Abstract
Purpose :
In this study, we compare the rates of capsular complications in Divide and Conquer (DC), Pop and Chop (PC), and Pop and Prechop (PPC) performed by beginning resident surgeons at the Hampton VA hospital.
Methods :
This is a retrospective study of resident cataract surgery using three different techniques of nucleofractis performed at the VA hospital in Hampton, Virginia. The first 50 cases of 10 residents from 2014-2018 are included in the study. Patient age, nuclear density, surgical technique, and occurrence of a capsular complication (PC tear or zonular dialysis) were recorded. The data was analyzed to compare the rate of capsular complications and calculate odds ratios between the different surgical techniques. The effect of patient age and nuclear density on complication rates was also analyzed.
Results :
Among the 500 resident cataract surgeries analyzed, 275 (55%) cases were completed using DC while 101 (20.2%) were completed using PC and 124 (24.8%) using the PPC technique. All the complications involved a rupture of the posterior capsule except one case of zonular dehiscence. The average patient age was 68.5 in the uncomplicated group and 69.7 in the complicated group (p=0.44). The average nuclear density was 2.8 in the uncomplicated group and 2.9 in the complicated group (p=0.57). The total rate of capsular complications was found to be 6.8%. Complication rates for each technique were 7.2% (DC), 9.9% (PC), and 3.3% (PPC) respectively (p<0.0001). Odds ratio calculations comparing the different techniques found that residents are 56% more likely to experience complications when performing PC vs DC (p=0.17), 90% more likely to experience complications when using DC versus PPC (p=0.22), and 3.6 times (258%) more likely to experience complications when using PC versus PPC (p=0.039).
Conclusions :
Previous studies have reported that DC, PC, and PPC are all safe and effective surgical techniques for beginning resident cataract surgeons. In this study, residents performing PPC were less likely to cause capsular complications than when performing DC or PC. This difference was statistically significant when comparing PPC versus PC. Further studies are needed to establish that PPC may be a suitable additional technique to DC that can be safely introduced to residents early in their cataract surgery training experience.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.