Abstract
Purpose :
To analyze surgical complications in resident-performed cataract extraction since the development of an advanced microsurgical simulation laboratory and curriculum in 2015. We aim to furthermore characterize the learning curve of novice surgeons, and calculate the relative risk of complication in ‘complex’ cases necessitating the use of pupil-expansion devices.
Methods :
This retrospective case series reviewed resident-performed cataract surgeries between 2013-2018 at one location within the Montefiore Medical Center in the Bronx, NY. The main outcome measures were complications including retained lens, anterior vitrectomy, same day and delayed pars plana vitrectomy (PPVx). Cases were furthermore characterized as complex if a pupil expansion device was utilized (Malyugan Ring or Iris Hooks). Data was subdivided by months and years for trend analysis.
Results :
A total of 1306 senior resident-performed cataract surgeries were systematically reviewed, of which 68 (5.21%) cases had intraoperative complications, and 150 (11.49%) complex cases required iris manipulation. The percentage of complex cases increased every year over the study period (range 3.57%-16.73%, p=0.0003) (Figure 1), whereas the annual rate of complication did not change significantly over the years (p=0.2). The complex surgeries were found to have a significantly higher complication rate compared to cataract surgery where iris manipulation was not required (13.25% vs 4.37%; OR=3.08). A 3-year subgroup analysis of 897 cases from 2016 to 2018 demonstrated a significant decline in month-to-month complications as the academic year progressed. Cases in the first month of surgical training had the highest rate of complication at 13.3%, which declined to 2.7% at the conclusion of training (range 0.0%-13.3%) (p=0.0013). The most common complication was vitreous loss requiring anterior vitrectomy (n=29, 3.23% of total cases). The percentage of cases requiring anterior vitrectomy significantly declined over the academic year, from 13.3% to 1.8% (range 0.0%-13.3%) (p=0.0002) (Figure 2).
Conclusions :
Since the introduction of microsurgical training center, residents have been able to operate with less complications and on more complex cases of cataract surgery over their academic year. Wet lab curriculum is effective in preparing and training residents for real cases, and more training should be implemented.
This is a 2020 ARVO Annual Meeting abstract.