VITREOUS LOSS DURING CONVERSION FROM CONVENTIONAL EXTRACAPSULAR CATARACT-EXTRACTION TO PHACOEMULSIFICATION

Purpose: To study the outcome of vitreous loss among senior surgeons c onverting from conventional extracapsular cataract extraction (ECCE) t o phacoemulsification. Setting: A university teaching hospital in the United Kingdom. Methods: A retrospective analysis of 87 planned catara ct extractions performed from January 1992 to December 1996 and compli cated by vitreous loss was done. Outcome measures included postoperati ve complication rates and visual acuity.Results: During the study, vit reous loss occurred in 39 patients having ECCE and in 48 having phacoe mulsification; the latter group included 8 patients with dropped nucle us. Postoperative complications included cystoid macular edema (18.7% of phaco patients, 30.8% of ECCE patients), retinal detachment (2.1% o f phaco patients, 5.1% of ECCE patients), and expulsive hemorrhage (5. 1% of ECCE patients). Phaco patients had higher rates of postoperative corneal edema (27.1%) than ECCE patients (12.8%) and transient intrao cular pressure elevation (33.3% versus 20.5%) but were more likely to receive posterior chamber intraocular lenses (70.8% versus 35.9%; P =. 0024, chi-square test). After excluding pre-existing diseases, 83.3% o f phaco patients and 67.6% of ECCE patients achieved a visual acuity o f 6/12 or better. Conclusions: With careful patient selection, experie nced extracapsular surgeons converting to phacoemulsification can achi eve favorable results even in the presence of complications such as vi treous loss or dropped nucleus.