Comparison of the posterior capsule rupture rates associated with conventional (start to finish) versus reverse methods of teaching phacoemulsification

PURPOSE: To evaluate the learning curve of continuous curvilinear capsulorhexis (CCC) and to assess the number of surgeries required to master it among residents in a postgraduate teaching institute. METHODS: The present prospective observational study was based on the completion time and complication rates related to CCC performed using various techniques by 10 students in the 2 nd (JR2) and 3 rd -year (JR3) of residency. CCC was performed either by a cystotome or capsulorhexis forceps or by a combined method in 253 eyes, of which 160 eyes (63.2%) were operated by JR3 and 93 (36.8%) by JR2. The complication rates were studied with respect to the number of capsular extensions, posterior capsular rent (PCR), zonular dehiscence, need for senior surgical assistance, and nucleus drop. RESULTS: The average time required for the completion of CCC was 412 ± 90.5 s. The average number of times residents required to fill the anterior chamber with viscoelastic was 6.9 ± 1.4. The average size of CCC was 7 ± 0.66 mm. Extended CCC was the most common complication. JR2 required assistance from a senior surgeon in 47 eyes (50.5%), whereas JR3 required assistance in 39 eyes (24.4%) ( P = 0.0001). The rate of PCR was not significantly different in JR2 (7.5%) and JR3 (8.8%). CONCLUSION: CCC is a difficult step to master in the trainee. Focusing and practicing on this step will help to reduce the complications and maximize proficiency. Approximately 6–eight surgeries are required to master CCC.

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“…demonstrated that the conventional way of teaching cataract surgery is equally safe and effective. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

“…The PCR rate in trainees performing cataract surgery is variable and ranges from 4.9% to 10%. [ 2 9 16 21 23 27 29 ] The variability in the occurrence of PCR in various studies is probably due to the differing trainee experience, methods followed to assess the teaching method and stage of intervention by the supervisor.…”

Section: Discussionmentioning

confidence: 99%

To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

et al. 2023

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“…These studies only emphasize that various modalities have been tried to improve the resident surgical outcomes. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Effect of wet-laboratory training on resident performed manual small-incision cataract surgery

Ramani

Pradeep

Sundaresh

2018

Indian J Ophthalmol

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Purpose:The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS).Methods:We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups.Results:The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) (P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% (P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A.Conclusion:The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome.

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“…Because capsulorrhexis and lens nucleus cracking and chopping are among the initial steps of phacoemulsification cataract extraction surgery which have a steep learning curve, some attending physicians would prefer to teach phacoemulsification starting from reverse order: the trainee surgeon performs I/A and IOL insertion after the supervisor completes capsulorrhexis and phacoemulsification of the lens. 28 , 32 , 33 This reverse teaching approach could deprive the chances of novice surgeons to practice performing the tasks that have the steepest learning curves, but this approach is better for patient care and safety.…”

Section: Discussionmentioning

confidence: 99%

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Ng¹,

Sun²,

Young³

et al. 2018

OPTH

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ObjectiveTo identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions.DesignThe ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor’s intervention, and 3) prior simulation training.SettingThe study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong.ResultsOf the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks.ConclusionResidents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification.

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Comparison of the posterior capsule rupture rates associated with conventional (start to finish) versus reverse methods of teaching phacoemulsification

Cited by 5 publications

References 18 publications

To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

Effect of wet-laboratory training on resident performed manual small-incision cataract surgery

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

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