Resident-performed Phacoemulsification Research Articles

Resident-Performed Phacoemulsification Cataract Surgery: Impact of Resident-Level Characteristics.

To evaluate the rate of complications in resident-performed phacoemulsification and influencing factors. In this retrospective cohort study, the outcomes of cataract surgeries performed by 18 ophthalmology residents were analyzed. The outcome of first 80 phacoemulsification cataract surgeries (1440 cataract surgeries) performed by each resident were analyzed. Outcome measures included the rate of intraoperative capsular rupture requiring anterior vitrectomy, nucleus drop, and incomplete attempts at uncomplicated procedures. Changes in the rate of complications over the surgical training course were also assessed. The most common surgical complications were capsular rupture (7.5%), followed by incomplete attempt(s) (5.9%), and nucleus drop (1.1%). Comparing the first 40 and second 40 surgeries, the rate of complications decreased as a function of surgeon experience in all resident cohorts. Greater theoretical skills and younger surgeon age were associated with a lower rate of intraoperative capsular rupture (hazard ratios = 1.421 and 1.481, respectively; P = 0.047 and P = 0.041, respectively). The use of antianxiety drugs and number of surgeries in the first 6 months demonstrated no predictive value for a lower rate of intraoperative complications (hazard ratios = 0.929 and 1.002; P = 0.711 and P = 0.745, respectively). The use of antianxiety medication and more surgeries in the first 6 months did not decrease the rate of intraoperative complications of phacoemulsification, while improvement of theoretical skills may have increased the safety of resident-performed cataract surgery.

Effect of surgical simulation training on the complication rate of resident-performed phacoemulsification

ObjectiveTo study the effect of additional training with ophthalmic surgical simulation on the intraoperative complication rates of phacoemulsification performed by residents.Methods and materialsThis was a retrospective study of phacoemulsification surgeries...

Surgical Results of Phacoemulsification Performed by Residents: A Time-Trend Analysis in a Teaching Hospital from 2005 to 2021.

Purpose To report a long-term trend of surgical results of phacoemulsification performed by residents in a teaching hospital. Methods This study analyzed 1,409 consecutive cases of phacoemulsification performed by residents under a single supervisor from July 2005 to March 2021. The 15.75-year period was divided into seven equal intervals for time-trend analysis. Main Outcome Measures. Rates of completion and complications were collected to assess the surgical results. Results The overall completion rate was 60.5% (852/1409), and the intraoperative complication rate was 14.5% (204/1409). The completion rates from the first to the seventh interval were 44.7%, 54.2%, 60.6%, 50.6%, 65.1%, 72.5%, and 81.8%, respectively. The completion rate improved significantly with time, mainly in the steps of anterior capsulorhexis and nucleus emulsification. The intraoperative complication rates from the first to the seventh interval were 27.4%, 20.4%, 14.0%, 11.8%, 8.2%, 9.6%, and 7.3%, respectively. The complication rate also decreased significantly with time, mainly in the steps of anterior capsulorhexis, nucleus emulsification, and cortex removal. The major complications included anterior capsulorhexis tear (n = 95), vitreous loss (n = 40), iris damage or prolapse (n = 36), and posterior capsule tear without vitreous loss (n = 29). There was a significant improvement of surgical results with the level of residency in the completion rate but not in the complication rate. Conclusions With a long-term evolution in the surgical training curriculum, it is possible to reach a goal of both higher completion and lower complication rates of resident-performed phacoemulsification.

Incidence of postoperative week 1 management changes after resident-performed phacoemulsification cataract surgery

BackgroundThe goal of this study was to investigate the incidence of departures from routine care at the postoperative week 1 (POW1) visit following uneventful resident-performed cataract surgery in asymptomatic patients who had a normal postoperative day 1 (POD1) examination.MethodsA retrospective chart review of phacoemulsification surgeries performed by the senior resident class at Montefiore Medical Center between June 20, 2018 and April 1, 2019 was performed. The most recent preoperative visit note, operative report, POD1 visit note, and POW1 visit note were evaluated and variables were recorded. Exclusion criteria consisted of any complications that would have necessitated close follow-up and a POW1 visit, whether discovered preoperatively, intraoperatively, at the POD1 visit, or leading up to the POW1 visit. The primary outcome measure was the incidence of unanticipated management changes at the POW1 visit following resident-performed cataract surgery.ResultsThe charts of 292 surgical cases of 234 patients that underwent phacoemulsification with intraocular lens implantation were reviewed. 226 cases (77%) had an uncomplicated pseudophakic fellow-eye history, with a routine surgery, and POD1 examination. 19 of these patients had symptomatic presentations at the POW1 timepoint, and an additional 30 had no POW1 visit at all. In total, 177 cases were included in the study, and only 4 of these cases (2.3%) had an unexpected management change at the POW1 visit.ConclusionsAsymptomatic patients who underwent uncomplicated cataract surgeries performed by resident surgeons followed by a routine POD1 visit had a low incidence of unexpected management changes at the POW1 visit. These results suggest that regularly scheduled POW1 visits could potentially be omitted for patients deemed to be at low risk for complications, and instead performed on an as-needed basis.

Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course

Abstract Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery. Setting James A. Haley Veterans' Hospital, Tampa, FL. Design Retrospective cohort study. Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010–2011) were compared with cases done by residents who completed the course (2011–2017). Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after). Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6–9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.

A Comparative Assessment of Intraoperative Complication Rates in Resident-Performed Phacoemulsification Surgeries According to Najjar-Awwad Preoperative Risk Stratification.

IntroductionPhacoemulsification cataract surgery presents a challenge to resident surgeons with lower experience, which confronts with patient safety. In this study, we compared major intraoperative surgical complications of resident-performed phacoemulsification surgeries between cases with low intraoperative risk and random cases with unknown intraoperative risk.MethodsThis prospective randomized controlled study was done on patients who underwent phacoemulsification surgery by third- and fourth-year residents in Khatam-al-Anbia eye hospital, Mashhad, Iran. Preoperative risk was calculated using Najjar-Awwad risk score after slit lamp examination and the patients with scores 7 or higher were considered high-risk. Patients were randomly assigned into a study group, in which only low-risk cases were operated by third-year residents, or control group, in which third-year residents were able to operate any patient regardless of the risk score. In both groups, the remaining patients were operated by fourth-year residents. All intraoperative complications were recorded. Data were analyzed using SPSS, considering P<0.05 significant.ResultsOverall, 475 patients with cataract in the study (N=232) and control (N=243) groups were operated. Mean overall Najjar-Awwad risk scores did not differ significantly between the groups, but pseudoexfoliation and poor pupil dilatation occurred significantly more frequently in the control group (P=0.010 and P=0.014, respectively). Overall, 36 surgeries in the study group (15.5%) and 47 surgeries in the control group (19.3%) were complicated (P=0.273). There was a significant difference between the third- and fourth-year residents regarding the inability to complete continuous curvilinear capsulorhexis (P=0.033). The risk of overall and major complications in high-risk cases was significantly higher among those operated by 3rd-year residents compared with those operated by 4th-year residents (OR=3.45, 95% CI=1.2–9.9, P=0.016 and OR=6.37, 95% CI=1.99–20.34, P=0.001, respectively).ConclusionAlthough supervised resident-performed phacoemulsification has a relatively safe learning curve in our residency program, it is best to stratify preoperative risk and assign high-risk cases to senior residents with higher experience.

Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery

ABSTRACTObjective: Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery. Design: Retrospective case-control study. Setting: Institutional. Methods: Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution. Observation Procedure: Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010. Main Outcome Measures: Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique. Results: There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7–6.0, p < 0.001) was associated with an increased risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7–9.2, p = 0.001) was associated with an increased risk of reoperation. Conclusions: Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

Risk factors for intra-operative complications during phacoemulsification performed by residents.

The purpose of this study was to determine the risk factors for occurrence of intra-operative complications during phacoemulsification performed by residents. One hundred fifty patients with cataract who underwent phacoemulsification by residents, with an experience of five or more phacoemulsification surgery, at a tertiary care centre were included in this study. The pre-operative data of these patients were collected from the hospital records. Surgeons were interviewed immediately after the surgery regarding the surgeon experience, phacoemulsification technique, machine factors, and intra-operative complications. Statistical analysis was done to determine pre-operative and intra-operative risk factors. The overall surgical complication rate in resident-performed phacoemulsification was 37% of which major and minor complications were 21 and 16%, respectively. Success in terms of placement of intraocular lens in capsular bag was 84%. The most common major and minor complications found were posterior capsular tear and irregular capsulorhexis, respectively. Systemic and ocular features of patients as well as type of machine (longitudinal versus torsional longitudinal) had no significant association in terms of complication rate. Increase in success rate was seen with increase in semester and number of surgeries performed. Patient factors including general physical condition, systemic diseases, and anatomical factors do not influence success in resident-performed phacoemulsification. With increase in semester of residents, there is a significant decrease in intra-operative complications. Minor complications in the beginning of case lead to increase in major complications later on during the case and decrease in success rate by junior-semester residents.

Evaluation of the Correspondence between Preoperative Risk Factors and Intraoperative Complications in Resident-Performed Phacoemulsification

A B S T R A C T Introduction: In this study, we aimed to evaluate the rates of preoperative risk factors and intraoperative complications in phacoemulsification, performed by ophthalmology residents. Moreover, we assessed the relationship between these risk factors and complications. Materials and Methods: In this prospective study, the rates of and the relationship between preoperative risk factors and intraoperative complications in resident-performed phacoemulsification were evaluated in the anterior segment clinic of Khatam-al-Anbia Eye Hospital, Mashhad, Iran. Results: In total, medical records of 475 patients undergoing phacoemulsification by 13 ophthalmology residents, were evaluated. The rate of intraoperative complications was estimated at 17.5%. Moreover, the rate of major complications including posterior capsule rupture, zonular dehiscence and vitreous loss, with potential effects on the final surgical results, was 7.2%. Based on the univariate analysis, preoperative risk factors, which were significantly associated with the incidence of intraoperative complications, were as follows: poor red reflex (P=0.001), pseudoexfoliation (P=0.002), poor pupil dilation (P=0.003), corneal clouding (P=0.003), dense cataract (P=0.004), shallow anterior chamber (P=0.02) and advanced age (P<0.05). Conclusion: Considering the correspondence between intraoperative complications and some preoperative risk factors, careful preoperative examination or utilization of systematic risk stratification systems might facilitate the prediction of high-risk cases and prevention of complications in resident-performed phacoemulsification.

Training of Resident Ophthalmologists in Cataract Surgery: A Comparative Study of Two Approaches.

Purpose. To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery. Methods. 502 eyes of 467 patients who underwent resident-performed phacoemulsification were included in the study by reviewing their medical records. Residents were allocated into two groups according to the method applied during their training in cataract surgery; Group A included residents that were trained with the “step-by-step” method and Group B those trained with the “one-step” method. Primary outcome was the incidence of main complications, defined as posterior capsular ruptures and/or zonular dehiscence with vitreous loss. Results. Each resident performed a median of 63 phacoemulsification surgeries. A statistically significant difference (p = 0.0032) was noted in the main complications rate between the two groups, yielding a mean of 17.3% in Group A and 7.25% in Group B. Other intraoperative complications were not shown to differ statistically significantly between study groups (p > 0.05). Among the first 40 surgeries of each resident, main complications rate differed also statistically significantly (p = 0.0048) between Group A (21.67%) and Group B (8.5%), while a better surgical performance-yielding statistical significance in Group A (p = 0.017) was indicated in both groups between the 20th and the 30th procedure. Conclusions. Training in cataract surgery using the “one-step” method may lead to an improvement in surgical competency, when measured by complications rates and, therefore, to significantly better quality of training for resident ophthalmologists.

Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery

To determine the incidence of and risk factors for posterior capsule rupture and vitreous loss during phacoemulsification performed by ophthalmology residents. Academic ophthalmology resident training center, Tehran, Iran. Cross-sectional study. This study included patients who had phacoemulsification by ophthalmology residents from August 2010 to August 2011. The complications occurring during surgery and the rate of vitreous loss and posterior capsule rupture were studied. Five hundred eyes of 500 patients, including 255 (51%) men and 245 (49%) women with a mean age of 67 years ± 10 (SD) (range 27 to 105 years), were studied. Fifty-one eyes (10.2%) developed vitreous loss, and 48 eyes (9.6%) developed posterior capsule rupture and vitreous loss. On univariate analysis, significant risk factors for vitreous loss included diabetes mellitus (P=.001), shallow anterior chamber (P=.01), absence of supervision by a faculty member (P=.007), larger capsulorhexis (P=.02), anterior capsule tear (P=.001), and longer effective phacoemulsification time (EPT) (P=.003). Multivariate data analysis using stepwise logistic regression analysis showed anterior capsule tear (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.09-6.29), longer EPT (OR, 1.01; 95% CI, 1.003-1.02), and lack of supervision by attending physicians (OR, 4.28; 95% CI, 1.44-12.67) to be significant independent risk factors associated with vitreous loss. Direct attending supervision and careful case selection for the level of cataract surgery residency are of utmost importance in avoiding sight-threatening complications.

Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery

To determine the complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery at a tertiary care center during the first 100 surgeries. Retrospective chart review of the first 100 performed phacoemulsification cases of six consecutive residents. Posterior capsule tear, vitreous loss, and dislocation of lenticular fragments into the vitreous were defined as intraoperative complications. Patient characteristics considered risk factors for surgery were identified and correlated with the occurrence of intraoperative complications. Complications occurred in 23 of 600 operations (3.8 %). Surgery was complicated by posterior capsular tear in 23 eyes (3.8 %) with vitreous loss in 17 eyes (2.8 %) and loss of lenticular fragments into the vitreous in seven eyes (1.2 %). Eyes with dense nuclear sclerosis (p = 0.002) and white cataracts (p = 0.019) were associated with a statistically significantly greater incidence of posterior capsular tears and vitreous loss (p = 0.007 and p = 0.027 respectively). An intraocular lens was implanted in 591 eyes as intended. Residents achieve an acceptable complication rate during their initial 100 phacoemulsification cases.

Risk factors for vitreous complications in resident-performed phacoemulsification surgery

To identify risk factors for intraoperative vitreous complications in resident-performed phacoemulsification surgery. Two urban public county hospitals. Case series. Phacoemulsification cataract surgeries performed by residents between January 4, 2005, and January 8, 2008, were retrospectively reviewed. Clinical characteristics of patients with and without intraoperative vitreous complications were compared and independent factors associated with vitreous complications identified using univariate and multivariate analysis. Of 2434 cases meeting inclusion criteria, there were 92 vitreous complications (3.8%). On univariate analysis, significant preoperative risk factors for vitreous complications included older age (P=.020), poor preoperative corrected distance visual acuity (CDVA) (P=.007), left eye (P=.043), history of trauma (P=.045), prior pars plana vitrectomy (P=.034), dementia (P=.020), phacodonesis (P=.014), zonule dehiscence (P<.0001), posterior polar cataract (P=.037), white/mature cataract (P=.005), dense nuclear sclerotic cataract (P=.0006), and poor red reflex (P=.002). Factors that remained significant on multivariate analysis were older age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05), poor preoperative CDVA (OR, 1.52; 95% CI, 1.14-2.03), left eye (OR, 1.63; 95% CI, 1.05-2.51), prior pars plana vitrectomy (OR, 1.88; 95% CI, 1.01-3.51), dementia (OR, 3.65; 95% CI, 1.20-11.17), and zonule dehiscence (OR, 8.55; 95% CI, 3.92-18.63). Elements of the preoperative history and examination can identify patients at higher risk for intraoperative complications during resident-performed phacoemulsification surgery.

Effect of Timing and Duration of Tamsulosin Exposure on Complications in Resident-Performed Phacoemulsification

Tamsulosin can cause intraoperative floppy iris syndrome and increase the risk of phacoemulsification complications. This study evaluated whether the risk of complications was associated with the timing or duration of preoperative tamsulosin exposure. The current study was a retrospective review of electronic medical records of resident-performed phacoemulsification surgeries from 1998 to 2008 at a Veterans Administration Hospital. There were 73 eyes with recent tamsulosin exposure (within 30 days preoperatively) and 28 eyes with remote exposure (> 30 days preoperatively but within 3 years of surgery). There was a trend toward more total complications in recent compared with remote tamsulosin exposure cases (31.5% vs 14.3%, P = .09). A longer duration of tamsulosin use was not statistically associated with an increased risk of total complications. The authors were unable to detect a statistically significant effect of duration of tamsulosin use on the risk of intraoperative complications in phacoemulsification surgery.

Intraoperative Phacoemulsification Complication Rates of Second- and Third-Year Ophthalmology Residents: A 5-Year Comparison

To determine whether year of residency is associated with intraoperative phacoemulsification complication rates. Retrospective cohort study. One attending physician supervised 691 resident-performed phacoemulsification procedures on 492 patients. Second- and third-year residents performed 228 and 463 cases, respectively. All resident-performed phacoemulsification procedures performed between October 2003 and June 2008 and supervised by one attending surgeon (SR) were considered for this study. Data were collected on the residency year of the physician performing the surgery, preoperative risk indicators, and intraoperative complications, including anterior and posterior capsular tears with or without vitreous loss, zonular dialysis or dehiscence, burns, nuclear fragment loss, and Descemet's membrane tear. Cases were classified as difficult if they had 1 or more preoperative risk indicators including: pseudoexfoliation; proliferative diabetic retinopathy; prior vitrectomy; a 4+ dense, white, or brunescent cataract; current Flomax (Boehringer-Ingelheim, Ingelheim, Germany) use, pre-existing zonular dialysis; and intraoperative use of Trypan blue, iris hooks, or pupil dilator. Intraoperative complications are presented as rate per 100 surgeries (95% confidence intervals [CIs]). Intraoperative complication rates and case difficulty. Fifty-three patients experienced at least 1 complication, with 25 cases experiencing multiple complications. Intraoperative complication rates were similar among second- and third-year resident groups (7.9% vs. 7.6%; P = 0.88). Similarly, vitreous loss rates among second- and third-year residents were comparable (4.8% vs. 3.0%; P = 0.27). Risk indicators were more common among third-year cases (24.6% vs. 15.8%; P = 0.008). Having 1 or more risk indicators increased the odds of an intraoperative complication (odds ratio [OR], 3.09; 95% CI, 1.73-5.49). After controlling for risk indicators, second-year resident surgeries still had a similar risk of intraoperative complications as third-year resident surgeries (OR, 1.15; 95% CI, 0.6-2.19). The year of residency did not significantly influence intraoperative complication rates, even after controlling for differences in case difficulty.

Resident-Performed Phacoemulsification Surgery in Tamsulosin-Treated Patients

To compare intraoperative complication rates and visual outcomes for patients treated and not treated with tamsulosin hydrochloride who underwent resident-performed phacoemulsification, and to determine whether the recognition of intraoperative floppy iris syndrome in 2005 affected the subsequent complication rates for tamsulosin-treated patients. This comparative retrospective cohort study included 101 tamsulosin-treated eyes and 404 non-tamsulosin-treated eyes from January 1, 1998, to August 31, 2008. Main outcome measures were major and minor complication rates and postoperative best-corrected visual acuity. Complication rates were compared between August 11, 1999, to December 31, 2005, and January 1, 2006, to September 3, 2008, for both tamsulosin-treated and non-tamsulosin-treated eyes. The major complication rates were 3.0% for tamsulosin-treated eyes and 8.9% for non-tamsulosin-treated eyes (P = .08), while the minor complication rates were 24.8% and 12.1%, respectively (P = .002). Both groups had an equal likelihood of attaining better than 20/40 postoperative visual acuities (82.2% vs 82.9%, respectively; P = .85). Frequency of major complications between tamsulosin-treated and non-tamsulosin-treated eyes was 6.0% vs 15.8%, respectively (P = .09), from August 11, 1999, to December 31, 2005, compared with 0.0% vs 2.0%, respectively (P > .99), from January 1, 2006, to September 3, 2008. Differences in the major complication rates for tamsulosin-treated and non-tamsulosin-treated eyes were not significant, whereas tamsulosin exposure was associated with a significant increase in minor complications. Both groups had similar, good postoperative visual outcomes. After 2005, a reduction in major complications was seen in both groups, attributed to programmatic changes in surgical education. Recognition of intraoperative floppy iris syndrome did not impart a significant additional protective effect in preventing major complications.

Risk Factors for Intraoperative Complications in Resident-Performed Phacoemulsification Surgery

To determine the risk factors for intraoperative complications in resident-performed phacoemulsification surgery and the effect of complications on postoperative visual acuity. Retrospective case series. A total of 320 consecutive eyes of predominantly male (96.6%) and elderly patients (mean age +/-1 standard deviation = 73.1+/-10.0 years) undergoing phacoemulsification surgery by ophthalmology residents at a Veterans Administration Hospital between January 2006 and 2007. There were no exclusion criteria for type of cataract undergoing phacoemulsification surgery. Data were collected by review of patients' electronic medical records. Collected data included the patient demographics, ocular comorbidities, cataract features, resident, resident experience, attending, right or left eye, anesthesia type, wound type, phacoemulsification technique, preoperative and postoperative visual acuities, and presence of any intraoperative complication. Multivariate models were constructed to determine potential risk factors for intraoperative complications. Major intraoperative complication rate, risk factors for major intraoperative complications, and best-corrected postoperative visual acuity. The major intraoperative complication rate was 4.7%, which included 3.1% of cases with vitreous loss. The strongest association with a major complication was the presence of a case identified as challenging preoperatively, which had an odds ratio of 6.0 (95% confidence interval [CI], 1.5-24.1, P=0.01). The challenging features most strongly associated with major complications were mature 4+ nuclear sclerotic cataracts and zonular pathology (antecedent trauma and pseudoexfoliation), which had odds ratios of 18.9 (95% CI, 3.1-117, P=0.002) and 26.2 (95% CI, 4.3-159, P=0.003), respectively. A major complication decreased the likelihood of achieving 20/40 or better visual acuity within 90 days of surgery (95% of uncomplicated eyes vs. 71% of complicated eyes; P=0.009). Residents performing phacoemulsification surgery achieved a low overall rate of major complications. However, specific features of cataracts, such as mature nuclei and zonular pathology, carried increased intraoperative risk. Anticipating risk may help to decrease surgical complications further and to counsel patients appropriately.

The Resident Surgeon Phacoemulsification Learning Curve

To analyze outcomes of resident-performed phacoemulsifications and to assess the resident phacoemulsification learning curve. Retrospective chart review of resident-performed phacoemulsification cases at the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, from July 1, 1999, through June 30, 2002. Outcomes measured included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraoperative complications, and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). We analyzed 680 cases. Postoperative mean UCVA was 20/39, and mean BSCVA was 20/25 (> or = 20/20 in 44.0% of cases and > or = 20/40 in 97.8%). There were no differences in visual acuity outcomes over the course of residency training. Intraoperative complications occurred in 34 cases (5.0%), with a significant reduction in vitreous loss rates after the first 80 resident cases (5.1% vs 1.9%; P = .03). Mean adjusted phacoemulsification time was 0.68 minutes, with a significant reduction in adjusted phacoemulsification time after the first 80 cases (0.87 vs 0.52 minutes; P < .001). Quality visual outcomes after phacoemulsification can be attained throughout residency training; however, surgical competency, when measured by complication rates and phacoemulsification efficiency, continues to improve significantly with increasing surgical experience well beyond the first 80 resident phacoemulsification cases.

Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School

Aim:To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior...