Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center

Low, Stephanie A.W.; Braga-Mele, Rosa; Yan, David; El‐Defrawy, Sherif

doi:10.1016/j.jcrs.2018.07.028

Cited by 36 publications

(38 citation statements)

References 21 publications

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“…Previous retrospective reviews comparing residents versus attending's cataract extractions have shown similar outcomes and complication rates overall. 18,25 Similar outcomes were also found when comparing attending and resident-performed tube shunt procedures. 19 Interestingly, Low et al 18 comment that residents who are in their initial 5-to 8-week training period in cataract surgery had higher rates of complications when compared with their supervising attending.…”

Section: Discussionsupporting

confidence: 54%

“…As shown in previous studies, having experienced surgeons to train residents in a new surgical technique has been beneficial in reducing complications in the operative setting. 14,18 Additionally, residency wet-laboratory workshops, review of surgical videos prior to cases, and close supervision from attending surgeons may also lead to more efficient surgical time management while maintaining low complication rates. 19 Microhyphema, or suspended red blood cells in the anterior chamber, is an expected observation in the first 2 weeks following phaco-KDB due to blood reflux from Schlemm's canal, 10 and often does not affect the final IOP or best corrected vision.…”

Section: Discussionmentioning

confidence: 99%

“…17 Data from research studies suggest that resident-performed procedures are generally safe and effective, but there is a lack of published literature on outcomes of MIGS procedures performed by residents. 18,19 The aim of this study was to compare outcomes of phaco-KDB performed by an ophthalmology attending and residents as the primary surgeon up to 12 months postoperatively.…”

mentioning

confidence: 99%

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Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Pratte

Landreneau

Hirabayashi

et al. 2020

Journal of Academic Ophthalmology

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Objective Kahook Dual Blade goniotomy (KDB) has proven effective in lowering intraocular pressure (IOP) and reducing the medication burden in patients with glaucoma. This study compares outcomes up to 12 months postoperatively after KDB combined with phacoemulsification (phaco-KDB) between an ophthalmology attending and residents. Methods A retrospective analysis was performed on 160 eyes of 113 patients who received a phaco-KDB performed by either an ophthalmology attending or a resident under direct guidance of the attending. Data for each patient was collected preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The primary outcome measure was surgical success, defined as 20% IOP reduction or at least 1 medication reduction at 12 months. The secondary outcome measures included mean IOP and medication reduction at each postoperative time point, adverse events, operating time, and survival time, defined as time to failure to meet the criteria for surgical success or requiring a secondary IOP-lowering procedure. Results Preoperative mean IOP was comparable between the two groups (p = 0.585), while baseline medications were higher in the attending group (p = 0.040). Rate of successful outcomes was similar in both groups at 12 months (73.3% attending vs. 87.5% residents, p = 0.708). Mean IOP reduction (1.7 vs. 4.3%, p = 0.278) and medication reduction (0.7 vs. 0.6, p = 0.537) also did not differ at 12 months. Presence of adverse events was similar between the groups (21.6 vs. 27.3%, p = 0.938). The survival time was significantly longer in the attending group (356.3 ± 20.2 days vs. 247.1 ± 26.8 days, p = 0.003). Resident cases took ∼10 minutes longer compared with attending cases (p < 0.001). Conclusion IOP lowering outcomes and rate of adverse events of KDB were similar whether the primary surgeon was an attending or a resident surgeon. The survival time was significantly longer in the attending group, but overall success rate was 77.5% for both groups. This suggests phaco-KDB is an effective procedure that can be safely performed by a trainee under direct supervision of an experienced surgeon.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Pratte

Landreneau

Hirabayashi

et al. 2020

Journal of Academic Ophthalmology

View full text Add to dashboard Cite

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“…However, the CCC phase and nuclear extraction phase are both important surgical phases that cannot be regarded as identical to incision creation, cortical aspiration, or lens insertion. For example, from a surgical skills training perspective, the rate of surgical complications that developed in these two phases is clearly higher than in other phases 19 . The rate that the model confused the CCC phase with the nuclear extraction phase was almost zero, indicating a strong capability to distinguish phases.…”

Section: Discussionmentioning

confidence: 93%

Real-Time Extraction of Important Surgical Phases in Cataract Surgery Videos

Morita

Tabuchi²,

Masumoto³

et al. 2019

Sci Rep

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The present study aimed to conduct a real-time automatic analysis of two important surgical phases, which are continuous curvilinear capsulorrhexis (CCC), nuclear extraction, and three other surgical phases of cataract surgery using artificial intelligence technology. A total of 303 cases of cataract surgery registered in the clinical database of the Ophthalmology Department of Tsukazaki Hospital were used as a dataset. Surgical videos were downsampled to a resolution of 299 × 168 at 1 FPS to image each frame. Next, based on the start and end times of each surgical phase recorded by an ophthalmologist, the obtained images were labeled correctly. Using the data, a neural network model, known as InceptionV3, was developed to identify the given surgical phase for each image. Then, the obtained images were processed in chronological order using the neural network model, where the moving average of the output result of five consecutive images was derived. The class with the maximum output value was defined as the surgical phase. For each surgical phase, the time at which a phase was first identified was defined as the start time, and the time at which a phase was last identified was defined as the end time. The performance was evaluated by finding the mean absolute error between the start and end times of each important phase recorded by the ophthalmologist as well as the start and end times determined by the model. The correct response rate of the cataract surgical phase classification was 90.7% for CCC, 94.5% for nuclear extraction, and 97.9% for other phases, with a mean correct response rate of 96.5%. The errors between each phase’s start and end times recorded by the ophthalmologist and those determined by the neural network model were as follows: CCC’s start and end times, 3.34 seconds and 4.43 seconds, respectively and nuclear extraction’s start and end times, 7.21 seconds and 6.04 seconds, respectively, with a mean of 5.25 seconds. The neural network model used in this study was able to perform the classification of the surgical phase by only referring to the last 5 seconds of video images. Therefore, our method has performed like a real-time classification.

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“…8,10,21 This is consistent with several recent studies which have demonstrated similar complication rates and outcomes, when comparing trainees and attendings at academic centers. 24,25 However, the recovery period was prolonged, with the majority reaching significant VA improvement only after post-operative month three. While some did experience post-operative complications, most of these resolved within the first month after PPV, and the majority had no significant impact on final visual acuity.…”

Section: Discussionmentioning

confidence: 99%

<p>Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy</p>

Lin

Scott

Tendhar

et al. 2020

OPTH

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To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees. Methods: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20). Main Outcomes/Measures: Visual acuity was recorded pre-and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression. Results: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p<0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3). Conclusions/Relevance: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.

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Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center

Abstract: There were no differences in complication rates between the two groups.

Cited by 36 publications

References 21 publications

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Real-Time Extraction of Important Surgical Phases in Cataract Surgery Videos

<p>Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy</p>

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