2. Hong Kong Eye Hospital

3. Acknowledgement  OT nursing staff  MRO staff Unplanned AV rate 2010-112

4. Introduction  Importance of auditing cataract surgery outcomes Most commonly performed surgery Surgeons at different levels of training The Royal College of Ophthalmologists – cataract surgery guidelines recommendations  Especially important this year with increase in cataract surgery load Unplanned AV rate 2010-113

5. 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 edema Retinal detachment Unplanned AV rate 2010-114 Surv Ophth 2001

6. Methods  Cataract surgeries performed in HKEH between 1 April 2010 to 31 Jan 2011 Phacoemulsification Extracapsular cataract extraction  No of AV________ No of surgeries performed Unplanned AV rate 2010-11 5 Mechanical vitrectomy Planned AV excluded Information from nursing record Confirmed with patient record Both as surgeon and supervisor Information from CDARS Combine surgery excluded

7. Primary outcome  Unplanned AV rate Hospital Phaco versus ECCE Specialist versus non-specialist Individual surgeon  Individual surgeon information confidential Feedback to surgeon Unplanned AV rate 2010-116

8. Results  Phacoemulsification 40 phaco surgeons 4094 phaco 60 unplanned AV cases Rate 1.5%  ECCE 35 ECCE surgeons 650 ECCE 18 unplanned AV cases Rate 2.8% Unplanned AV rate 2010-117

9. Comparison of results 2007/82009/102010/11 Phacoemulsification AV rate (%) 1.92.01.5 ECCE AV rate (%)4.12.62.8 Unplanned AV rate 2010-118

10. Specialist vs non-specialist Unplanned AV rate 2010-119 SpecialistNon-specialistOverall Phacoemulsification AV rate (%) 1.31.91.5 ECCE AV rate (%)1.43.92.8

11. Unplanned AV rate 2010-1110 Phacoemulsification No serious outliers Variation in surgical load

12. Unplanned AV rate 2010-1111 ECCE Lesser ECCE Less surgical experience Smaller denominator

13. Secondary outcomes  Mean final visual outcomes  Stage when PCR occurred  Lens status  Other major complications Unplanned AV rate 2010-1112

14. Final visual outcomes Unplanned AV rate 2010-1113 Mean Snellen VA (range)* Phacoemulsification0.40 (0.05-0.8) ECCE0.41 (0.1-0.7) *Cases with other accountable cause of poor visual acuity excluded

15. Stage of phaco when PCR occurred Unplanned AV rate 2010-1114 More than half after nucleus removed

16. Lens status Unplanned AV rate 2010-1115 Aphakia (%)Pseudophakia Sulcus (%)SFIOL (%)ACIOL (%) Phacoemulsification2353520 ECCE4720033

17. Other complications PhacoemulsificationECCE Dropped nucleus61 Retained cortical matter71 Vitreous hemorrhage53 Suprachoroidal hemorrhage01 (limited) Choroidal detachment20 Retinal break40 Retinal detachment10 Unplanned AV rate 2010-1116

18. Conclusions  Unplanned AV rates of cataract surgeries in 2010-11 acceptable compared with International data Previous annual rates  Increasing the surgical load did not adversely affect the surgical outcomes Unplanned AV rate 2010-1117