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M. Caldwell, C. Reilly; A Review of Seven Years of Resident Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1089. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To review surgical techniques and outcomes of residents in the San Antonio Uniformed Services Health Education Consortium Ophthalmology Residency over the past seven years to evaluate for trends during the course of training as well as over the years.
A database of 1724 cataract surgeries performed at Wilford Hall Medical Center and Brooke Army Medical Center by residents between 1999 and 2006 was reviewed. The cases were divided first by year in training (R1, first half of R2, second half of R2, first half of R3, second half of R3), and then the same group was divided by calendar year. The subgroups were then analyzed and compared by type of procedure, type of anesthesia, incision, and intraoperative and postoperative complication rates.
A shift away from extracapsular cataract extraction was noticed over the seven year period, making up 5.4% in 1999 and less than 1% in 2006. Retrobulbar anesthesia also decreased from 46.7% of cases in 2000 to 5.6% of cases in 2006 with topical anesthesia making up 35.1% and 66.0% of cases respectively. Clear cornea incisions replaced scleral tunnels as the most common approach accounting for 1.0% of cases in 1999 and 83.0% in 2006. These same trends also held true through residency training from year 1 to year 3. Extracapsular cataract extraction accounted for 65% of first year surgeries and only 0.75% of surgeries performed in the second half of the third year of residency. Retrobulbar anesthesia was used in 72% of first year surgeries and 28% near the end of residency. Only 3 of 14 first year phacos (21%) were clear cornea incisions, but made up 57.3% of third year surgeries. The anterior vitrectomy rate over the seven year period was relatively stable around 6-8% with a slight decreasing trend. The anterior vitrectomy rate showed a significant decrease during residency, highest at 21.9% during first year and decreasing to 6.0% by the second half of second year where it leveled off.
Cataract extraction is an evolving surgery which has changed significantly even in the past decade. The techniques used by residents can be learned in a graduated manner. The volume of surgical data generated by resident cataract surgery lends itself to database analysis which can give valuable insights to training.
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