Visual outcome and major surgical complications of extracapsular cataract extraction versus manual small-incision cataract surgery performed by resident doctors at tertiary care institute as part of learning curve

Abstract

Background: Cataract surgery has its own learning curve to the resident doctors. Our resident doctors are trained in extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS). In ECCE and initial cases of MSICS, they are trained to do can-opener capsulotomy (COC) and then they are trained in continuous curvilinear capsulorrhexis (CCC). Aim: We designed a study to compare the visual outcome and major surgical complications of resident doctor performed ECCE versus MSICS at our institute. Setting and Design: This was a hospital-based study in ophthalmology department (retrospective study). Materials and Methods: A total of 239 patients with visually significant cataract presenting to our outpatient department were enrolled in the study. Data of consecutive cataract surgeries done by 10 junior residents (JRs) from March to August 2017 were analyzed. First-year residents were trained for ECCE (JR1 group) for 6 months. During the same time period, 2nd-year residents were trained for MSICS (with COC) for first 3 months (JR2 group). Then, as a part of learning curve, 2nd-year residents were then trained for MSICS (with CCC) for next 3 months (JR3 group). Data were analyzed using the Chi-square test, percentages. Results: Out of 239 cataract surgeries performed by residents over a 6-month period, ECCE were 52 (21.8%) and MSICS were 187 (78.2%) cases. Both the surgeries in MSICS (2nd-year residents) and ECCE (1st-year residents) had good visual outcome (94.6% vs. 84.6%). The overall major surgical complication rate for MSICS was 7.0% while that for ECCE was 11.5%. Conclusion: We conclude that both surgeries can be taught to beginner surgeons with good visual outcome. Both surgeries have safe learning curve with good visual results when done under supervision as evidenced by a low rate of major surgical complications.