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Original Article
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Diverse complications are encountered in ECCE carried out versus extracapsular cataract extraction(ECCE) with posterior
by trainees. In general, the intraoperative complications in chamber intraocular lens for agerelated cataract. Cochrane
this series are acceptably low. The posterior capsule rent rate Database Syst Rev 2012;4:CD008811.
of 6.2% is less than 11.4% and 11.3% reported from Sierra 3. TabinG, ChenM, EspandarL. Cataract surgery for the
developing world. Curr Opin Ophthalmol 2008;19:559.
Leone[13] and Western Nigeria[14] respectively. It was higher
than 4.5% rate each reported from USA[15] and SouthEastern 4. SalowiMA, ChoongYF, GohPP, IsmailM, LimTO. CUSUM:
Adynamic tool for monitoring competency in cataract surgery
Nigeria.[16] Both in training and in practice posterior capsule performance. Br J Ophthalmol 2010;94:4459.
rent and attendant vitreous loss are potentially serious
5. BhagatN, NissiriosN, PotdevinL, ChungJ, LamaP,
complications. It has been advocated that the surgical ZarbinMA, etal. Complications in residentperformed
training of a resident should include the management of phacoemulsification cataract surgery at New Jersey Medical
these complications; thus, discouraging the practice where School. Br J Ophthalmol 2007;91:13157.
the supervisor takes over when these complications occur.[17] 6. HennigA. Sutureless nonphaco cataract surgery: Asolution
to reduce worldwide cataract blindness? Community Eye
Capsular flaps were noted in 7.5% of the series. Adequate Health 2003;16:4951.
anterior capsulotomy whether by can opener or continuous 7. SandfordSmithJ. Sutureless cataract surgery: Principles and
curvilinear capsulorhexis is essential for a good outcome. It steps. Community Eye Health 2003;16:4953.
is one of the steps, which must be mastered well in learning 8. RodriguesIA, SymesRJ, TurnerS, SinhaA, BowlerG,
ECCE. The trainees in this series were taught can opener ChanWH. Ophthalmic surgical training following
modernising medical careers: Regional variation in experience
anterior capsulotomy. across the UK. BMJ Open 2013;3:E002578.
9. KhannaR, PujariS, SangwanV. Cataract surgery in
Corneal complications were the most important postoperative developing countries. Curr Opin Ophthalmol 2011;22:104.
complications. It was much higher than 6.7% reported from 10. HaripriyaA, ChangDF, ReenaM, ShekharM. Complication
Northern Nigeria.[18] Whereas older patients and those with rates of phacoemulsification and manual smallincision
uveitis or glaucoma may have compromised endothelium,[19] cataract surgery at Aravind Eye Hospital. JCataract Refract
touching of the cornea with instruments, prolonged surgery and Surg 2012;38:13609.
excessive manipulations all contribute to corneal edema and 11. ThomasR, NaveenS, JacobA, BraganzaA. Visual outcome
Descemets folds postoperatively. Atrainees attention needs and complications of residents learning phacoemulsification.
to be drawn to minimal handling of the cornea. Indian J Ophthalmol 1997;45:2159.
12. SchroederB. Sutureless cataract extraction: Complications,
Iritis and other inflammations were also noted. As with corneal management and learning curves. Community Eye Health
2003;16:5860.
edema excessive manipulations encourage inflammation and
13. CookNJ. Evaluation of high volume extracapsular cataract
should be avoided. Late complications were not evaluated in
extraction with posterior chamber lens implantation in Sierra
the present study. Leone, West Africa. Br J Ophthalmol 1996;80:698701.
14. BekibeleCO, UbahJN, FasinaO. Acomparative evaluation of
The trainees in this series had been trained in intracapsular outcome of cataract surgery at AgoIwoye, Ogun State. Niger
cataract extraction(ICCE). In the late 90s and early 2000s J Surg Res 2004;6:259.
when there was a paradigm shift in cataract surgery in Nigeria 15. BlomquistPH, RugwaniRM. Visual outcomes after vitreous
from ICCE to ECCE, they were retrained in ECCE. Perhaps loss during cataract surgery performed by residents.
the type and rate of complications of surgery may have been JCataract Refract Surg 2002;28:84752.
different if they were green horns in eye surgery. 16. EzegwuiIR. Cataract surgery services in a teaching hospital
in a developing country. Int J Ophthalmol 2009;9:4202.
In conclusion, capsular flaps and posterior capsular rent/ 17. YorstonD. Cataract complications. Community Eye Health
vitreous loss are some of the intraoperative complications 2008;21:13.
encountered by a trainee performing ECCE. Corneal 18. MpyetCD, AhmadUI. Initial experience with posterior
complications and iritis/other inflammation are common chamber intraocular lens implant. Niger J Surg Res
2000;2:1358.
postoperative complications. Stepwise supervised training
19. GogateP, WoodM. Recognising highrisk eyes before
can minimize these complications and achieve a good outcome
cataract surgery. Community Eye Health 2008;21:124.
even in the hands of trainees.
References How to cite this article: Ezegwui IR, Aghaji AE, Okpala NE,
OnwasigweEN. Evaluation of complications of extracapsular cataract
1. FosterA, GilbertC, JohnsonG. Changing patterns in global extraction performed by trainees. Ann Med Health Sci Res 2014;4:115-7.
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2. AngM, EvansJR, MehtaJS. Manual small incision cataract
surgery(MSICS) with posterior chamber intraocular lens Source of Support: Nil. Conflict of Interest: None declared.
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