May 2006
Volume 47, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2006
A Risk Scoring System Facilitating Selection of Appropriate Phacoemulsification Cases for Trainee Eye Surgeons
Author Affiliations & Notes
  • S.A. Osborne
    Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom
  • C.V. Bunce
    Research and Development, Moorfields Eye Hospital, London, United Kingdom
  • P.S. Severn
    Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom
  • S.G. Fraser
    Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom
  • Footnotes
    Commercial Relationships  S.A. Osborne, None; C.V. Bunce, None; P.S. Severn, None; S.G. Fraser, None.
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science May 2006, Vol.47, 634. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : 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.

Methods: : 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

Results: : 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).

Conclusions: : 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.

Keywords: cataract • training/teaching cataract surgery • clinical (human) or epidemiologic studies: risk factor assessment 
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