Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

Abstract

Abstract Objective The purpose of this study was to determine the proportion of complex cataract surgery performed by third-year ophthalmology residents at an academic Veterans Administration Medical Center. Methods A chart review was conducted of all resident cataract surgeries performed at the James J. Peters Veterans Administration Medical Center in The Bronx, NY between July 1, 2007, and June 30, 2017. Correct categorization was confirmed by review of operative report and reason for complex categorization was recorded, as well as the use and type of nonstandard device or technique. Results A total of 2,429 routine and 114 complex cataract surgeries were performed by 40 different residents over the 10-year period. In total, 4.5% of all cataract surgeries were categorized as complex. The most common reasons for complex categorization included intraoperative floppy iris syndrome (35.8%), miosis (38.4%), zonular instability (9.6%), mature cataract (7%), posterior synechiae (7.8%), and posterior capsular plaque (1.8%). Nonstandard techniques/devices included iris hooks (65.3%), pupil expansion device (8.5%), extracapsular cataract extraction (6.8%), synechiolysis (7.6%), mechanical iris dilation (0.8%), capsular tension ring (9.3%), and primary posterior continuous curvilinear capsulorhexis (1.7%). Conclusion A review of third-year resident cataract surgery experience at our institution's VA hospital where a significant amount of their surgical volume, approximately 50%, is obtained revealed that complex cataracts constituted a minimal portion of the cases. Education in cataract surgery should be competency based, extend beyond achieving minimums, and focus on variety and complexity of surgical experience. Formal tracking of routine versus complex cases should be considered to optimize training experience and assure patient safety.