Risk factors for complications in resident-performed cataract surgery: A systematic review

Area of Science:

• Ophthalmology
• Surgical Education

Background:

• Cataract surgery is a common procedure with potential complications.
• Resident-performed surgeries require careful risk assessment for patient safety and effective training.

Purpose of the Study:

• To systematically identify and analyze risk factors associated with complications in resident-performed cataract surgery.
• To inform graduate medical educators on patient and surgeon factors to consider during resident training.

Main Methods:

• Systematic review adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
• Searched four databases in September 2023, including peer-reviewed, full-text, English-language articles.
• Included 15 studies after rigorous screening, excluding fellowship or combined surgeries.

Main Results:

• Patient-related factors: older age, hypertension, prior vitrectomy, zonular pathology, pseudoexfoliation, poor visual acuity, small pupils, and specific cataract types.
• Surgeon-related factors: resident postgraduate year, right-handedness, absence of supervision, extended phacoemulsification time, and high phacoemulsification power/torsion.
• Study quality assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), with most studies rated as moderate due to risk of bias.

Conclusions:

• Several patient and surgeon-specific factors increase the risk of complications during resident cataract surgery.
• Educators must consider these identified risk factors to optimize resident training and ensure patient safety.
• Proactive risk management is essential for successful surgical education and outcomes.