Effect of surgical simulation training on the complication rate of resident-performed phacoemulsification

To study the effect of additional training with ophthalmic surgical simulation on the intraoperative complication rates of phacoemulsification performed by residents.

This was a retrospective study of phacoemulsification surgeries performed by third-year residents at Siriraj Hospital. The operations were classified into two groups according to the experience of the surgeon in simulation training, that is, trained vs untrained. The main outcome was the total rate of complications. Other outcomes, including posterior capsule rupture, anterior capsulorhexis tearing, zonular dehiscence, retaining of lens material and intraocular lens (IOL) implantation methods, were also analysed.

In total, 2971 operations were performed, comprising 1656 operations by 21 residents in the trained group, and 1315 by 20 residents in the untrained group. The total rate of complications in the simulator-trained group was lower than in the untrained group (13.6% vs 17.3%, p=0.005). Only the rate of retaining lens material showed a statistically significantly reduction (p<0.001); however, the rates of posterior capsule rupture, anterior capsulorhexis tearing and zonular dehiscence were not significantly different (p=0.08, 0.17, 0.23, respectively). The IOL implantation methods and surgical aphakia rate between the two groups were similar (p=0.44). In the subgroup analysis, the posterior capsule rupture rate in the first half of all cases performed by the residents was lower in the trained group (8.8% vs 12.4%, p=0.02).

Ophthalmic simulation training reduces the total rate of complications of resident-performed phacoemulsification. It also shortens the learning curve for cataract surgery training, as indicated by the decreased posterior capsule rupture rate in the initial cases of cataract surgery.