Abstract
Purpose :
Certain demographics and ocular features are associated with an increased risk of intraoperative complications during phacoemulsification surgery; however, these factors are not clearly defined for resident-performed phacoemulsification. The purpose of this study was to identify risk factors for developing intraoperative complications during resident-performed phacoemulsification.
Methods :
Charts of patients undergoing resident-performed phacoemulsification for visually significant cataract at a tertiary-care county hospital between July 1, 2016 - June 30, 2022 were reviewed. Exclusion criteria were inadequate data, or cataract surgery combined with another procedure. Demographics, preoperative medical and ocular characteristics, and intraoperative variables were recorded. Main outcome measures were intraoperative complications, including vitreous loss, zonular dehiscence, dropped nucleus, lens misplacement, and anterior and posterior capsular tears. Stepwise logistic regression was performed to identify risk factors and estimate their effects.
Results :
661 eyes of 512 patients were included in the study. Mean age was 60.4 years (18.1) and 248 patients were male (37.5%). The most common racial categories included Hispanic [406 (61.4%)] and Black [140 (21.2%)] patients. One or more intraoperative complication(s) occurred in 61 (9.2%) eyes, with anterior capsular tears [27 (4.1%)], vitreous loss [26 (3.9%)], and posterior capsular tear [25 (3.8%)] as the most common complications (Table 1). Risk factors for intraoperative complications were Black race (P=0,003), grade 4 nuclear sclerotic cataract (NSC, P=0.001), and presence of diabetic retinopathy (DR, P=0.007) (Table 2). Resident surgical experience and requiring additional surgical tools were not significant risk factors for developing intraoperative complications.
Conclusions :
Higher stage NSC cataracts, DR and black race were associated with increased risk for intraoperative complications. Additional work defining the relationship between preoperative characteristics and certain complications during phacoemulsification may allow for the creation of a preoperative risk score for residents.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.