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Outcomes and complications of cataract surgery performed by residents: how steep is the learning curve?

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First Author: M.Portela PORTUGAL

Co Author(s):    C. Fernandes   P. Arede   M. Baptista   J. Portelinha           

Abstract Details

Purpose:

To analyse the outcomes in resident-performed cataract surgery and to study the complication rate at the beginning of their training in a tertiary-care hospital.

Setting:

Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

Methods:

Retrospective review of the first 50 consecutive phacoemulsifications performed by 7 residents. Data such as sex, age at the time of surgery, ocular comorbidities, intraoperative and postoperative complications and the need for a second procedure was collected. The main outcome measures were preoperative and postoperative corrected distance visual acuity (CDVA; decimal scale). Level of training was acessed by comparing the first and second halves of each residents’ surgeries and it was correlated with intraoperative and postoperative complications and with postoperative CDVA. Statistical analyses were performed using Numbers Data Analysis and SPSS Statistics. P ≤ 0.05 was considered statistically significant.

Results:

350 eyes were included. Mean age was 76,6±7,29 years and 62,6% were women. There were intraoperative complications in 18,8% of surgeries: posterior capsule tear (14,2%) and vitreous loss (9%) which rate declined as residents progressed in training (P<0.004 and P<0.02). Mean CDVA improved significantly after surgery (P<0.001) (from 0,34±0,14 to 0,82±0,23) and did not vary with resident experience (P=0.57). Intraoperative complication rate influenced postoperative CDVA (average 0,72) (P<0.001). There were postoperative complications in 27,5% of surgeries. Need for a second procedure (15,6% of eyes) did not vary with resident experience (P=0.2).

Conclusions:

This study provides an insight into what are the main difficulties at the very beginning of cataract surgery training. In our study, despite a high rate of intraoperative complications, there is an early decrease in posterior capsule tear and vitreous loss rates. Primary resident-performed cataract surgery in our tertiary-care hospital achieved visual outcomes and complication rates similar to those found in other training hospitals.

Financial Disclosure:

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