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Jonathan Huz, Neil Kalbag, Albert S Khouri; Outcomes of resident performed mature cataract surgery: A 1 year study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2809.
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© ARVO (1962-2015); The Authors (2016-present)
To report on outcomes and adverse events associated with resident-performed phacoemulsification in patients with mature cataracts.
Resident-performed phacoemulsification in patients with mature cataracts were identified between 2008-2012 at Rutgers New Jersey Medical School. A retrospective review was performed for preoperative history, intraoperative surgical technique, and postoperative course including: visual acuity (logMAR), IOP, and medications among others. Visual acuity (VA) exclusions: cases deemed to have poor visual potential from optic nerve or retinal pathology.
Forty cases were identified of which, 11 were identified as having poor visual potential. VA data is presented for the remaining 29 cases. Twenty-five of twenty-nine patients were followed for 1 month or greater and 13/29 were followed for at least 1 year. Mean preoperative VA was 1.9 ± 0.3 logMAR units (Snellen equivalent = 20/1589) improving to 0.9 ± 0.5 logMAR units (20/159) on post-operative day one and 0.3±0.3 (20/40) at final follow-up (p <0.001; pre-op VA vs. Final VA). Nineteen of twenty-nine (66%) patients achieved a postoperative best corrected VA of 20/40 or better. Mean preoperative IOP was 16.3±6.0 mmHg, which increased to 18.7±8.4 on post-op day one (p=0.11). Mean IOP decreased to 13.9±5.0 at post-op week one, and remained stable at a mean of 15.5-16.4 from post-op month one until the 12-month time point. No statistically significant reduction in IOP was noted at any time point. Postoperative day one IOP spikes, defined as an IOP greater than 30 mmHg or a 10mmHg increase from the preoperative measurement, occurred in 7/40 (18%) of cases. Intraoperatively, iris hooks were utilized in 4/40 (10%) cases, Kuglen hooks in 5/40 (12.5%) cases, and a Malyugin ring was used in 2/40 (5%) of cases. Intraoperative adverse events included vitreous loss with anterior vitrectomy (2/40; 5%) and posterior capsular rupture (2/40, 5%). There were no cases of lens drop into the vitreous. In addition to the previously noted IOP changes, postoperative complications included pseudophakic macular edema in 3/40 (7.5%), pseudophakic bullous keratopathy in 1/40 (2.5%) and a macular hole in 1/40 (2.5%).
Resident-performed phacoemulsification of mature cataracts results in good VA in the majority of patients with an adverse event profile similar to surgery on immature cataracts.
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