 1.60

Diabetic retinopathy 0.159 !.001 1.17 1.07, 1.28

First-eye surgery 0.127 !.001 1.14 1.09, 1.18

Male 0.044 .019 1.05 1.01, 1.08

Age 0.014 !.001 1.01 1.012, 1.016

Calendar year 0.074 !.001 0.93 0.92, 0.94

BZ B coefficient; CIZ confidence interval; Exp(B)Z exponentiation of

the B coefficient

1764 DECREASING RATE OF CAPSULE COMPLICATIONS



4/6

2002 to 2006 database was 2.3%. In the examined sam-ple, the incidence was 2.72% (95% CI, 2.05-3.39). Thus,there was no statistical difference between the data-

base and the sample because the database incidencewas within the sample CI. The true number of capsulecomplications in the sample was 62; however, the re-ported number was 43. In the sample, there wasfalse-positive registration of 5 (11.6%) of 43 cases of re-ported complications. Twenty (32%) of 62 cases witha true capsule complication had a false-negative regis-tration (underreported). In other words, the ability ofthe database to find capsule complications was65.5% (sensitivity) and the ability to find uncompli-cated cases was 99.8% (specificity). The false-negative registrations were evenly distributed across

the study years.

DISCUSSION

In the present study, we found that the incidence ofcapsule complication in Swedish cataract surgery de-creased from 2002 to 2009 and that the decrease cannotbe explained solely by a change in patient characteris-tics. These findings are of interest from a medical and

a health-care economic perspective. Previously, ourgroup performed a case-control study comparing 324cases with a capsule complication and 331 control

cases, randomly selected from the year 2003 in theNCR database.910,1213 The study, among otherthings, showed increased care costs, worse long-termoutcomes, and a higher rate of retinal detachment afteran intraoperative capsule complication. Various riskfactors for a capsule complication were identified;however, the sample was limited.

The risk factors for capsule complication in the pres-ent study were expected. Poor CDVA (0.1 [20/200] orworse) was most strongly related to a capsule compli-cation. This relationship was also reported recently byBayramlar et al.14 Poor vision is a proxy for dense

cataract. Ng et al.15

found a significant trend towardcapsule complications as the nuclear sclerosis grade in-creased. Also Martin and Burton16 report a significantincrease in the risk for capsule complications withdenser cataracts. The significant relationship betweenpoor vision and a capsule complication remained un-changed in our study when cases with macular degen-eration were excluded (data not shown). The presenceof glaucoma in the surgery eye has been related toa capsule complication by others,17 in line with ourfinding. The termglaucoma involves previous filtratingsurgery, small pupils, and increased rate of pseudoex-

foliation, all of which are determinants of a capsulebreak. The literature does not consistently report ageas a risk factor for a capsule complication. The signifi-cance testing in our study was influenced by the largenumber of cases; however, in the multivariate analy-sis, age, along with poor vision, glaucoma, and othereye diseases, had the strongest association witha complication.

The parallel and significant decrease in capsulecomplications and risk factors over time makes sense.Sweden has had a high cataract surgical rate for sev-eral years, and during the past 9 years, the rate has

been between 8000 and 9000 cataract extractions per

Table 4. Change over time in risk factors for a capsulecomplication.

YearMean

Age (Y)Glaucoma

(%)Other

Factor (%)Poor CDVA (%0.1)in Surgical Eye (%)

2002 76.15 9.8 7.0 25.32003 75.90 9.2 6.7 23.2

2004 75.72 9.2 6.9 22.8

2005 75.55 8.6 7.0 22.2

2006 75.15 8.5 7.1 22.4

2007 74.93 8.5 7.0 20.2

2008 74.84 8.7 6.9 20.4

2009 74.86 9.1 7.0 19.2

Table 5. Incidence of capsule complication in patients withCDVA in surgical eye of 0.1 (20/200) or worse by age group.

Younger Than 75 Years 75 Years and Older

Incidence(%) Number Total

Incidence(%) Number Total

2002 3.6 246 6846 5.7 704 12274

2003 3.8 247 6453 5.0 533 10713

2004 3.4 226 6599 4.9 516 10632

2005 3.1 211 6914 4.1 423 10342

2006 2.6 176 6807 3.9 357 9256

2007 2.7 172 6271 3.9 324 8305

2008 2.6 169 6606 3.6 298 8182

2009 2.5 174 6975 3.7 324 8831

Figure 1. Percentage of capsule complications per year by surgicalvolume (Group 1 Z more than 16 000 surgeries; Group 2 Z 8000to 15 999 surgeries; Group 3 Z fewer than 8000 surgeries).




5/6

1 million. This may be the reason for a gradual changetoward younger and healthier eyes among those oper-ated on during the 8-year study period. However,as shown inTable 5, this is not the only reason for a de-crease in the capsule complication incidence. Thedecrease is even greater indifficult eyes, suggestingrefined surgery, be it a consequence of more experi-enced surgeons, improved equipment or technique,or a combination. The difference in the capsule compli-cation rate between high-volume clinics and low-volume clinics may suggest that surgeons with a largeannual volume do better than surgeons with a lowannual volume. Unfortunately, the construction ofthe database does not permit analysis of surgeons an-nual volume and the incidence of capsule complica-tions. However, others have pointed out thatincreased surgical experience helps prevent a capsulecomplication.8,16,18 There has been an increasing trend

in Sweden for cataract surgeons to exclusively performhigh-volume cataract surgery at their own clinics or bytraveling to other clinics, performing surgery ona weekly basis. Perhaps improved phacoemulsifica-tion machines or phaco tips, capsule staining, andother technical improvements have contributed toa decreased capsule complication rate in dense cata-racts, but this is only a speculation.

Any recording of surgical complications can beflawed by underreporting. A continuous decline inthe capsule complication rate was evident during theinitial years of its registration; thus, the question arose

whether this could be the result of deliberate conceal-ment of sensitive information. This concern was theimpetus behind the validation assessment. Indeed,this study found false-negative registrations, albeitstatistically nonsignificant. The underreporting, if re-lated to the number of cases with a capsule complica-tion, may have seemed somewhat disheartening.However, if it is regarded in terms of frequencies,2.72% in the sample versus 2.30% in the entire register,the sensitivity appears acceptable. A regular valida-tion of randomly chosen clinics and data would likelyimprove future data quality. The underreporting did

not increase during the validation study period, whichmakes our observation that there was a steady de-crease in capsule complication during 2002 to 2006more robust.

In conclusion, the nationwide incidence of a capsulecomplication in Sweden decreased year by year dur-ing the initial phase of the registration period (2002through 2006), after which it reached a plateau. Thismay be explained by the fact that cataract surgerywas performed in younger and healthier eyes overthe period. However, the complication rate decreasedeven more in challenging cases, indicating that the sur-

gery has become more technically refined over time.

REFERENCES

1. Wegener M, Alsbirk PH, Hjgaard-Olsen K. Outcome of

1000 consecutive clinic- and hospital-based cataract surgeries

in a Danish county. J Cataract Refract Surg 1998; 24:

11521160

2. Norregaard JC, Bernth-Petersen P, Bellan L, Alonso J, Black C,

Dunn E, Andersen TF,Espallargues M, AndersonGF. Intraoper-ative clinical practice and risk of early complications after cata-

ract extraction in the United States, Canada, Denmark, and

Spain. Ophthalmology 1999; 106:4248

3. Lundstrom M, Barry P, Leite E, Seward U, Stenevi U. 1998

European Cataract Outcome Study; report from the European

Cataract Outcome Study. J Cataract Refract Surg 2001;

27:11761184

4. Tan JHY, Karwatowski WSS. Phacoemulsification cataract

surgery and unplanned anterior vitrectomydis it bad news?

Eye 2002; 16:117120. Available at: http://www.nature.com/

eye/journal/v16/n2/pdf/6700015a.pdf. Accessed June 21, 2011

5. Kothari M, Thomas R, Parikh R, Braganza A, Kuriakose T,

MuliyilJ. Theincidence of vitreousloss andvisual outcome in pa-

tientsundergoing cataract surgery in a teaching hospital. IndianJ

Ophthalmol 2003; 51:4552. Available at: http://www.ijo.in/article.asp?issnZ0301-4738;yearZ2003;volumeZ51;issueZ1;

spageZ45;epageZ52;aulastZKothari. Accessed June 21,

2011

6. Chan FM, Mathur R, Ku JJK, Chen C, Chan S-P, Yong VSH, Au

Eong K-G. Short-term outcomes in eyes with posterior capsule

rupture during cataract surgery. J Cataract Refract Surg 2003;

29:537541

7. Hyams M, Mathalone N, Herskovitz M, Hod Y, Israeli D,

Geyer O. Intraoperative complications of phacoemulsification

in eyes with and without pseudoexfoliation. J Cataract Refract

Surg 2005; 31:10021005

8. Zaidi FH, Corbett MC, Burton BJL, Bloom PA. Raising the

benchmark for the 21st centurythe 1000 cataract operations

audit and survey: outcomes, consultant-supervised training

and sourcing NHS choice. Br J Ophthalmol 2007; 91:731736.

Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/

PMC1955623/pdf/731.pdf. Accessed June 21, 2011

9. Johansson B, Lundstrom M, Montan P, Stenevi U, Behndig A.

Capsule complication during cataract surgery: long-term out-

comes; Swedish Capsule Rupture Study Group report 3.

J Cataract Refract Surg 2009; 35:16941698

10. Jakobsson G, Montan P, Zetterberg M, Stenevi U, Behndig A,

Lundstrom M. Capsule complicationduring cataract surgery: ret-

inal detachment after cataract surgery with capsule complica-

tion; Swedish Capsule Rupture Study Group report 4.


11. Lundstrom M, Stenevi U, Thorburn W. The Swedish National

Cataract Register: a 9-year review. Acta Ophthalmol Scand

2002; 80:248257. Available at: http://www3.interscience.wiley.com/cgi-bin/fulltext/118927388/PDFSTART. Accessed

June 21, 2011

12. Lundstrom M, Behndig A, Montan P, Artzen D, Jakobsson G,

Johansson B, Thorburn W, Stenevi U. Capsule complication

during cataract surgery: background, study design and addi-

tional care; Swedish Capsule Rupture Study Group report 1.


13. Artzen D, Lundstrom M, Behndig A, Stenevi U, Lydahl E,

Montan P. Capsule complication during cataract surgery:

case-control study of preoperative and intraoperative risk fac-

tors; Swedish Capsule Rupture Study Group report 2.


14. Bayramlar H, Hepsen IF, Yilmaz H. Mature cataracts increase

risk of capsular complications in manual small-incision cataract

1766 DECREASING RATE OF CAPSULE COMPLICATIONS

http://www.nature.com/eye/journal/v16/n2/pdf/6700015a.pdfhttp://www.nature.com/eye/journal/v16/n2/pdf/6700015a.pdfhttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955623/pdf/731.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955623/pdf/731.pdfhttp://www3.interscience.wiley.com/cgi-bin/fulltext/118927388/PDFSTARThttp://www3.interscience.wiley.com/cgi-bin/fulltext/118927388/PDFSTARThttp://www3.interscience.wiley.com/cgi-bin/fulltext/118927388/PDFSTARThttp://www3.interscience.wiley.com/cgi-bin/fulltext/118927388/PDFSTARThttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955623/pdf/731.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955623/pdf/731.pdfhttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=1;spage=45;epage=52;aulast=Kotharihttp://www.nature.com/eye/journal/v16/n2/pdf/6700015a.pdfhttp://www.nature.com/eye/journal/v16/n2/pdf/6700015a.pdf


6/6

surgery of pseudoexfoliative eyes. Can J Ophthalmol 2007;

42:4650

15. Ng DT, Rowe NA, Francis IC, Kappagoda MB, Haylen MJ,

Schumacher RS, Alexander SL, Boytell KA, Lee BB. Intraoper-

ative complications of 1000 phacoemulsification procedures:

a prospective study. J Cataract Refract Surg 1998; 24:

13901395

16. MartinKRG, Burton RL. The phacoemulsification learning curve:per-operative complications in the first 3000 cases of an experi-

enced surgeon. Eye 2000; 14:190195

17. Abbasoglu OE, Hos al B, Tekeli O, Gursel E. Risk factors for

vitreous loss in cataract surgery. Eur J Ophthalmol 2000;

10:227232

18. Tayanithi P, Pungpapong K, Siramput P. Vitreous loss during

phacoemulsification learning curve performed by third-year

residents. J Med Assoc Thai 2005; 88(suppl 9):8993

First author:

Mats Lundstr

om, MD, PhDEyeNet Sweden, Blekinge Hospital,Karlskrona, Sweden



article envoyé par fedia

Documents