Document Detail

Second instrument tip breaks during phacoemulsification.
MedLine Citation:
PMID:  19020637     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Second instrument tip breaks during phacoemulsification are complications that are anecdotally recalled, yet little information exists on why and how often they occur, whether they are consistently tracked, and how they are managed. They may be an underreported, but potentially serious, complication of phacoemulsification. METHODS: We surveyed 114 cataract surgeons in Ontario to determine reported rates of second instrument tip breaks, their management, and presumed etiology. We reviewed 4 Toronto cataract centres for incident reports, instrument sterilization processes, and purchase histories. Using scanning electron microscopy (SEM), we compared the characteristics of a broken Sweeney tip to new and used second instruments. RESULTS: Of the 35 surgeons responding to the survey, 34% had experienced a second instrument tip break during their careers. Approximately 73% (16 cases) of the 22 cases reported were managed successfully during the procedure by the primary surgeon, 14% (3 cases) required imaging by computerized tomography or x-ray, and another 14% (3 cases) required pars plana vitrectomy for tip retrieval. Purchase histories revealed that 1 Sweeney hook was exchanged monthly, equivalent to 100 to 150 surgeries. SEM of new and used second instruments revealed signs of metal fatigue on both new and used second instruments. INTERPRETATION: Although both physicians and hospitals lack a method for ensuring quality control of second instruments, approximately one third of cataract surgeons encounter second instrument tip breaks during the course of their careers. Although most cases are managed intraoperatively, consistent hospital tracking records and standardized instrument inspection by institutions and surgeons are needed to determine how these complications occur and to establish protocols for complication reporting and management.
Fariba Nazemi; Silvia Odorcic; Rosa Braga-Mele; David Wong
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Canadian journal of ophthalmology. Journal canadien d'ophtalmologie     Volume:  43     ISSN:  0008-4182     ISO Abbreviation:  Can. J. Ophthalmol.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2009-02-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0045312     Medline TA:  Can J Ophthalmol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  702-6     Citation Subset:  IM    
Department of Ophthalmology, University of Toronto, Toronto, Ont.
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MeSH Terms
Anterior Eye Segment / radiography,  surgery
Device Removal
Equipment Failure / statistics & numerical data*
Eye Foreign Bodies / radiography,  surgery
Health Surveys
Intraoperative Complications*
Microscopy, Electron, Scanning
Phacoemulsification / instrumentation*
Quality Control
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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