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Related Experiment Videos

Learning Curve in External DCR - A Trainee's Perspective.

Karan Bhatia, Sabyasachi Sengupta, Madhu Bhadauria

    Nepalese Journal of Ophthalmology : a Biannual Peer-Reviewed Academic Journal of the Nepal Ophthalmic Society : NEPJOPH
    |April 11, 2018
    PubMed
    Summary

    External Dacryocystorhinostomy (DCR) by trainee ophthalmologists shows a high success rate for acquired naso-lacrimal duct obstruction (NLDO). Success rates improve over time as surgical skills develop, with a significant reduction in complications.

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    Area of Science:

    • Ophthalmology
    • Surgical Training
    • Oculoplastics

    Background:

    • Acquired naso-lacrimal duct obstruction (NLDO) significantly impacts patients' quality of life.
    • External Dacryocystorhinostomy (DCR) is a common surgical intervention for NLDO.
    • Assessing surgical outcomes during a trainee's learning curve is crucial for surgical education.

    Purpose of the Study:

    • To evaluate the success rate of external Dacryocystorhinostomy (DCR) for acquired naso-lacrimal duct obstruction (NLDO) performed by trainee ophthalmologists.
    • To analyze the trend of success rates and complication rates over time as trainees gain experience.
    • To determine the learning curve associated with external DCR in a training setting.

    Main Methods:

    • Prospective observational study conducted in a tertiary eye hospital.

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  • 114 adult patients with acquired complete NLDO underwent external DCR by trainees with <3 years of experience.
  • Postoperative assessment at 6 months included lacrimal sac syringing for patency and subjective epiphora evaluation via questionnaire.

    • Main Results:

    • Anatomical success rate was 93.7%, improving from 87% to 100% across tertiles of patient cases (p<0.05).
    • Overall complication rate decreased from 29% to 8% across tertiles (p<0.05).
    • Loss of the anterior nasal flap was the most frequent complication (10 cases).

    Conclusions:

    • External DCR is a successful primary procedure for acquired NLDO, even when performed by trainees.
    • Surgical success rates and patient outcomes improve significantly as trainees progress through their learning curve.
    • Complication rates decrease substantially with increasing surgical experience, highlighting the importance of supervised training.