Abstract
Purpose :
Cataract surgery is a fundamental skill learned during ophthalmology residency however few studies have evaluated the outcomes of trainees’ surgeries. We performed a retrospective, observational, clinical study to identify risk factors associated with complications (posterior capsular tear (PCT) with and without vitreous loss) and poor postoperative visual outcomes (best corrected visual acuity (BCVA) < 20/40) occurring in resident performed cataract surgeries.
Methods :
845 cataract surgeries performed by ophthalmology residents as primary surgeons between January 1, 2011 and April 30, 2014 were retrospectively reviewed from a large teaching hospital’s electronic medical records. Surgeries resulting in PCT with or without vitreous loss as well as those resulting in a BCVA <20/40 were compared with respect to patient demographic variables, clinical characteristics, surgical procedures, ocular examination results including comorbidities, and resident surgical experience.
Results :
PCT occurred in 8.6% of cases and 16.7% of surgeries resulted in a postoperative BCVA of <20/40. PCT was positively and independently associated with first quartile of residency training (p=.011). Residents experienced significantly more complications in their first quartile of cases when a topical block was employed (p<.001), when operating on patients with diabetic retinopathy (p=.032) or glaucoma (p=.016), on patients using an alpha blocker (p=.014), and when operating on a cataract of moderate or dense grade (p<.001). Postoperative BCVA <20/40 was found to be independently related to dense cataract grade (p=.035) and the presence of several pre-existing ocular conditions including diabetic retinopathy (p<.001) and macular degeneration (p<.001). Interestingly, patients with a history of cataract surgery in the fellow eye were less likely to experience PCT (p=.014) and were more likely to experience a favorable visual outcome (p=.020).
Conclusions :
This study found a strong association between resident surgical experience and surgical complications involving PCT after controlling for a number of risk factors and clinical variables. These findings suggest the possibility that some intraoperative complications may be prevented by assigning novice ophthalmology residents to operative cases with fewer known risk factors.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.