Hong Kong Eye HospitalHong Kong Eye Hospital

Acknowledgement

OT nursing staff MRO staff

Unplanned AV rate 2010-11 2

Introduction Importance of auditing cataract surgery

outcomesMost commonly performed surgery Surgeons at different levels of trainingThe Royal College of Ophthalmologists –

cataract surgery guidelines recommendations

Especially important this year with increase in cataract surgery load

Unplanned AV rate 2010-11 3

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 edemaRetinal detachment

Unplanned AV rate 2010-11 4Surv Ophth 2001

Methods Cataract surgeries performed in HKEH

between 1 April 2010 to 31 Jan 2011PhacoemulsificationExtracapsular cataract extraction

No of AV________

No of surgeries performed

Unplanned AV rate 2010-11 5

Mechanical vitrectomyPlanned AV excludedInformation from nursing recordConfirmed with patient recordBoth as surgeon and supervisor

Information from CDARSCombine surgery excluded

Primary outcome Unplanned AV rate

HospitalPhaco versus ECCESpecialist versus non-specialistIndividual surgeon

Individual surgeon information confidentialFeedback to surgeon

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Results Phacoemulsification

40 phaco surgeons4094 phaco60 unplanned AV casesRate 1.5%

ECCE35 ECCE surgeons650 ECCE18 unplanned AV casesRate 2.8%

Unplanned AV rate 2010-11 7

Comparison of results

2007/8 2009/10 2010/11

PhacoemulsificationAV rate (%)

1.9 2.0 1.5

ECCE AV rate (%) 4.1 2.6 2.8

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Specialist vs non-specialist

Unplanned AV rate 2010-11 9

Specialist Non-specialist Overall

PhacoemulsificationAV rate (%)

1.3 1.9 1.5

ECCE AV rate (%) 1.4 3.9 2.8

Unplanned AV rate 2010-11 10

Phacoemulsification

No serious outliers

Variation in surgical load

Unplanned AV rate 2010-11 11

ECCE

Lesser ECCELess surgical experienceSmaller denominator

Secondary outcomes Mean final visual outcomes Stage when PCR occurred Lens status Other major complications

Unplanned AV rate 2010-11 12

Final visual outcomes

Unplanned AV rate 2010-11 13

Mean Snellen VA (range)*

Phacoemulsification 0.40 (0.05-0.8)

ECCE 0.41 (0.1-0.7)

*Cases with other accountable cause of poor visual acuity excluded

Stage of phaco when PCR occurred

Unplanned AV rate 2010-11 14

More than half after nucleus removed

Lens status

Unplanned AV rate 2010-11 15

Aphakia (%) Pseudophakia

Sulcus (%) SFIOL (%) ACIOL (%)

Phacoemulsification 23 53 5 20

ECCE 47 20 0 33

Other complications

Phacoemulsification ECCE

Dropped nucleus 6 1

Retained cortical matter 7 1

Vitreous hemorrhage 5 3

Suprachoroidal hemorrhage 0 1 (limited)

Choroidal detachment 2 0

Retinal break 4 0

Retinal detachment 1 0

Unplanned AV rate 2010-11 16

Conclusions

Unplanned AV rates of cataract surgeries in 2010-11 acceptable compared withInternational dataPrevious annual rates

Increasing the surgical load did not adversely affect the surgical outcomes

Unplanned AV rate 2010-11 17