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Sylvia Linner Groth, Robert Van der Vaart, Kenneth Cohen; The effect of a structured surgical curriculum on outcomes from resident phacoemulsification surgery complicated by posterior capsular rupture. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):650.
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To evaluate if a structured resident surgical curriculum improves outcomes following phacoemulsification (phaco) surgery complicated by posterior capsular rupture and vitreous loss requiring anterior vitrectomy.
We performed a retrospective chart review including all patients operated on by PGY3 & PGY4 residents from Jan 2012 - Nov 2014 with a single attending (KC) complicated by posterior capsular rupture requiring an anterior vitrectomy (CPT 67010) while undergoing phaco surgery. Primary outcome was visual acuity (VA), with secondary outcomes of intraocular pressure (IOP) and subsequent procedures required. Our primary analysis excluded patients with pre-existing ocular disease. Final VA of 20/40 or better was considered a success. Secondary analysis included all patients and 2 lines or greater improvement in VA was considered a success.
50 eyes included 20 female, 30 male; 22 right eyes, 28 left eyes with mean age of 62.8 ± [sem]1.7 yrs. 16 eyes had pre-existing ocular disease and were excluded from subanalysis. 7 eyes had pre-op VA of 20/40 or better, 18 had 20/50 to 20/100 and 25 eyes were 20/200 or worse. Of the 36 eyes without ocular disease, final VA was 20/40 or better in 78% of patients. At day 1 post-op 21% (n=48) were 2 lines or more better in VA, at 1 week, 1 month, 6 months and 1 year they were, 43% (n=46), 61% (n=44), 69% (n=32) and 76% (n=17), respectively. Pre-op IOP was 14.4 ± 0.4 mm Hg, at 1 day post-op 20.2 ± 1.7 and at 1 week 17.4 ± 0.9. At 1 day post-op, 9 eyes had IOP > 25 mmHg. At 1 week 4 eyes had IOP < 25 mmHg. 11 eyes required secondary procedures related to the complication including pars plana vitrectomy/lensectomy (n=7), secondary IOL placement (n=3), retinal detachment repair (n=1). At post-op day 1, 7 patient required additional pressure medications, and at 1 week and 1 month, 9 and 5 patients, respectively.
The University of North Carolina resident surgical curriculum includes lecture, wet lab practice and instruction, and surgical video review. At UNC, surgical outcomes of resident performed phaco complicated by vitreous loss requiring anterior vitrectomy are comparable to published data of similar cases performed by surgeons of all levels of experience. The presence of a structured resident surgical curriculum allows residents to achieve favorable outcomes in these complicated cases.
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