Objective structured assessment of posterior capsular rupture management

Posterior capsular rupture (PCR) management requires specific technical skills. Simulation-based training may support skill acquisition but requires validated, procedure-specific assessment tools. This study aimed to develop and validate a structured scale for assessing technical performance during PCR management.

The Objective Structured Assessment of Posterior Capsular Rupture (OSA-PCR) was developed using a Delphi consensus process involving 20 cataract surgeons. Validation was subsequently conducted in a prospective simulation-based study including 12 residents and surgeons, who performed two standardized PCR scenarios on a virtual-reality simulator, separated by structured instructor-guided training. The 24 recorded performances were independently evaluated by four experts. Psychometric evaluation of the OSA-PCR included reliability, internal consistency, construct validity, and responsiveness, with correlation to simulator scores.

The final OSA-PCR comprised 19 items, all achieving 100% consensus in the third Delphi round. Interrater reliability was excellent (ICC[2,1] = 0.95; 95% CI, 0.89-0.98; ICC[2,4] = 0.90; 95% CI, 0.77-0.96), as was intrarater reliability (ICC[3,1] = 0.98). Internal consistency was high (Cronbach α = 0.93; McDonald ω = 0.94). OSA-PCR scores showed strong correlation with EyeSi Surgical scores (r = 0.90; 95% CI, 0.77-0.96) while providing greater discrimination among lower-performing cases. Scores improved significantly after training (median 63.5 vs. 96.6; P = 0.0005) but did not differ significantly across experience levels (P = 0.71).

The OSA-PCR is a valid, reliable, and responsive instrument for assessing technical performance during simulated PCR management. It enables structured, procedure-specific evaluation and may support competency-based training and assessment in cataract surgery education.