Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal

Abstract

Abstract:Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors' intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst postoperative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors' intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer's Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.

Manual Small Incisional Cataract Surgery Learning Curve: Observational Comparison of Three Trainee Training

“…We felt that 50 surgeries was a better quantity for the trainee to be conversant enough. A similar extensive study by Emmanuel et al, demonstrated that after 64 surgeries, the need of strict supervision diminished [7].…”

“…Similar to them, our study also had more females. It might be due to the fact that the surgeries were being offered free and thus issue of costs and money wouldn't arise [7].…”

“…Phacoemulsification is a much costlier surgery. It has a prolonged and sometimes-traumatic learning curve [7]. Phacoemulsification has always found to have higher complication rates as compared to MSICS among trainees [6] and thus is a more practical approach for young surgeon training.…”

“…Being an observational study, several parameters could lead to a bias: The quality and extent of vision depends on the health of macula. Surgical training progress being assessed on Snellen's visual outcome is also known to be fraudulent [7].…”

A journey of postgraduate in acquiring skills of manual SICS

“…The practice that allows for modest mastery of ECCE as currently ensured in our training center have been associated with reduced duration of training, reduced adverse intraoperative complications. [11,12]…”