Surgical outcomes of cataract extractions performed by residents using phacoemulsification

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Abstract
Purpose: To assess whether changes in surgical technique, resident training, and phacoemulsification equipment affected the complication rate for cataract extractions performed by residents. Setting: Combined urban and rural setting at a tertiary care academic center and a general care Veterans Administration Hospital, Salt Lake City, Utah, USA. Methods: This retrospective study analyzed 396 patients who had cataract surgery by phacoemulsification and intraocular lens implantation performed by four residents. The residents’ first 50 cases were compared with the last 50 cases performed at the end of their training. Surgical and 1 day postoperative complications were examined. Results: Twenty of 396 surgical cases (5.1 %) involved complications, and the overall vitreous loss rate for the four residents was 1.8%. A statistically significant difference was observed between the two residents with the highest and lowest number of intraoperative complications (P < .05) and between the two residents with the highest and lowest number of 1 day postoperative complications (P < .05). The rate of posterior capsule rupture with vitreous loss was 2.6% in the residents’ early cases; the decrease to no cases of posterior capsule rupture in the late cases was also statistically significant (P < .02). Conclusion: The results indicate that with proper training and supervision, residents can obtain an acceptably low complication rate using phacoemulsification. As their skill increased, they were able to use phacoemulsification successfully on more complicated cases. Individual skill was also an important factor in the complication rate.