Complication Rates of Complex Cataract Surgeries for Third-Year Residents Over Time

2018

Author: Xinyi Chen,

Contributors: Divya Srikumaran, Shameema Sikder, Tahreem Mir, Michael Boland, Fasika Woreta

Purpose:

Resident cataract surgeries can be associated with higher complication rates given the steep learning curve. Risks factors for complications should be studied to understand how to reduce complications. We examined associations between case complexity and intraoperative complications of PGY4-performed cataract surgeries over the course of one year.

Methods:

A retrospective study was conducted on cataract surgeries (n = 500) performed by residents at Johns Hopkins Wilmer Eye Institute over the course of their third-year residency from 2016-17. Complex cases were identified as those with a small pupil, 4+ on the four-point scale for dense/white/brunescent cataract, history of trauma, pseudoexfoliation, posterior polar cataract, post-vitrectomy, pre-existing zonular weakness, or high myopia. Intraoperative complications were defined as anterior capsular tear with sulcus or sutured IOL implant, posterior capsular tear with or without vitreous loss, posterior capsular tear with dropped lens fragment, and zonular dehiscence.

Results:

Overall complication rate decreased from 13.9% in the first quarter of the year to 5.9% in the second quarter (p=0.049) and to 2.2% in the last quarter (p=0.005). 40% of the cases were complex cases. There was no statistically significant difference between percentage of complex cases over the year. However, complex cases in the first quarter had a higher complication rate (25.0%) than in the last quarter (6.5%) (p=0.032). In particular, dense cataracts (OR 2.4, 95% CI: 1.1-4.9, p=0.021) and history of trauma (OR 4.2, 95% CI: 1.9-9.3, p<0.001) were="" associated="" with="" higher="" complication="" rates.="" for="" routine="" cases,="" no="" statistical="" difference="" was="" found="" for="" complication="" rates="" over="" the="" year="" (p="0.145)." were="" associated="" with="" higher="" complication="" rates.="" for="" routine="" cases,="" no="" statistical="" difference="" was="" found="" for="" complication="" rates="" over="" the="" year="" (p="">

Conclusions:

Residents are more competent at performing complex cataract surgeries at the end of their third year. Residency programs must pay attention to high-risk cases at the beginning of the year to reduce complications, particularly cases with risk factors of history of trauma or mature cataracts.