Phacoemulsification: Risk Factor Analysis after the Learning Curve

Objectives: To assess the main risk factors for complications in phacoemulsification performed by an experienced surgeon. Study Design: Two hundred and fifty phacoemulsification procedures performed during a 1-year period were analysed. Most of them were done by 5 mm incisions, under conjunctival flap with no suture. Setting: Eye Clinic, University of Verona, Italy. Main Outcome Measures: Intraoperative complications: anterior and posterior capsular tears, vitreous loss, iris damage, corneal damage. Postoperative complications: inflammation, fibrinous reactions, endothelial damage, astigmatism, surgical reinterventions. Results: Intraoperative complications were 3.8%. They were related to: pupil diameter less than 3 mm (P < 0.001), use of a diaphragmatic pump (P < 0.001), presence of hard nucleus (P < 0.001). Postoperative complications were 6.5%. They were related to: intraoperative complications (P < 0.001), pupil diameter less than 5 mm (P < 0.001), low endothelial cell count (P < 0.01). Two sutured incisions required resuturing in the postoperative period. Conclusions: Phacoemulsification has become a very safe procedure in normal cataractous eyes. Eyes with advanced cataracts or additional pathologies are still at increased risk for complications.