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S. I. Pachydaki, J. Y. Kim, N. Brar, S. L. Cremers; Safety and Efficacy of Torsional Phacoemulsification Performed by Ophthalmology Residents. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1076.
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The recently developed torsional phacoemulsification cataract surgery is considered to be more efficient and safer than conventional longitudinal phacoemulsification. We report early data showing excellent visual outcomes and safety profile of cataract surgery performed by trainees using torsional ultrasound.We also compare the features of cataracts as graded by the LOCSIII system with surgical parameters of torsional phacoemulsification.
A prospective study of 22 consecutive cases of cataract surgery performed by torsional phacoemulsification at a teaching institution was conducted. Eight cases were performed by a single resident without any prior experience with torsional phacoemulsification under the supervision of one attending (resident group). Fourteen cases were performed by the supervising attending (attending group).
There was no difference in the age, total LOCS score (sum of LOCSIII grading parameters), the ratio of Cumulative Delivered Energy (CDE) by the total LOCS score (CDE / LOCS), the preoperative and postoperative best corrected visual acuity (BCVA) between the two groups (p>0.05 for all). Total surgery time and irrigation fluid used was higher in the resident group (p<0.01 for both). At week one, BCVA improved on average by 1.5 line in both groups. 87.5% of patients in the resident group and 100% in the attending group had a BCVA of 20/30 or better. There was no correlation of improvement of BCVA and the CDE / LOCS ratio, fluid used or surgery time (p>0.05 for all). The CDE / LOCS ratio appeared to decrease with time in the resident group, suggesting a learning curve for use of torsional phacoemulsification technology. There was a trend toward less irrigation fluid used in both groups and shorter surgery time with more surgeries performed in the attending group. There was no correlation between the CDE, surgical time and fluid used during surgery and any of the parameters of the LOCS grading system (p>0.05). There was however a statistically significant correlation between the CDE/LOCS ratio with the fluid used (p=0.03) and surgery time (p=0.03) for the attending group only. No complications occurred perioperatively.
The CDE / total LOCS ratio may help estimate surgery time and fluid used in torsional phacoemulsification. Even though there appears to be a learning curve in the resident group, residents can safely perform cataract surgery using it with good visual outcome. It is feasible to incorporate novel technology such as torsional phacoemulsification in residency training with good visual outcome.
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