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Surgeons-in-Training Rate Difficult Steps of Cataract Surgery

Ophthalmic surgeons- in-training said phacoemulsification and capsulorrhexis are the most difficult stages of cataract surgery to learn, according to a survey presented at the 23rd Congress European Society of Cataract and Refractive Surgeons in Lisbon, Portugal. The survey authors suggest that more time should be spent on these aspects of cataract surgery in a wet lab.

When the study began, the trainees had a mean 9.4 months of training. The patients' mean BCVA was 20/70 before cataract surgery.

On a scale of increasing difficulty from 1 to 5, the trainee surgeons gave phaco a mean score of 3.32 and capsulorrhexis a mean score of 3.3. These two steps also had the lowest completion rates, with phaco at a 66.7% completion rate and capsulorrhexis a 74.4% completion rate.

Peribulbar blockade, draping the surgical field and corneal incision were all scored less than 2, and all had an almost 100% completion rate, the survey found. Hydrodissection was given a mean difficulty score of 2.42 with a 92.3% completion rate; I&A received a mean difficulty score of 2.8 with a 78.4% completion rate and IOL insertion received a mean difficulty score of 2.58 with a completion rate of 83.1%.

In the 100 eyes, posterior capsular tear occurred in 9%, including 4% with vitreous loss. There was one case of zonular dehiscence.

The study authors noted that one explanation for the low completion rates by the trainees may be that senior surgeons prefer to perform most of the surgery. In addition, "first-year trainees found the capsulorrhexis more difficult than phacoemulsification, whereas the opposite was true for the second-year trainees," the study authors said.

About this data: The complete study is published in the Journal of Cataract and Refractive Surgery. Dooley IJ, O'Brien PD. Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees. J Cataract Refract Surg. 2006; 32:604-608.