Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

Abstract

PurposeTo determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.Patients and methodsEighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.ResultsOut of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.ConclusionB-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Anterior Capsule of the Lens: Comparison of Morphological Properties and Apoptosis Induction following FLACS and Standard Phacoemulsification Surgery

“…For several years, the phacoemulsification technique has been the standard method for cataract extraction and the continuous technical improvements such as the clear corneal microincisions, the use of foldable intraocular lenses, and the application of lower ultrasound energy for the fragmentation of the lens have made cataract surgery efficient and safe. The bimanual microincision cataract surgery (B-MICS) is a minimally invasive variant of the traditional coaxial phacoemulsification, which, allowing clear corneal microincisions of 1.4 mm, uses a sleeveless phaco tip with a separated irrigating chopper that grants a higher stability of the anterior chamber and the possibility of using both right and left hands during the surgical procedure [ 2 , 3 ].…”

Comparing morphologic features and complications of main clear corneal incision between junior and senior residents observed using anterior segment optical coherence tomography

“…They reported a limited 0.6% general incidence of complications [ 9 ], which differs from our result. Cavallini et al [ 17 ] compared the morphological features of the main incision in bimanual microincision cataract surgery between experienced and training surgeon groups. Both the mean incision length and angle of clear corneal incisions in each eye were significantly lower in the training group than in the experienced group.…”

“…Both the mean incision length and angle of clear corneal incisions in each eye were significantly lower in the training group than in the experienced group. Endothelial wound gaping and posterior wound retraction in clear corneal incisions were observed in 11.6% and 9.8% of eyes operated on by a junior surgeon, and in 10.8% and 7.8% of eyes operated on by a senior surgeon after 18 months, respectively, which were comparable between the two groups [ 17 ]. Similarly, the morphological features of the main incision in eyes that underwent phacoemulsification by junior and senior residents were comparable in the current study.…”

“…The mean (SD) lengths and angles of incision reported by Teixera et al and Schallhorn et al were 1640 (220.0) μm, 1810 (270.0) μm and 38.5° (5.0°), 26.8° (5.5°), respectively [ 18 , 19 ]. The mean (SD) length and inclination of incisions using AS-OCT by Cavallini et al [ 17 ] in training surgeons (1318 [194] µm and 141.8° [6.4°]) were significantly lower than those of experienced surgeons (1427 [244] µm and 148.4° [5.4°]) [ 17 ]. We found no significant difference in the length or angle of the main phacoemulsification incision between eyes operated on by senior or junior residents.…”

Bimanual Microincision Cataract Surgery versus Coaxial Microincision Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials and Cohort Studies

“…Some related studies have been conducted. In one long-term follow-up study comparing the clinical results, such as PCO incidence and clear corneal incision (CCI) architecture of B-MICS, between surgeons in training and experienced surgeons [ 32 ], the PCO incidence was higher and corneal incisions were shorter and less angled for less experienced surgeons. The higher PCO incidence may be due to insufficient cleaning of the posterior capsule; the different CCI architectures may be induced by the difficulty in using the nondominant hand.…”