Incidence and Risk Factors for Intraoperative Complications in Resident-performed Phacoemulsification Surgery

To investigate the incidence and risk factors of intraoperative complications during phacoemulsification surgery performed by ophthalmology residents at an academic training center.

This comparative case series included 1121 eyes of 821 patients that underwent phacoemulsification cataract surgery by ophthalmology residents from March 2020 to March 2021. Patients' medical records were reviewed for demographics, systemic and ophthalmic comorbidities, biometric data, surgical details, anesthesia type, residents' training year, and the occurrence of any intraoperative complications. Multivariate models were used to identify potential risk factors for intraoperative complications.

Intraoperative complications were observed in 63 eyes (5.6%). From the most to the least frequent, they included posterior capsular rupture with vitreous loss in 29 eyes (2.6%), anterior capsular tear in 21 eyes (1.9%), nucleus drop in 8 eyes (0.7%), zonular dehiscence in 3 eyes (0.3%), and posterior capsular rupture without vitreous loss in 2 eyes (0.2%). On univariate analysis, mature or brunescent cataracts (OR = 3.096, P = 0.031), residents' training year (OR = 2.238, P = 0.017), and pseudoexfoliation (OR = 2.247, P = 0.049) were associated with vitreous loss. Multivariate data analysis indicated that mature or brunescent cataracts (OR = 4.046, P = 0.009) and residents' training year (OR = 3.238, P = 0.005) were independent risk factors for vitreous loss.

We observed a higher rate of intraoperative complications in eyes with mature or brunescent cataracts or in procedures performed by less experienced residents. Proper case selection and direct attending supervision are crucial in preventing intraoperative complications at ophthalmology training centers.