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Training of resident ophthalmologists in cataract surgery: a comparative study of two approaches

Session Details

Session Title: Cataract I

Session Date/Time: Friday 14/02/2014 | 10:30-12:30

Paper Time: 10:36

Venue: Kosovel Hall (Level -2)

First Author: : ArgyriosTzamalis GREECE

Co Author(s): :    Lampros Lamprogiannis   Stavros Dimitrakos   Ioannis Tsinopoulos        

Abstract Details

Purpose:

To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery.

Setting:

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Medical Faculty, “Papageorgiou” General Hospital, Thessaloniki, Greece

Methods:

502 eyes of 467 patients, who underwent resident-performed cataract surgery by means of phacoemulsification at a tertiary care centre during period 2009-2012 were included in a retrospective comparative study by reviewing their medical records. All surgical procedures were performed by 8 consecutive residents who did not have any previous experience as main surgeon on intraocular procedures and completed at least 40 phacoemulsification surgeries. Residents were allocated into two groups according to the method that was applied during their training in cataract surgery; Group 1 including residents that were trained with the "step-by-step" method and Group 2 including residents that were trained with the "one-step" method after assisting in at least 300 phacoemulsification cases performed by experienced instructors. The first 40 cases were additionally studied in a separate analysis. Primary outcomes were the incidence of main complications, defined as posterior capsular ruptures and zonular dehiscence with vitreous loss, and other intraoperative complications rate. All residents received equal traditional didactic and wet-lab training prior operating on real conditions.

Results:

Each resident performed a median of 63 phacoemulsification surgeries (range: 42-105). A statistically significant difference (p=0.0019, Fisher’s exact test) was noted in the main complications rate between the two groups, yielding a mean of 22.5% in Group 1 and 9.48% in Group 2 respectively. Other intraoperative complications, such as anterior capsule tear or extended capsulorrhexis (Group 1 = 3.28 %, Group 2 = 4.17 %) , wound dehiscence (Group 1 = 1.2 %, Group 2 = 0.9 %) and corneal lesions of any kind (Group 1 = 2.5 %, Group 2 = 1.2 %) were not shown to differ statistically significantly between study groups (p>0.05). Among the first 40 surgeries of each resident, capsular tear rates differed also statistically significantly (p=0.014, Fisher’s exact test) between Group1 (22.5%) and Group2 (12.1%), while a better surgical performance -yielding statistical significance in Group1 (p=0.017, chi-square test)- was indicated in both groups in the 3rd decade of operations, where main complications rate was 7.5% in comparison to 1st, 2nd and 4th decade where this was assessed 16.25%, 13.75% and 17.5% respectively.

Conclusions:

Training in cataract surgery with the use of "one-step" method may lead to an improvement in surgical competency, when measured by complication rates and phacoemulsification efficiency, and therefore, to a better quality of training for resident ophthalmologists, probably lowering their learning curve. FINANCIAL INTEREST: NONE