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Whitney Smith, Fatimah Gilani, Richard Ober; The Difference in Rate of Major Complications in PGY-4 Phacoemulsification Cataract Surgery Performed with the Sovereign versus Infiniti systems: A 10 year experience at the University of Arizona. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1926.
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© ARVO (1962-2015); The Authors (2016-present)
Cataract surgery is one of the cornerstones of ophthalmic training. The learning curve for resident-performed phacoemulsification is steep and residents tend to improve with time. Increased availability of newer technology, including surgical simulators and phacoemulsification machinery, is commonly believed to decrease rates of major complications. This study sought to identify the difference in rate of major complications of PGY-4 level cataract surgery done with the Sovereign system (AMO, Abbott Park, IL) versus the Infiniti system (Alcon, Fort Worth, TX).
A retrospective review was performed of 2506 cataract cases at the Southern Arizona Veterans Administration Hospital in Tucson, Arizona. Operative notes were used to identify all cases from July 2001 to June 2011 where a PGY-4 resident was the primary surgeon. Major complications were defined as posterior capsular disruption, vitreous loss, and retained lens fragments. The Sovereign phacoemulsification system was used from July 2001 to June 2007 on 1308 cases by 12 residents and the Inifiniti system was used on 1198 cases from July 2007 to June 2011 by 11 residents.
There was no statistically significant difference between the rate of major complications with the Sovereign (5.6%) or Inifiniti (6.6%) phacoemulsification systems (p=0.038). Rates of posterior capsular disruption and retained lens fragments were slightly higher with the Sovereign system (4.5% and 3.8%) than with the Inifiniti system (3.6% and 2.7%, respectively), while the rate of vitreous loss was higher with the Inifiniti system (3.3%) than with the Sovereign (3.0%). None of these results were statistically significant (p=0.021, 0.045, 0.018).
The rate of major complications from PGY-4 resident-performed phacoemulsification surgery did not depend on the phacoemulsification system used. Residents can gain experience through performing cases or through a simulated surgery environment. Further studies are needed to determine the optimal balance between surgical experience and surgical simulation for resident training.
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