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Laser-assisted cataract surgery in resident in training surgical education

Poster Details

First Author: J.McCulley USA

Co Author(s):                        

Abstract Details

Purpose:

To test the hypothesis that Femtosecond Laser Assisted Cataract Surgery (FLACS) should be incorporated in resident-in-training cataract surgical training at an early stage.

Setting:

Two University-affiliated, large teaching hospitals, University of Texas, Southwestern Medical School, Dallas,Texas.

Methods:

Two femtosecond cataract lasers were installed in the operating rooms of two separate University teaching hospitals. Supervisory faculty were trained and credentialed on the lasers such that they could oversee resident FLACS procedures. Separately, faculty and residents-in-training were queried as to the ease of the procedure compared to their background observations of manual cataract surgery (MCS). Specifically the following were comparatively assessed: creation of corneal incisions, capsulorhexis , hydrodissection, nuclear division, nuclear removal, cortical removal, phaco time and energy.

Results:

Routine water-tight corneal incision were not achieved because of increased wound trauma with an unfamiliar surgical approach for residents-in-training. Well-centered, free-floating capsulorhexis were uniformly obtained, with rare manageable tags. Significant problems with hydrodissection in the face of posterior bubbles, when encountered, resulted in one posterior capsular blow-out. Identifying the fine cuts in the nucleus for nuclear division created a challenge. A different method of cortical removal, i.e., “Hurricane Method” had to be learned rather than radial centripetal stripping. Phaco time and energy were decreased with FLACS compared to historical manual energy and times.

Conclusions:

FLACS has an associated learning curve even for experienced surgeons that is accentuated in the hand of residents-in-training. The hoped for self-sealing water-tight corneal wounds, safety of hydrodissection, efficient nuclear division were not achieved in the hands of residents. Improvement in quality of rehexis was achieved as well as a decrease in phaco time and energy. A “familiarity biases” occurred as these residents previously assisted in MCS resulting in their assessment that MCS was “easier” than FLACS. Based on our experience, we now recommend that residents become proficient with MCS prior to introducing FLACS, e.g., after fifty MCS’s.

Financial Disclosure:

One or more of the authors receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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