Conversion from phacoemulsification to extracapsular cataract extraction: incidence, risk factors, and visual outcome

PURPOSE: To evaluate the incidence, risk factors, and visual outcome in cases converted from phacoemulsification to routine extracapsular cataract extraction (ECCE). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: A retrospective study was performed in 540 eyes that had clear corneal phacoemulsification performed by an experienced phacoemulsification surgeon. The cases in which phacoemulsification was initiated and then converted to ECCE were studied. The main parameters evaluated were the factors responsible for the conversion, corneal endothelial cell loss, and visual outcome. RESULTS: Twenty eyes (3.7%) required conversion to ECCE during phacoemulsification. Pupillary miosis (6 cases), posterior capsule rupture (5 cases), prolonged phaco time (4 cases), posterior extension of the capsulorhexis (2 cases), corneal thermal burn (1 case), subluxation of the lens (1 case), and malfunctioning of the ultrasonic handpiece (1 case) were the reasons for the conversion. The mean percentage of endothelial cell loss was 11.06% +/- 2.3 (SD); 18 cases (90.0%) achieved a visual acuity of 20/40 or better at 6 weeks. CONCLUSIONS: Intraoperative pupillary miosis, posterior capsule rupture, and very hard nuclear cataract causing prolonged phacoemulsification were the major risk factors for conversion to ECCE. Optimal preoperative preparation and prompt recognition of complications during phacoemulsification can lead to timely conversion to ECCE to achieve a good visual outcome.