Impact Of Simulation Based Manual Small Incision Cataract Surgery (Msics) Training On The Visual And Surgical Outcomes Amongst Ophthalmology Trainees In A Developing Country

Manual small incision cataract surgery (MSICS) remains one of the commonly done surgeries in developing nations as it is safe and cost-effective. However, the surgery does have a learning curve. The importance of the simulation based training was felt during the recent COVID-19 pandemic. The purpose of this study is to assess and compare the visual outcomes and complication rates of manual small incision cataract surgery (MSICS) performed by Ophthalmology trainees receiving simulator training in addition to the traditional wet lab training.

L V Prasad Eye Institute, Hyderabad, India 

This retrospective study performed in a tertiary care center included two set of trainees. Group 1 (n=340) included eyes operated on for MSICS by trainees who underwent traditional wet lab training whereas Group 2 (n= 676) included those who received MSICS simulator training apart from the wet lab training

Mean surgeries performed by trainees before joining the institute were 316 (+/- 632.2) and 186 (+/-234.4) in group 1 and group 2 respectively(p=0.25). Posterior capsular rupture with vitreous loss was reported in 7.3% in group1 and 6.5 % in group2 (p=0.6). Zonular dialysis was more common in group 1(3.5%) than in group 2 (1.4%) (p=0.002). Nuclear fragment drop was again more common in group 1(1.1%) than group2 (0.2%) (p=0.02). Wound related complications (premature entry,button-hole,irregular wound) were also reported to be significantly higher in group 1(12.06%) than group 2(1.33%) (p=0.00001). However, there was no difference in the final visual outcomes with both the groups reporting 20/40 or better in approximately 90% of eyes (p=0.569)

MSICS simulator trained surgeons reported lesser complications as compared to the ones trained only in the wet lab. Simulator training can be an important tool and can be used to strengthen the existing MSICS training to reduce the overall burdern of the cataract related blindness in the developing nations.