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S.A. Osborne, C.V. Bunce, P.S. Severn, S.G. Fraser; A Risk Scoring System Facilitating Selection of Appropriate Phacoemulsification Cases for Trainee Eye Surgeons . Invest. Ophthalmol. Vis. Sci. 2006;47(13):634.
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To establish whether a previously validated scoring system for the prediction of posterior capsule rupture during phacoemulsification surgery could be used to: 1. Predict the difficulty of a phacoemulsification case, and;
2. Select appropriate phacoemulsification cases for trainees based on their previous phacoemulsification experience.
The study sample was consecutive phacoemulsification cases undertaken by all senior surgeons at a single ophthalmic unit over a three week period. Each case was scored using a potential complication scoring sytem devised by Habib et al, Sunderland Eye Infirmary. This scoring system uses data readily available from a patient's pre–operative notes. Immediately post–operatively, each case was given two scores by the operating surgeon on a printed questionnaire. (The surgeon was masked with regard to the potential complication score).
The first score was to indicate the perceived difficulty of the case. The surgeon scored the case 1 to 5, where 1 was very easy and 5 was very difficult.
The second score was based on the question "In your opinion, how much phaco experience would a supervised trainee require before being able to safely perform a case of the same difficulty?" The four possible responses were:
1. <50 previous phacoemulsifications
2. 51–200 previous phacoemulsifications
3. >200 previous phacoemulsifications
4. Suitable for a Consultant only
There were a total of 170 phacoemulsification cases in this study. Using Cuzick's non–parametric test for trend, there was evidence for a trend of increasing perceived difficulty with increasing potential complication score (p=0.05).
Using the same test, there was evidence for a trend of increasing experience required with increasing potential complication score (p <0.001).
The authors advocate that Habib's potential complication score can be used to predict the difficulty of a phacoemulsification case, and that it can be used to aid the selection of appropriate cases for trainees of varying experience. The authors recommend that, as a guideline, cases scoring 1 with Habib's system are suitable for all trainees, cases scoring 2 should be performed only by trainees who have performed more than 50 previous phacoemulsifications, and cases scoring 3 or more should be performed only by trainees who have performed at least 200 previous phacoemulsifications or by senior grade surgeons.
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