Phacoemulsification Learning Curve In A Large Series Of Cases.

To assess the performance of the first cataract surgeries performed by the same surgeon in training. Also, to determine which steps of the procedure are the most difficult to perform, and to measure the rate of intra and early postoperative complications.

IMOL, Monterrey, Mexico.

This is a retrospective study which included the first 160 eyes that underwent cataract surgery by the same training surgeon. The primary outcomes measures were: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraoperative and early postoperative complications. The secondary outcomes were safety (percentage of eyes in which the postoperative CDVA was worse than the preoperative CDVA) and refractive outcomes. For the first 50 cases a venturi pump (Stellaris) was used, all the others were performed with a peristaltic pump (Centurion).

UCVA improved in all eyes. 3 eyes did not improve their CDVA after surgery due to retinal pathologies, and only 2 eyes loss 1 line of CDVA.

Intraoperative complications included: 1 dropped nucleus, 2 posterior capsule ruptures (PCR), zonular detachment of less than 3 clock hours in 1 eye, 5 eyes had a small tear in Descemet membrane at the main incision, and 3 eyes needed a suture to close the main incision. The most difficult step to master was nucleus disassembly and removal.

The first day after surgery, 15 eyes had corneal edema, which resolved completely one week after surgery, and 1 eye had a TASS. One month after surgery, 1 eye had a posterior capsule opacification, and one eye had a peripheral retinal tear.

Learning how to perform cataract surgery is a crucial step in ophthalmology. Due to the continuous improvements in phacoemulsification machines, intraoperative complications have decreased.  

Visual outcomes during the learning curve are good, as all the patients improved their UCVA. Sightseeing complications (dropped nucleus, PCR) were relatively low (1.8%), and occurred during the first 50 surgeries, therefore it is important to have an experienced retinal surgeon around in order to help or manage these complications. Also, using a peristaltic pump might reduce the complication rate, as the AC is more stable. A proper patient selection (start with easy cases) should be encouraged in order to avoid or decrease the complication rate.