Intraoperative complications of 1000 phacoemulsification procedures: a prospective study

J Cataract Refract Surg. 1998 Oct;24(10):1390-5. doi: 10.1016/s0886-3350(98)80235-6.


Purpose: To determine the frequency and nature of intraoperative complications of endocapsular phacoemulsification cataract surgery.

Setting: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia.

Methods: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications.

Results: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases.

Conclusion: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, Local / methods
  • Capsulorhexis
  • Clinical Competence
  • Female
  • Humans
  • Incidence
  • Intraoperative Complications*
  • Male
  • Middle Aged
  • Ophthalmology / education
  • Phacoemulsification / adverse effects*
  • Prospective Studies
  • Visual Acuity