title: Second instrument tip breaks during phacoemulsification.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, University of Toronto, Toronto, Ont. fariba.nazemi@utoronto.ca
authors.forename: Fariba
authors.initials: F
authors.lastname: Nazemi
authors.forename: Silvia
authors.initials: S
authors.lastname: Odorcic
authors.forename: Rosa
authors.initials: R
authors.lastname: Braga-Mele
authors.forename: David
authors.initials: D
authors.lastname: Wong
mesh_terms: D000869:Anterior Eye Segment / Q000000981:diagnostic imaging / Q000601:surgery; D020878:Device Removal; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005129:Eye Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery; D006306:Health Surveys; D006801:Humans; D007431:Intraoperative Complications; D008855:Microscopy, Electron, Scanning; D018918:Phacoemulsification / Q000295:instrumentation*; D011786:Quality Control; D012008:Recurrence; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014821:Vitrectomy; D014965:X-Rays