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Lai Jiang, Coby Ray, Zachary Mortensen, Alexander Compton, Eneko Larumbe, David McCartney; Single-incision phacoemulsification cataract surgery performed by ophthalmology residents: a review of 1466 consecutive cases. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2220. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The majority of phacoemulsification cataract surgeries are currently performed using two or more incisions. This study aims to report both the complication rates and improvement in operative efficiency over time for a novel nuclear disassembly technique with the use of a single instrument when performed by third year ophthalmology residents.
Surgical time, cumulative dissipated energy (CDE), operative and postoperative complications, as well as other clinical outcomes data was collected through a retrospective chart review of 1466 consecutive adult cataract extraction cases utilizing the single incision phacoemulsification technique performed by 12 residents over 3 sequential years. Combined phacoemulsification with other surgeries, and non-primary resident cases were excluded from this study. Learning curve analysis was performed using various longitudinal regression models.
Follow up ranged between a minimum of 6 to 36 months. The average change in logMAR BCVA preoperatively to a mean of 60 days postoperatively was 0.27 (range -1.0 to 1.3). The most common intraoperative complication was vitreous loss (1.30%) and the most common postoperative complication was corneal edema > 90 days (0.34%). A preliminary formula to estimate operative time for the first 82 surgeries, the minimum number among all residents was determined as: time (min) = 38.68 + 1.51 (density of cataract) – 0.14 (number of surgeries performed). This formula indicates an 84 second mean improvement in operative time per 10 surgeries completed. Our data further reveals a mean improvement of 7.42 minutes between the first and last 20 cases. Improvements in operative efficiency beyond 82 surgeries and the effects of surgical experience on CDE were also modeled with detailed analysis to follow.
Our data documents notable improvements in surgical efficiency over the course of a resident’s training in a novel phacoemulsification technique. We were able to develop a formula used to predict the estimated operative time not previously published. When compared to the complication rates published in the literature, the single-incision technique may be safer in patient populations similar to ours. Whether this technique would be safer in other teaching environments is uncertain and would require significantly larger studies.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Downward trend of operative time based on number of cases
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