Learning Curve of Ophthalmic Postgraduate Students During Training in Manual Small Incision Cataract Surgery (MSICS): A Cross-sectional Study

Abstract

Introduction: Ophthalmology residency programs play a critical role in training surgeons to perform cataract surgery. A fundamental component for developing competency in cataract surgery is undergoing a structured surgical training program. There is an inverse relationship between the number of surgeries performed by a resident and adverse surgical outcomes. Aim: To assess the learning curve of Manual Small Incision Cataract Surgery (MSICS) performed by postgraduate students during their residency tenure by estimating the difficulties encountered and intraoperative and postoperative complications during surgical training. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Hassan Institute of Medical Sciences (HIMS) Teaching Hospital, Hassan, Karnataka, India, from July 1st 2020 to January 1st 2023. Study included 249 patients undergoing MSICS by three postgraduates, who enrolled in the Master of Surgery (MS) Ophthalmology course and received hands-on training in a wet lab were selected. They performed MSICS in a stepwise manner under the supervision of a trained ophthalmologist. Surgeries were recorded and discussed in surgical audits, and intraoperative and postoperative complications were analysed. The collected data was statistically analysed using descriptive statistics such as frequency and percentage. Results: A total of 249 patients, including 135 (54.2%) females and 114 (45.7%) males, with a mean age of 68.4 years, were included in the study. The majority (47%) of cases were senile immature nuclear sclerotic cataracts grade 3-4. Difficulties encountered during the surgeries were tunnel formation (24.6%), capsulotomy (4.5%), nucleus delivery (21.5%), cortical wash (34.3%), and Intraocular Lens (IOL) insertion (14.8%). Intraoperative complications observed were premature entry (46.3%), roof tear (16.1%), Descemet's membrane detachment (7.3%), iridodialysis (7.3%) and Posterior Capsular Rent (PCR) (22.1%). Postoperative complications included wound gaping (0.4%), anterior chamber reaction (10.8%), corneal oedema (25.4%), striate keratopathy (58%) and raised intraocular pressure (5.1%). Conclusion: The most common difficulty encountered during the first year of residency was tunnel formation, while the most common difficulty encountered during the second and third years was cortical wash. The most common intraoperative complication was premature entry, and the most common postoperative complication was striate keratopathy. Stepwise learning by the resident under continuous monitoring by a consultant lowers complications and gives confidence to postgraduate students.

Keywords

• manual small incision cataract surgery
• postgraduate residency programme
• resident curriculum design
• surgical training for postgraduates