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Giannis A. Moustafa, Durga S Borkar, Matthew McKay, Emily Eton, Nicole Koulisis, Alice C. Lorch, Carolyn E. Kloek; Outcomes in resident performed cataract surgeries with iris challenges: results from the PCIOL Study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4805. doi: https://doi.org/.
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To assess the outcomes of resident performed cataract surgeries with iris challenges including pre- and intraoperative miosis, iris prolapse, and floppy iris syndrome (IFIS) and to compare these outcomes to similar surgeries performed by attending physicians.
All cases (1931 eyes of 1434 patients) of cataract extraction by phacoemulsification with intraocular lens insertion performed by ten comprehensive ophthalmologists at an academic practice in Boston, MA between January 1 and December 31, 2014, were retrospectively reviewed. The preoperative consultation, operative report, and postoperative day one (POD1), week one (postoperative days 5-14), and month 1 (post-operative weeks 3-8) visits were reviewed. Independent- or paired-sample t-test, Mann-Whitney U, Chi-square, Fischer exact, Kruskal-Wallis, Spearman correlation, and multiple linear regression were used for data analysis.
Sixty-five eyes with preoperative or intraoperative miosis, or IFIS operated on by residents (Group A) and 168 operated on by attendings (Group B) were included. Best-corrected visual acuity improved significantly in both groups (p<.0001), but final BCVA was better in Group A (p=.028); however, when adjusting for ocular comorbidities, no difference was observed (p=0.16). Mean operative time was 44 and 31 minutes in Group A and B, respectively (p<.0001). Group A surgeons more often attempted additional pharmacologic or mechanical pupil dilation as compared with Group B (98% vs 87% of cases, p=.008). Intra-ocular pressure (IOP) on POD1 was higher in Group A cases (20.15 vs 18.23 mmHg, p=.018), and overall longer operative time was associated with a higher IOP on POD1 (p<.0001). Incidence of other intra- and postoperative complications including anterior and posterior capsule tear, zonular dehiscence, iris trauma, retained lens fragments, displaced lens or out-of-the-bag lens placement, and macular edema, did not differ between the groups (p>.05).
Residents are able to perform phacoemulsification surgery in eyes with miosis and IFIS with outcomes comparable with those of experienced attending ophthalmologists. As compared with attending performed cases, resident surgeries take longer and are more likely to employ iris retraction intra-operatively. Longer case time was associated with higher IOP on POD1.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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