Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery

PURPOSE: To determine the incidence of and risk factors for posterior capsule rupture and vitreous loss during phacoemulsification performed by ophthalmology residents. SETTING: Academic ophthalmology resident training center, Tehran, Iran. DESIGN: Cross-sectional study. METHODS: This study included patients who had phacoemulsification by ophthalmology residents from August 2010 to August 2011. The complications occurring during surgery and the rate of vitreous loss and posterior capsule rupture were studied. RESULTS: Five hundred eyes of 500 patients, including 255 (51%) men and 245 (49%) women with a mean age of 67 years +/- 10 (SD) (range 27 to 105 years), were studied. Fifty-one eyes (10.2%) developed vitreous loss, and 48 eyes (9.6%) developed posterior capsule rupture and vitreous loss. On univariate analysis, significant risk factors for vitreous loss included diabetes mellitus (P=.001), shallow anterior chamber (P=.01), absence of supervision by a faculty member (P=.007), larger capsulorhexis (P=.02), anterior capsule tear (P=.001), and longer effective phacoemulsification time (EPT) (P=.003). Multivariate data analysis using stepwise logistic regression analysis showed anterior capsule tear (odds ratio [OR], 2.63; 95% confidence interval [Cl], 1.09-6.29), longer EPT (OR, 1.01; 95% Cl, 1.003-1.02), and lack of supervision by attending physicians (OR, 4.28; 95% CI, 1.44-12.67) to be significant independent risk factors associated with vitreous loss. CONCLUSION: Direct attending supervision and careful case selection for the level of cataract surgery residency are of utmost importance in avoiding sight-threatening complications.