Learning curve of resident-performed phacoemulsification surgeries: Complications and outcomes

Abstract

Purpose : This study aims to compare the outcomes of and incidence of complications in phacoemulsification surgeries performed by second-, third-, and fourth-year residents

Methods : A retrospective study considered 424 consecutive resident-performed phacoemulsification surgeries from Jun - Nov 2016. The surgeries were performed by ophthalmology residents from the University of Campinas (UNICAMP) in Brazil, who were guided by a senior surgeon. The study included surgeries performed by 10 second-year residents (R2 group), 9 third-year residents (R3 group), and 5 fourth-year residents (R4 group) and evaluated best-corrected visual acuity(BCVA) before surgery, intra- and postoperative complications, final BCVA(on the 30th postoperative day), and endothelial parameters based on specular microscopy and pachymetry results before surgery and on the 60th postoperative day

Results : There were 80 surgeries in the R2 group, 142 surgeries in the R3 group, and 202 surgeries in the R4 group. Mean age of R2 patients was 70.3 ±7.5 years old (range of 50 – 85 years), mean age of R3 patients was 66.9 ±9.2 years old (26 – 85 years); and mean age of R4 patients was 67.0 ±12.0 years old (26 – 91 years). Average BCVA before surgery was 0.26 ±0.18. A total of 50 intra-operative complications occurred (11.79% of all surgeries): there were 17(21.25%) in the R2 group, 22(15.49%) in the R3 group, and 11(5.45%) in the R4 group. Complications included 31 cases of posterior capsule tears, 19 cases of vitreous loss, 2 cases of nuclear loss into the vitreous cavity, 6 cases of aphakia, 2 wound burns, 4 cases of zonular dialysis, 4 cases of Descemet’s membrane detachment, and 9 iris lesions. Long-term monitoring revealed no endophthalmitis and 2 cases of bullous keratopathy (1 in the R2 group and 1 in the R3 group). Final BCVA exhibited statistically significant improvement (p=0.001). When preoperative specular microscopy results were compared to those of the 60th postoperative day, no statistical differences were found in most of parameters tested (p=0.28 in the case of endothelium density and p=0.30 for the percentage of hexagonal cells), with the exception of the coefficient of variation (p=0.03). Likewise, pachymetry results did not differ significantly(p=0.08)

Conclusions : Despite the learning curve, surgical phacoemulsification performed by surgeons in training resulted in low rates of complication and good visual outcomes

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.