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Trainee Ophthalmologists experiences with 3 piece IOL insertion in cataract surgery: survey response in one of the largest postgraduate teaching deaneries in the UK

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First Author: J.Panthagani UK

Co Author(s):    S. Madathilethu   E. Bilton   G. Moussa              

Abstract Details


To ascertain Ophthalmology trainee confidence and training in implanting a 3-piece IOL. The Royal College of Ophthalmologists in the UK stipulate a minimum of 350 independent cataract operations that are required before the end of training. In the era of pre-loaded injectable single piece IOLs, confidence and familiarity with 3-piece IOLs have reduced which may be needed in the emergency setting of managing a posterior capsule rupture and subsequent sulcus IOL placement.


West Midlands Deanery, UK. One of the largest post graduate teaching regions in the UK with 55 trainees.


An electronic survey was sent to all trainee Ophthalmologists in the region in March 2020. Data collected included the stage of training (junior trainees in Years 1-3 and senior trainees in Years 4-7), the number of independent cataract surgeries performed, the number of times inserting or observing a 3-piece IOL insertion, confidence level (score from 0 to 10) and the training received. Trainees were also asked if they performed or observed the insertion of a 3-piece IOL in the last 6 months and the reason for this. Statistical analysis was performed with SPSS Version 23.0 statistic software package.


Response rate 75% (junior and senior trainees n= 21, 20 respectively). Mean number of total IOLs inserted 6.1 (SD 7.5), those observed 7.4 (SD 11.4). Mean confidence level amongst junior and senior trainees was 1.2 and 6.1 respectively (p=<0.01). Senior trainees that completed >350 cases, confidence score was 6.4 (SD 2.3), and those performing <350 cases at 4.0 (SD 2.6) (p=0.04). Most training received was during the time of surgery (61%). Only 2 attended dry lab training. Senior trainees in the last 6 months performed a mean of 1.1 (SD 1.2) IOL insertion (most commonly due to a complication).


These results suggest a lack of experience and exposure in using 3-piece IOLs. Recommendations have been made to the training programme director for the deanery to run a regular 3-piece IOL dry lab session to ensure competence in an essential albeit infrequent skill. Rather than the arbitrary 350 cataract operations that need to be completed prior to the end of training, there should be a greater focus in the management of specific cataract surgery complications, even in dry lab simulation settings. Ensuring familiarity and competence should consequently improve confidence in the management of cataract surgery related complications.

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