Anterior chamber instability caused by incisional leakage in coaxial phacoemulsification.

Purpose: To establish the percentage of fluid loss through incisions during coaxial phacoemulsification and analyze whether simple measures can reduce it.

Setting: Department of Ophthalmology, Royal Free Hospital, London, United Kingdom.

Methods: This prospective study comprised consecutive patients having routine uneventful cataract surgery. Surgeons used their standard techniques. Incisional leakage was defined by the difference between the total volume of irrigation fluid used and the volume aspirated by the phacoemulsification machine. Nonparametric statistical tests were used to compare phaco-chop techniques performed by consultants, differing only by the duration of the chopper in situ. In 1 technique, the chopper was removed after all the segments were chopped. The other technique required the chopper to be in situ throughout the phacoemulsification stage.

Results: The study evaluated 105 patients. The mean incisional leakage was 127 mL +/- 60 (SD) (range 10 to 300 mL), with a significant positive correlation with operation duration and actual phaco time (P<.0001). The mean percentage of incisional leakage was 67% +/- 11% (range 20% to 89%). The mean fluid loss through incisions was 75% in operations performed with the chopper in situ throughout the phacoemulsification stage and 59% when the chopper was removed after all segments were chopped (P<.005).

Conclusions: Significant intraoperative fluid leakage occurred through the incisions. Removal of the chopper after chopping led to a significant reduction in fluid loss and improved chamber stability.