Posters

To study the difficulty level of various steps in manual small incision cataract surgery (MSICS) among ophthalmology trainees and measures that can be taken to reduce the learning curve

Poster Details

First Author: P. Pantola INDIA

Co Author(s):    M. Khan   P. Muollick                 

Abstract Details

Purpose:

1. To identify the various steps in MSICS which are considered difficult by trainees 2. To suggest remedial measures to reduce the learning curve With the anticipated demographic change of double the cataract subject pool in 20-year time will SICS be the saviour ? It has advantage over ECCE of a self sealing sutureless wound and over Phacoemulsification of less need for technology & lower cost MSICS helps in increasing the surgical coverage without compromising the surgical outcome

Setting:

Cross – sectional study conducted in tertiary care postgraduate teaching hospitals A total of 50 resident trainees (MS/DNB) pursuing Postgraduate program were given a questionnaire. Demographic characteristics like age, gender, number of SICS done, whether initiated into phacoemulsification were asked.

Methods:

Participants were required to mark the perceived difficulty levels of 10 steps in MSICS in a 5 - point scale ranging from very easy (1) to very difficult (5)The trainees were asked open ended questions regarding measures that can be taken to help them master the surgical steps. For each step of surgery, the frequency and percentage of participants grading the step from very easy to very difficult was calculated The probability value was derived using the Mann-Whitney U test to find the correlation between the perceived difficulty of steps with number of MSICS done,age ,gender,graduated to phacoemulsification or not

Results:

Median age was 27 years with 38 % males and 62 % females. 76 % - less than 10 SICS. 44% - graduated to phacoemulsification. The steps considered very difficult by included Sup rectus bridle suture, CCC(Continuous curvilinear capsulorrhexis), Wound construction, Rotation & delivery of nucleus, Irrigation & Aspiration (I&A). By applying the Mann - Whitney U test, age (< 27 or > 27 years) and gender (M or F) was not found to be correlated with the perceived difficulty of the steps Performing more than 10 surgeries reduced the perceived difficulty level of I & A and IOL implantation. For trainees who were already initiated into phaco, trend towards decreased difficulty level for cortical aspiration.

Conclusions:

CCC, Wound construction and I & A are the steps which need to be given adequate emphasis in any SICS training schedule. However lack of standardization of ophthalmic surgical training is a major hurdle. Learning MSICS requires training and guidance with greater emphasis on surgical steps perceived as difficult by trainees. Effective and validated surgical training programs are required to ensure that residents in training achieve greater levels of competence in cataract surgery.

Financial Disclosure:

NONE