Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School

Abstract

C ataract extraction is one of the most common intraocular procedures ophthalmology residents perform in the course of their training. Assessing and analysing the complications related to cataract surgery can be a valuable tool to benchmark performance and to help a residency programme improve resident surgical training.Phacoemulsification has become the preferred technique for cataract surgery, although reports suggest a higher rate of complications than with extracapsular cataract extraction (ECCE) or intracapsular cataract extraction (ICCE) techniques.

Determinants of cataract surgical opportunities and complication rates in UK higher specialist training

“…[5][6][7][8][9] Similar reports also exist for experienced surgeons and for overall surgical programmes, including surgeons of varied levels of experience. [10][11][12] There has, however, been no report of the complication rates of more experienced trainees and as such no suitable benchmark exists for cataract surgical audit by individual trainee surgeons themselves, or by those charged with their ongoing training.…”

“…However, our result of 2.3% compares extremely favourably with these, as one US reviewer in 2003 estimated an overall rate of 7% vitreous loss from the combined published studies of residents' cataract surgery, 5 although all these reports included far fewer cases and fewer surgeons than our study. 5,6,8,[14][15][16] Comparison of higher specialist training programmes in the UK with US residency programmes is not particularly valid due to the higher level of experience of UK SpRs compared to the US residents. The minimum average number of cataract operations that a residency programme must provide to gain accreditation is 45 (defined by the Residency Review Committee responsible for accrediting residency programmes), even if the actual average cataract numbers of surgeries performed in US residency programmes is more than double this figure.…”

Cirurgia de catarata realizada por residentes: avaliação dos riscos

“…Com a disseminação do uso da facoemulsificação, o ensino desta técni-ca vem sendo inserida no programa de todos os principais centros oftalmológicos do mundo (3)(4) . As taxas de complicações durante a facoemulsificação realizadas por residentes variam na literatura de 2,0 a 14,7% (4)(5) . A perda vítrea continua sendo a mais indesejada destas complicações, e estudos mostram que, olhos com perda vítrea não atingem acuidade visual esperada em muitos casos (6)(7) .…”

Cataract surgery: benchmarks for established and trainee surgeons

“…It is accepted that posterior capsule rupture (PCR) rates for learners are higher than those for experienced phacoemulsification surgeonsFan unsurprising finding. 5,6 With this number of procedures being undertaken in the NHS by trainees, it is a matter of public health relevance to know what complication rates should be expected for this group of training surgeons.A recent electronic audit of 55 567 cataract operations identified an overall PCR rate of 1.92% for 406 surgeons of all grades working in the English NHS.4 Analysis of risk factors for PCR revealed surgeon's grade to be an important determinant of complication risk. …”

“…It is accepted that posterior capsule rupture (PCR) rates for learners are higher than those for experienced phacoemulsification surgeonsFan unsurprising finding. 5,6 With this number of procedures being undertaken in the NHS by trainees, it is a matter of public health relevance to know what complication rates should be expected for this group of training surgeons.…”