Purchase this article with an account.
Kevin Miller, Raouf Sherief, Kevin Kaplowitz, Timothy Chou, Azin Abazari; Surgical outcomes following complicated phacoemulsification cataract surgery performed by beginner resident surgeons. Invest. Ophthalmol. Vis. Sci. 2016;57(12):939.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The rate of intraoperative complications in beginner cataract surgeons during ophthalmology residency has been shown to be significantly higher compared to their more experienced counterparts. A “learning curve” of resident training for phacoemulsification has been previously described. The aim of this retrospective study is to investigate the final visual outcome in patients with complicated cataract surgery. This study will evaluate if our patients still had good visual outcomes despite these intraoperative complications.
After obtaining institution review board approval, a retrospective chart review of all cataract surgeries done by second year residents at our institution was performed. Surgeries done by 8 consecutive second year residents from 2010 to 2015 were analyzed for this study. Patients with an intraoperative complication, including posterior capsule tear, vitreous loss, dropped lens fragment, or any other non-routine event were included for analysis in this study.
Of 150 cataract surgeries performed by beginner resident surgeons, 24 cases with intraoperative complication were identified (16%). Of these cases, 17 (70%) had preoperative risk factors for surgical complications, including poor dilation, mature cataract, poor red reflex, and pseudoexfoliation. In addition, 62.5% (15/24) had ocular comorbidities limiting final visual outcome including macular degeneration, advanced glaucoma, diabetic macular edema, and tractional macular detachment. 41.6% (10/24) had visual acuity of 20/40 or better at their last visit. Of the 14 patients that did not have a visual acuity of 20/40 or better, 9 had preexisting ocular pathology limiting visual potential, and if these patients were excluded, 66.7% (10/15) had acuity of 20/40 or better. Patients gained on average 8 lines of vision compared to their preoperative acuity.
Preoperative risk factors for surgical complications may lead to high surgical complication rates in surgeries performed by beginner resident surgeons. In carefully selected cases, patients can achieve good final visual acuity after cataract surgery by beginner resident surgeons. The overall complication rate was higher in this study compared to some prior studies. This may be due to the fact that only outcomes of beginner resident surgeons were analyzed, rather than more experienced residents as in most prior analyses.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only