Incidence of Intraoperative Complications During Two-handed Phacoemulsification in Dogs: 250 Cases
L. Albuquerque; F.Q. Pereira; A.C.V.R. Almeida; C. Faganello; P.S. Hünning; J.A.T. Pigatto
Veterinary College, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
Phacoemulsification during learning stage is associated with numerous complications. This study was designed to evaluate the incidence of intraoperative complications during two-handed phacoemulsification in dogs. Phacoemulsification was performed on 250 eyes in 180 dogs (90 bilateral and 70 unilateral) between October 2005 and July 2008. Details of all patients including race, sex, stage of the cataract, and age at operation were recorded. At the time of surgery, the following information was recorded: surgical time, amount of ultrasound, the volume of balanced saline solution (BSS) and viscoelastic (OVD) used, and occurrence of intraoperative complications. All dogs underwent preoperative examination. The surgery was performed by same surgeon using an Evolution phacoemulsification machine (U.S., IOL, Inc. Lexington, KY, USA). Surgical site was prepared with asepsis technique. Corneal incision was made with 3.2 mm angle ophthalmic knife. Anterior chamber was filled with methylcellulose 2%. Anterior capsulorhexis was done in all cases by bent 27 gauge needle or Utrata forceps. Side port was made with 15 degree knife. After hydrodissection two handed phacoemulsification technique using a chopper was used. The remaining lens matter and viscoelastic was aspirated. Corneal incision was closed with interrupted 100 nylon suture and anterior chamber was restored with balanced salt solution. The most prevalent breeds were Poodle (n = 102), crossbred dog (n = 19) and American Cocker Spaniel (n = 14). The stages of the cataracts were incipient (6%), immature (20%), mature (67%) and hypermature (7%). The age of the dogs ranged from 9 months to 12 years, with a mean age of 5.2 years. The mean surgical time and phacoemulsification ultrasound time was 32 min. and 3.4 min respectively. The mean volume of BSS solution and OVD used during surgical procedures were 230 ml and 8 ml respectively. Rates of intraoperative complications were as follows: radial tear in the anterior capsule (n:35), posterior capsule rupture (n:20), posterior capsule rupture with vitreous loss (n:8), displacement of lens fragments into the vitreous cavity (n:6), miosis (n:6), iris herniation (n:4) and hyphema (n:3). The volume of BSS and OVD used during surgical procedures was smaller in the incipient and immature cataract. Mature and hypermature cataracts were associated with higher complications during phacoemulsification. In conclusion, two-handed phacoemulsification allows the surgeon more options to remove the nucleolus, reducing phacoemulsification time, surgical time and the incidence of intraoperative complication rates. Additionally, earlier surgical intervention in dogs with cataract is recommended to reduce the rates of intraoperative complications.