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A. R. Anchala, C. D. Simpson, J. Yonker; The Effect of a Microsurgical Training Course on Resident Performed Cataract Surgery Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5587.
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To investigate the impact of a newly instituted microsurgical training course (MTC) on the outcomes of resident performed cataract surgery.
Retrospective chart review was conducted on all Class 1 (primary surgeon) ACGME logged phacoemulsification cataract extractions (CE) during PGY-2 year performed during the academic years of 2006-7 (Group 1) and 2007-8 (Group 2). Each group consisted of seven PGY-2 residents at one ophthalmology residency training program. During the time period that Group 1 was in their PGY-2 year there was no formal MTC. The following year, Group 2 participated in a formal MTC during their PGY-2 year. Group 1 residents performed 30 CE while Group 2 residents performed 44 CE. Intraoperative complications, such as posterior capsular rupture, were recorded. Surgical operative time, from first incision to completion of the case, was recorded for each cataract extraction performed. Best corrected visual acuity (BCVA) was recorded at postoperative day 1, week 1, month 1 and month 3. Each patient was dilated at the 1 month postoperative visit for detection of cystoid macular edema (CME).
There was no statistically significant difference between the two groups with regard to patient visual acuity, open posterior capsule, or postoperative complications, such as CME. There was a trend toward better postoperative BCVA in the trained group; the average BCVA was 20/40 in Group 1 and 20/25 in Group 2 at the 3 month follow up visit (p=0.14). A trend toward decreased incidence between groups 1 and 2 of intraoperative posterior capsular tears (24.4% and 12 % respectively, p=0.14) and postoperative CME (7.7% and 3.5% respectively, p=0.22) was also noted. There was a significant difference between the two groups with regard to intraoperative case length; Group 1 had a average case time of 68.9 minutes while Group 2 averaged 49.6 minutes (p=0.0004).
Given the decreasing surgical numbers of ophthalmology residents, alternative surgical training techniques, such as MTC, will be essential to produce competent ophthalmic surgeons. In our series, MTC resulted in a statistically significant decrease in operative time for resident performed cataract extractions. The data further suggests that MTC in resident training may result in improved postoperative BCVA with fewer postoperative and intraoperative complications.
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