SUMMARYTo assess prospectively the complications and outcomes in a single-surgeon series during the phacoemulsification learning curve a prospective analysis of 400 phacoemulsi fication procedures in 358 patients was carried out. The main outcome measures were capsular tear, vitreous and nuclear loss, best corrected post-operative visual acuity and refractive cylinder. Capsular tears occurred in 6.3%of phacoemulsification procedures, with vitreous loss in 1.5%. One nucleus was lost into the vitreous. Best cor rected visual acuity, including pre-existing pathology, was 6/9 or better in 83.6% of eyes. There was 1 dioptre or less change of astigmatism from pre-operative to 6 weeks in 91 % of eyes. It is concluded that phacoemulsification with careful patient selection can be a safe procedure even during the learning curve.

Cataract surgery data collected from 31 units in 13 European countries allowed participants to compare their performance with that of their colleagues in an anonymous manner. Significant variation was found in the outcomes among the units, with many units reporting results above and below the averages.

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With the increasing trend towards phacoemulsification a perceived increased complication rate during the learning curve gives rise to a dilemma as to the best stage at which a surgeon-in-training can safely learn the technique. We prospectively analysed the complications and visual outcome of the first 160 phacoemulsification procedures performed by three surgeons-in-training. The main outcome measures included posterior capsule tear, vitreous and nuclear loss, surgical re-intervention rate and visual outcome. Posterior capsule tear occurred in 7 eyes (4.4%) and vitreous loss in 6 (3.8%). No nucleus was lost in the vitreous. Surgical re-intervention was required in 1 eye. Best corrected visual acuity was 6/12 or better in 88% of eyes. These results compare favourably with reports of surgeons-in-training learning extracapsular surgery and also with recently reported phacoemulsification series. This study indicates that with careful case selection and supervision phacoemulsification can be a safe procedure.

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