TY - JOUR
T1 - The impact of case complexity in resident-performed cataract surgery
AU - Park, Sally Se
AU - Tseng, Michael
AU - Mian, Zara
AU - Moon, Jee Young
AU - Shrivastava, Anurag
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/8
Y1 - 2023/8
N2 - Purpose: To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. Methods: Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. Results: Of the 1,348 cases, 371 (27.5%) documented capsular staining (“Dye-only”), 91 (6.8%) required pupil expansion (“PED-only”), and 100 (7.4%) used both capsular stain and a PED (“Both”). The remainder of cases (n=786, 58.3%) were classified as “Routine.” Compared to the “Routine” group, “PED-only” and “Both” had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27–6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07–5.12, P=0.04). Among the PPVx cases, the “PED-only” group has significantly higher odds than “Routine” and “Dye-only” (OR=4.64, 95% CI 1.68–12.79, P=0.01; and OR=6.48, 95% CI 1.7–25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46–42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1–8.43, P=0.032) had increased odds of complication. Conclusion: Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.[Figure not available: see fulltext.].
AB - Purpose: To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. Methods: Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. Results: Of the 1,348 cases, 371 (27.5%) documented capsular staining (“Dye-only”), 91 (6.8%) required pupil expansion (“PED-only”), and 100 (7.4%) used both capsular stain and a PED (“Both”). The remainder of cases (n=786, 58.3%) were classified as “Routine.” Compared to the “Routine” group, “PED-only” and “Both” had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27–6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07–5.12, P=0.04). Among the PPVx cases, the “PED-only” group has significantly higher odds than “Routine” and “Dye-only” (OR=4.64, 95% CI 1.68–12.79, P=0.01; and OR=6.48, 95% CI 1.7–25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46–42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1–8.43, P=0.032) had increased odds of complication. Conclusion: Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.[Figure not available: see fulltext.].
KW - Cataract
KW - Intraoperative complications
KW - Phacoemulsification
KW - Resident
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U2 - 10.1007/s00417-023-06027-y
DO - 10.1007/s00417-023-06027-y
M3 - Article
C2 - 36929055
AN - SCOPUS:85150043455
SN - 0721-832X
VL - 261
SP - 2307
EP - 2314
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
IS - 8
ER -