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Quantifying surgical skill in macular surgery.

Mark Alberti1, Mads Forslund Jacobsen1,2, Martin Nissen Hermann1

  • 1Department of Ophthalmology, Rigshospitalet - Glostrup, Glostrup, Denmark.

Acta Ophthalmologica
|September 22, 2021
PubMed
Summary
This summary is machine-generated.

Macular hole surgery by novice surgeons causes significantly more inner retinal damage than by experienced surgeons. This damage, measured by volume defect and reduced retinal sensitivity, correlates with surgical experience.

Keywords:
ILM peelingmacular holesurgical trainingvitreoretinal surgery

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Surgical Quality Measurement

Background:

  • Macular hole surgery involves delicate procedures like internal limiting membrane peeling.
  • Assessing surgical quality objectively is crucial for patient outcomes.
  • Forceps manipulation during surgery can potentially damage the inner retina.

Purpose of the Study:

  • To develop an objective quality measure for macular hole surgery.
  • To evaluate the relationship between surgical experience and patient outcomes.
  • To quantify inner retinal damage caused by forceps during macular hole surgery.

Main Methods:

  • Retrospective analysis of 32 patients undergoing macular hole surgery.
  • Categorization of surgeons into novice (<20 cases), intermediate (150+ cases), and experienced (2000+ cases) groups.
  • Measurement of inner retinal volume defect (GCL++) using optical coherence tomography and retinal function via confocal microperimetry.

Main Results:

  • Significant differences in GCL++ volume defect were observed across surgeon experience groups (p=0.0004).
  • Novice surgeons showed a substantially larger volume defect compared to intermediate and experienced surgeons (p=0.016 and p=0.0002).
  • A correlation was found between inner retinal volume defect and reduced retinal sensitivity (p=0.02).

Conclusions:

  • Inner retinal damage from forceps is a common occurrence during macular hole surgery, particularly during internal limiting membrane peeling.
  • The extent of inner retinal structural and functional damage is associated with the surgeon's experience level.
  • Objective quality measures can highlight the impact of surgical experience on patient outcomes.