ESCRS - FP08.06 - Assessment Of Patient Selection For Cataract Surgery And Comparison Of Refractive Outcomes Between A Junior Resident, A Senior Resident And A Consultant: Results Of A Tertiary Center

Assessment Of Patient Selection For Cataract Surgery And Comparison Of Refractive Outcomes Between A Junior Resident, A Senior Resident And A Consultant: Results Of A Tertiary Center

Published 2023 - 41st Congress of the ESCRS

Reference: FP08.06 | Type: Free paper | DOI: 10.82333/366d-yy09

Authors: Marta Sofia Rodrigues Correia* 1 , Maria Filipa Madeira 1 , Margarida Baptista 1 , Mariana Portela 1 , Miguel Cordeiro 1

1Ophthalmology,Centro Hospitalar de Lisboa Ocidental,Lisbon,Portugal

Purpose

The primary aim of this study is to compare refractive outcomes of cataract surgery performed by a junior resident, a senior resident and a consultant. The secondary purpose is to detect demographic and clinical differences in the selection of patients between the surgeons.

Setting

Ophthalmology Outpatient Clinic, Ophthalmology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

Methods

Retrospective observational study where medical records of patients submitted to phacoemulsification surgery by a junior resident (MRC), a senior resident (MP) and a consultant (MAC) between January of 2022 and January of 2023 were reviewed. The first 30 career cases performed by MRC were selected and 30 cases of MP and MAC were randomly selected from the time frame described. The authors analyzed patient demographics, clinical characteristics, postoperative refraction outcomes, pre and postoperative visual acuity (VA, logmar scale) and surgical complications. Descriptive analyses, parametric and non-parametric tests were performed using IBM SPSS Statistics® version 28.0. A p value < 0,05 was considered significant.

Results

90 patients were included, with a median age of 75,12 ± 8,61 years and 21,1% (n=19) being male. MAC operated on a higher percentage of patients with pseudoexfoliation syndrome and lower pre-operative VA compared to MRC and MP (p=0,03 and p=0,04). Surgical time for MRC was significantly longer than MP and MAC (mean 41,63±10,65 minutes, p<0,001). A higher improvement in VA was found in MAC (mean -0,62±0,56 logmar) compared to MP and MRC (p=0,025). 95,6% (n=86) of patients achieved a spherical equivalent (SE) post-surgery of ±1D, constituting a significant reduction from presurgical values and in percentage of patients in need to far-correction (p=0,04 and p<0,001). No differences were found in surgical complications (n=5) between surgeons.

Conclusions

This work highlights the importance of appropriate case selection for the different levels of surgical expertise to achieve optimal refraction outcomes. In the literature, factors contributing to a more complex surgery include male patients, older age, systemic use of a-blockers, diminished pupil size, ocular comorbidities, presence of SPX, among others and, likewise, we found a higher rate of these factors among cases performed by the consultant. Furthemore, we illustrate that with the right selection of patients, improvement of VA, low post-operative SE and independence of spectacles seems to be achieved by surgeons of all levels of expertise without increasing the risk for the patient.