Evaluation of cataract operation complications and recommendations to maximise safety and efficiency among trainees

Session Details

Session Title: Moderated Poster Session: New and Interesting

Venue: Poster Village: Pod 1

First Author: : Y.Hah SINGAPORE

Co Author(s): :    Z. Thng   L. Lee                    

Abstract Details

Purpose:

The rate of cataract surgery complications is directly related to the skill and expertise of the surgeon, with a higher incidence of complications among junior ophthalmology trainees. Part of cataract training involves mentorship from senior surgeons to identify the surgical weaknesses and errors that lead to complications and suggestions on how to overcome them. As a tertiary training hospital, all videos for cataract complications among the trainees at our centre are presented at a monthly department surgical video round. For this paper, we aim to identify the common mistakes made by trainees, stages at which complications occur and recommendations discussed.

Setting:

This was a descriptive retrospective analysis of complications for cataract extraction with intraocular lens implant performed by ophthalmology residents at Tan Tock Seng Hospital, Singapore.

Methods:

The meeting minutes and presenter reports for the monthly-held surgical video rounds from June 2016 to June 2017 were analysed and recommendations for each stage compiled.

Results:

The most common complication for phacoemulsification among trainees was posterior capsular rupture and it frequently occurred during last fragment removal. Risk factors included poor visualisation as microscope was not in focus, poor handling of the phaco probe or second instrument as well as poor understanding of the phaco machine settings. Small pupils, small capsulotomy, insufficient hydrodissection and incomplete cracking of nucleus seemed to be fairly common in all the videos discussed. For extracapsular cataract extraction, the most common stage of complication occurred during irrigation and aspiration at which trainees inadvertently aspirated the posterior capsule, followed by zonulysis during tin-can capsulotomy.

Conclusions:

Cataract complications are usually preventable. It is crucial to have a platform like a surgical video round which allow trainees to discuss and receive guidance from senior surgeons on how to improve on their surgical skills. Recommendations provided can help a trainee master the surgical steps while keeping the complications at acceptably low levels.

Financial Disclosure:

None