Video-based evaluation of cataract surgery and intraoperative complications: a single surgeon's 12-year experience

To evaluate the intraoperative complications of cataract surgeries, identify their independent risk factors, and determine how complication rates evolve over time by reviewing surgical videos, considering both the surgeon's experience and baseline patient characteristics.

This retrospective, cross-sectional study evaluated 523 high-quality cataract surgery videos (selected from 1770) performed by a single surgeon with over five years of baseline experience. Videos were divided into group 1 (2010-2017, n = 274) and group 2 (2018-2022, n = 249). Patient cooperation, intraoperative complications, and specific preceding surgical steps were analyzed via video. Cataract grading and pupil diameter were obtained from patient files and video recordings. Univariate and multivariate logistic regression analyses were performed.

Univariate analysis showed complication rates (p = 0.026), cataract hardness (p = 0.002), and accompanying ocular findings (p = 0.009) were significantly higher in group 1. Patient cooperation was significantly lower in eyes with complications in group 1 (p = 0.003). Multivariate regression analysis revealed that only poor patient cooperation (OR = 4.862, 95% CI 741-13.579, p = 0.003) and higher nucleus grade (OR = 5.510, 95% CI 1.258-24.134, p = 0.024) were significant independent predictors of intraoperative complications.

Patient cooperation and cataract hardness are the primary independent predictors of surgical safety. It is crucial that high-risk cases are carefully pre-assessed and operated on by experienced surgeons equipped with advanced crisis management strategies. High-quality surgical video recordings provide analytically indispensable insights, proving highly beneficial for both postoperative case review and the training of resident physicians.