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"We carried out a retrospective analysis on a consecutive series of 136 phacoemulsification procedures. We had five different residents involved, each of whom was just commencing phaco surgery for the first time after wet lab training. We used a clear corneal incision with divide-and-conquer phaco technique," said Dr Morris. Low phaco times and powers were recorded for the level of skill of the surgeons in cataract surgery. In the series of 136 patients, Dr Morris said they experienced six cases of posterior capsular rupture (4.4%), three involving the same surgeon who, he noted, "was struggling more with the surgery than the others." In terms of other complications, two cases had retained nuclear fragments and one patient experienced a severe iris phaco burn. In order to get an idea of how this series of complications for new residents practising phacoemulsification compared with the national average, Dr Morris studied the data from the Royal College of Ophthalmologists National Cataract Audit which was carried out between 1997-1998 and published in the British Journal of Ophthalmology in 1999. "We looked at the data for some 18,000 patients who had undergone treatment for cataracts in the UK. At that time about 80% of those patients had phacoemulsification treatment and 20% had extracapsular surgery. Of those 80% who had been treated by phaco, 4.4% experienced posterior capsular rupture, 0.3% had loss of nuclear fragments, 1.1% retained lens material and 0.4% experienced a torn iris," said Dr Morris. Of these 18,000 patients, 1,000 had surgery carried out by junior resident doctors with similar levels of experience as the five residents at the Royal Hampshire County Hospital, Winchester. These figures showed a 1.6% increased risk of complications for cataract surgery with novice surgeons compared to more experienced practitioners. "We set out to try to have a better idea of how effectively we were training residents using the Sovereign machine. We concluded that our complication rate was acceptable and despite six cases of posterior capsular rupture and two of retained nuclear fragments, it was still comparable to that documented by the UK national cataract survey in 1997-1998," said Dr Morris. When asked if the relatively low complication rate could be attributed more to the merits of the Sovereign phacoemulsification system than to the surgical skills of the five surgeons, Dr Morris said that it was not possible to separate out the two factors in a meaningful way.Robert Morris, FRCOphth |
