The impact of case complexity in resident-performed cataract surgery.
Cataract
Intraoperative complications
Phacoemulsification
Resident
Journal
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
ISSN: 1435-702X
Titre abrégé: Graefes Arch Clin Exp Ophthalmol
Pays: Germany
ID NLM: 8205248
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
13
05
2022
accepted:
25
02
2023
revised:
16
02
2023
medline:
26
7
2023
pubmed:
18
3
2023
entrez:
17
3
2023
Statut:
ppublish
Résumé
To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. Of the 1,348 cases, 371 (27.5%) documented capsular staining ("Dye-only"), 91 (6.8%) required pupil expansion ("PED-only"), and 100 (7.4%) used both capsular stain and a PED ("Both"). The remainder of cases (n=786, 58.3%) were classified as "Routine." Compared to the "Routine" group, "PED-only" and "Both" had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27-6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07-5.12, P=0.04). Among the PPVx cases, the "PED-only" group has significantly higher odds than "Routine" and "Dye-only" (OR=4.64, 95% CI 1.68-12.79, P=0.01; and OR=6.48, 95% CI 1.7-25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46-42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1-8.43, P=0.032) had increased odds of complication. Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.
Identifiants
pubmed: 36929055
doi: 10.1007/s00417-023-06027-y
pii: 10.1007/s00417-023-06027-y
pmc: PMC10018582
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2307-2314Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Tzamalis A, Lamprogiannis L, Chalvatzis N, Symeonidis C, Dimitrakos S, Tsinopoulos I (2015) Training of resident ophthalmologists in cataract surgery: a comparative study of two approaches. J Ophthalmol 2015:932043. https://doi.org/10.1155/2015/932043
doi: 10.1155/2015/932043
pubmed: 26075088
pmcid: 4446480
Han JV, Patel DV, Wallace HB, Kim BZ, Sherwin T, McGhee CNJ (2019) Auckland Cataract Study III: refining preoperative assessment with cataract risk stratification to reduce intraoperative complications. Am J Ophthalmol 197:114–120. https://doi.org/10.1016/j.ajo.2018.09.026
doi: 10.1016/j.ajo.2018.09.026
pubmed: 30278159
Nderitu P, Ursell P (2018) Updated cataract surgery complexity stratification score for trainee ophthalmic surgeons. J Cataract Refract Surg 44:709–717. https://doi.org/10.1016/j.jcrs.2018.04.036
doi: 10.1016/j.jcrs.2018.04.036
pubmed: 30041740
Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Asaria RH, Galloway P, Sparrow JM (2009) The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye (Lond) 23:31–37. https://doi.org/10.1038/sj.eye.6703049
doi: 10.1038/sj.eye.6703049
pubmed: 18327164
Dada VK, Sharma N, Sudan R, Sethi H, Dada T, Pangtey MS (2004) Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study. J Cataract Refract Surg 30:326–333. https://doi.org/10.1016/S0886-3350(03)00573-X
doi: 10.1016/S0886-3350(03)00573-X
pubmed: 15030820
Goldman JM, Karp CL (2007) Adjunct devices for managing challenging cases in cataract surgery: capsular staining and ophthalmic viscosurgical devices. Curr Opin Ophthalmol 18:52–57. https://doi.org/10.1097/ICU.0b013e3280121b24
doi: 10.1097/ICU.0b013e3280121b24
pubmed: 17159448
Fong CS, Mitchell P, de Loryn T, Rochtchina E, Hong T, Cugati S, Wang JJ (2012) Long-term outcomes of phacoemulsification cataract surgery performed by trainees and consultants in an Australian cohort. Clin Exp Ophthalmol 40:597–603. https://doi.org/10.1111/j.1442-9071.2012.02759.x
doi: 10.1111/j.1442-9071.2012.02759.x
pubmed: 22300362
Woodfield AS, Gower EW, Cassard SD, Ramanthan S (2011) Intraoperative phacoemulsification complication rates of second- and third-year ophthalmology residents a 5-year comparison. Ophthalmology 118:954–958. https://doi.org/10.1016/j.ophtha.2010.08.047
doi: 10.1016/j.ophtha.2010.08.047
pubmed: 21539981
Rutar T, Porco TC, Naseri A (2009) Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology 116:431–436. https://doi.org/10.1016/j.ophtha.2008.10.028
doi: 10.1016/j.ophtha.2008.10.028
pubmed: 19167084
Aaronson A, Viljanen A, Kanclerz P, Grzybowski A, Tuuminen R (2020) Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience. Ann Transl Med 8:1541. https://doi.org/10.21037/atm-20-845
doi: 10.21037/atm-20-845
pubmed: 33313286
pmcid: 7729371
Ellis EM, Lee JE, Saunders L, Haw WW, Granet DB, Heichel CW (2018) Complication rates of resident-performed cataract surgery: impact of early introduction of cataract surgery training. J Cataract Refract Surg 44:1109–1115. https://doi.org/10.1016/j.jcrs.2018.06.022
doi: 10.1016/j.jcrs.2018.06.022
pubmed: 30078539
pmcid: 6157597
Kaplowitz K, Yazdanie M, Abazari A (2018) A review of teaching methods and outcomes of resident phacoemulsification. Surv Ophthalmol 63:257–267. https://doi.org/10.1016/j.survophthal.2017.09.006
doi: 10.1016/j.survophthal.2017.09.006
pubmed: 28941765
Bai H, Yao L, Wang H (2020) Clinical investigation into posterior capsule rupture in phacoemulsification operations performed by surgery trainees. J Ophthalmol 2020:1317249. https://doi.org/10.1155/2020/1317249
doi: 10.1155/2020/1317249
pubmed: 32104591
pmcid: 7037484
Melega MV, Pessoa Cavalcanti Lira R, da Silva IC, Ferreira BG, Assis Filho HLG, Martini AAF, Dos Reis R, Arieta CEL, Alves M (2020) Comparing resident outcomes in cataract surgery at different levels of experience. Clin Ophthalmol 14:4523–4531. https://doi.org/10.2147/OPTH.S285967
doi: 10.2147/OPTH.S285967
pubmed: 33402815
pmcid: 7778434
Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK (2007) The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 125:1215–1219. https://doi.org/10.1001/archopht.125.9.1215
doi: 10.1001/archopht.125.9.1215
pubmed: 17846361
Oliveira-Ferreira C, Leuzinger-Dias M, Tavares Ferreira J, Macedo JP, Falcao-Reis F (2020) Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation. J Cataract Refract Surg 46:555–561. https://doi.org/10.1097/j.jcrs.0000000000000105
doi: 10.1097/j.jcrs.0000000000000105
pubmed: 32271522
Saifee M, Zhu I, Lin Y, Oldenburg CE, Ramanathan S (2020) Effect of full-time vs volunteer faculty supervision on resident cataract surgery complications. J Cataract Refract Surg 46:700–704. https://doi.org/10.1097/j.jcrs.0000000000000145
doi: 10.1097/j.jcrs.0000000000000145
pubmed: 32358263
pmcid: 9982644
Blomquist PH, Morales ME, Tong L, Ahn C (2012) Risk factors for vitreous complications in resident-performed phacoemulsification surgery. J Cataract Refract Surg 38:208–214. https://doi.org/10.1016/j.jcrs.2011.10.001
doi: 10.1016/j.jcrs.2011.10.001
pubmed: 22104643
Kim JY, Ali R, Cremers SL, Yun SC, Henderson BA (2009) Incidence of intraoperative complications in cataract surgery performed by left-handed residents. J Cataract Refract Surg 35:1019–1025. https://doi.org/10.1016/j.jcrs.2009.01.025
doi: 10.1016/j.jcrs.2009.01.025
pubmed: 19465287
Nderitu P, Ursell P (2019) Iris hooks versus a pupil expansion ring: operating times, complications, and visual acuity outcomes in small pupil cases. J Cataract Refract Surg 45:167–173. https://doi.org/10.1016/j.jcrs.2018.08.038
doi: 10.1016/j.jcrs.2018.08.038
pubmed: 30527439
Shingleton BJ, Crandall AS, Ahmed II (2009) Pseudoexfoliation and the cataract surgeon: preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg 35:1101–1120. https://doi.org/10.1016/j.jcrs.2009.03.011
doi: 10.1016/j.jcrs.2009.03.011
pubmed: 19465298
Ariga M, Nivean M, Utkarsha P (2013) Pseudoexfoliation syndrome. J Curr Glaucoma Pract 7:118–120. https://doi.org/10.5005/jp-journals-10008-1148
doi: 10.5005/jp-journals-10008-1148
pubmed: 26997794
Nagashima RJ (2004) Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 30:127–131. https://doi.org/10.1016/S0886-3350(03)00465-6
doi: 10.1016/S0886-3350(03)00465-6
pubmed: 14967279
Hyams M, Mathalone N, Herskovitz M, Hod Y, Israeli D, Geyer O (2005) Intraoperative complications of phacoemulsification in eyes with and without pseudoexfoliation. J Cataract Refract Surg 31:1002–1005. https://doi.org/10.1016/j.jcrs.2004.09.051
doi: 10.1016/j.jcrs.2004.09.051
pubmed: 15975469
Nath M, Odayappan A, Tripathy K, Krishnamurthy P, Nachiappan S (2021) Predicting zonular strength based on maximum pupillary mydriasis in patients with pseudoexfoliation syndrome. Med Hypotheses 146:110402. https://doi.org/10.1016/j.mehy.2020.110402
doi: 10.1016/j.mehy.2020.110402
pubmed: 33279326
Williams ER, Patnaik JL, Miller DC, Lynch AM, Davidson RS, Kahook MY, Seibold LK (2021) Iris manipulation during phacoemulsification: intraoperative and postoperative complications. Int J Ophthalmol 14:676–683. https://doi.org/10.18240/ijo.2021.05.06
doi: 10.18240/ijo.2021.05.06
pubmed: 34012881
pmcid: 8077016