Safety of resident performed surgeries in complex cataract cases and comparative analysis with staff surgeons: a review of 1500 consecutive cases.

Abstract

Purpose: To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff surgeons in a teaching hospital and determine the risk factors associated with posterior capsule tear (PCT) and POD1 IOP elevation.

Methods: This retrospective study included all cases of primary phacoemulsification in patients aged 18 years or older, performed by residents and staff surgeons from May 27, 2022, to May 31, 2023 in a tertiary eyecare center in Turkey. There were no exclusion criteria. Data collected included primary surgeon, level of experience, preoperative status of cases, intraoperative complications, other operative details and POD1 IOP measurements.

Results: A total of 1500 surgeries were included; 68.8% were performed by residents. Overall intraoperative complication rates were similar in groups in simple and complex cases. There was no statistically significant difference in PCT rates between groups in simple (2.4% and 1.9%, p = 0.800) and complex cases (3.7% and 5.1%, p = 0.455). Rate of POD1 IOP elevation above 25 mm Hg was also similar in groups (22.7% and 22.6%, p = 0.903). Pseudoexfoliation + small pupil and special cataracts were significant risk factors for PCT among residents (p = 0.048 and p = 0.033, respectively). Pseudoexfoliation + small pupil, glaucoma or ocular hypertension and uveitis were significant risk factors for POD1 IOP elevation.

Conclusion: Overall intraoperative complication and PCT rates were comparable between residents and staff surgeons in both simple and complex cases. Resident involvement was not a risk factor for POD1 IOP elevation.