The Impact Of Surgeon’S Experience And Sex On The Incidence Of Cystoid Macular Edema After Uneventful Cataract Surgery

To assess the rates of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in trainees vs experienced surgeons and to analyze the rate of pCME according to surgeon’s sex.

Department of ophthalmology, Medical University of Graz, Austria.

Medical reports of patients after phacoemulsification between 2010 and 2018 were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between trainees and experienced surgeons. Outcome parameters were incidence of pCME, patient’s sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon’s sex. Patients with preexisting retinopathy, combined procedures, IOL implantation in aphakic eyes and eyes with previous ophthalmic surgeries within the last three months remained unconsidered. Only uneventful surgeries were considered.

26.308 surgeries on 15.640 patients were included. The majority was performed by experienced surgeons (24.003, 91.2%) vs 2.305 (8.8%) by trainees (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by trainees and in 156 eyes (0.6%) following surgery by experienced surgeons. Chance for pCME was 1.56 higher in training surgeries (95% CI 1.02-2.38, p=0.041) and longer duration (OR=1.05; 95% CI 1.02-1.07, p=0.001). After excluding the first 100 surgeries for every trainee similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (trainees and experienced surgeons).

In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for trainees but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.