Learning curve of resident performed phacoemulsification versus manual small incision cataract surgery at a regional ophthalmic institute in western India

Abstract

: Manual small incision cataract surgery (MSICS) and phacoemulsification form part of the surgical armamentarium offered to the trainee doctors. We designed a study to document the visual outcomes and major surgical complications of manual small incision cataract surgery and phacoemulsification at our tertiary care centre. : The study was carried out at our tertiary care centre. The study design is a retrospective, institutional cohort study. Data of consecutive resident cataract surgeries done at our centre from October 2022 to April 2023 were recorded. 283 consecutive resident cataract surgical records were reviewed. MSICS was allotted to junior resident second year (JR2) and junior resident third year (JR3b) (first six months of JR3 residency) groups of residents while phacoemulsification was given to junior resident third year (JR3a) (last six months of JR3 residency) and to the senior residents (SRs). The preoperative and postoperative examination included best corrected visual acuity, intraocular pressure, thorough anterior and posterior segment examination. The surgical steps had been documented. The follow up protocol was one day, four days, fortnight, six weeks and 12 weeks. The major surgical complications were documented.Statistical analysis was done using the student “t” test. Chi square value was calculated and a p value of less than 0.05 was taken as significant.: 283 eyes of 283 patients were documented. Phacoemulsification was done in 136 cases and MSICS in 147 cases. Age, gender, grade of nucleus and the type of surgery were not significantly associated with the major surgical complication rate. The resident group was significantly associated with the major surgical complication rate (p value 0.01). The lowest complication rate was seen in JR3b operated MSICS cases (1.7%). This was closely followed by SR operated phacoemulsification cases (2.6%). 98.5% of phacoemulsification cases and 98% of MSICs cases had a best corrected visual acuity (BCVA) between 6/6 and 6/18 at 12 weeks postoperatively.: In conclusion both phacoemulsification and MSICS performed by resident doctors at our institute had good visual outcomes with an acceptable complication rate. As the surgical experience of the surgeon widens the surgical outcomes also improve.