Defining the surgical footprint in cataract surgery: patient outcomes dependent on the experience of the surgeon
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First Author: M.Forslund Jacobsen DENMARK
Co Author(s): M. Forslund Jacobsen L. Konge M. la Cour J. Høiberg Erichsen L. Holm A. Thomsen
Cataract surgery is a complex and demanding micro-surgical task. Less experienced cataract surgeons have higher complication rates compared to more experienced surgeons (Randleman et al. 2007; Ellis et al. 2018). However, only few studies have investigated the direct effect of surgical experience on patient outcomes within cataract surgery (Lhuillier et al. 2017). The purpose of this study was to investigate which patient related outcomes are dependent on the experience of the cataract surgeon.
The study was conducted at the Department of Ophthalmology – Rigshospitalet, Glostrup and Nordsjællands Hospital – Hillerød, Capital Region of Denmark, Denmark.
The study was designed as a prospective observational study. Novice cataract surgeons (<150 surgeries performed) and experienced cataract surgeons (>1000 surgeries performed) were included in the study. Patients operated by the participants were examined preoperatively, and postoperatively at one day, three days, and three weeks. Primary outcomes were change in central corneal thickness and endothelial cell loss. Secondary outcomes were BCVA, IOP, aqueous flare, and central macular thickness.
Surgery performed by novice surgeons compared to experienced surgeons was associated with a significant difference in visual acuity and central corneal thickness on the first day postoperative of -3.6 letters (ETDRS) (95%CI: -7.3; -0.4, p = 0.03) and 26.7 µm (95%CI: 6.8; 46.6), respectively. There was no significant difference in patients operated by novice and experienced cataract surgeons for the outcomes of IOP, aqueous flare, corneal volume, central endothelial cell count, central endothelial cell density measured at day one, three and three weeks postoperative.
Visual acuity and central corneal thickness in the immediate postoperative period was associated with the surgical experience of the cataract surgeon.