International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 10(5), March, 2018

Pages: 36-38

Date of Publication: 15-Mar-2018


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Visual Outcome and Complications of Resident Operated Phacoemulsification Cases Done by Third Year Residents in a Regional Institute of Ophthalmology

Author: Garima Agrawal, Swati Ravani, Shashank M. Patel

Category: Healthcare

Abstract:Introduction: Phacoemulsification is a state of the art surgery for cataract removal. Phacoemulsification involves removing the opacified crystalline lens via emulsification and aspiration followed by implantation of an intraocular lens. The surgery though simple has a learning curve. We designed a study to document the visual outcome and complications of resident operated phacoemulsification cases done by third year residents in a regional institute of ophthalmology.
Aim: We designed a study to document the visual outcome and complications of resident operated phacoemulsification cases done by third year residents in a regional institute of ophthalmology.
Material and Methods: Phacoemulsification was performed by Junior Resident under guidance of one Assistant Professor. The visual outcome and complications of the procedure were noted.
Results: We report good visual outcome with few complications in supervised resident performed phacoemulsification.
Discussion: Phacoemulsification can be performed by Junior Resident in a supervised manner with good postoperative results. This has also been documented by other studies.
Conclusion: Phacoemulsification can be performed by Junior Resident in a supervised manner with good post operative results.

Keywords: Phacoemulsification, Resident cases

DOI: 10.7324/IJCRR.2018.1056

Full Text:

Introduction:

 Phacoemulsification is a state of the art surgery for cataract removal.  Phacoemulsification  involves removing the opacified crystalline lens via emulsification and aspiration using an ultrasonic handpiece followed by implantation of an intraocular lens. 1The surgery though simple has a learning curve. Jaffe NS et al in their book on Cataract Surgery observe that phacoemulsification brings with it unprecedented demands on the surgeon. 2  They report that surgeons need good manual dexterity , expertise with the operating room microscope along with a thorough knowledge of intraocular anatomy and phacodynamics.2 The beginner surgeons at our teaching Institute who have no prior experience of cataract surgery are therefore started with extracapsular cataract extraction followed by manual small incision cataract surgery before making them perform phacoemulsification  . We designed a study to document the visual outcome and complications of resident operated phacoemulsification cases done by third year residents in a supervised manner at a regional institute of ophthalmology.

Aim:

 The study is designed to document the visual outcome and complications of phacoemulsification surgery done by third year residents in a supervised manner  at a regional institute of Ophthalmology.

Material and Methods:

Third year residents who have completed six months of their residency as junior resident three with satisfactory post operative results in at least  five extra capsular cataract surgery and 20 manual small incision cataract surgeries were considered eligible for phacoemulsification . Mastery over capsulorrhexis was essential. Every case was supervised by one Assistant Professor with an experience of at least 1500 phacoemulsification surgeries with satisfactory post operative results. We documented twenty phacoemulsification surgeries performed by  third year residents from July 2017 to December 2017.

 Patient selection was done for beginner resident phacoemulsification cases .Patients with well dilated pupil, clear cornea, nuclear sclerosis grade two or three with normal ocular surface were included in the study. Exclusion criteria included nuclear sclerosis grade one, nuclear sclerosis grade four or five, semi-dilated pupil, corneal opacities, other ocular co-morbidities as glaucoma, ocular surface disorder, retinal disorders. Uniocular patients were excluded from the study.

All patients were subjected to a thorough pre-operative work- up including visual acuity, intraocular pressure, slit lamp examination and  indirect ophthalmoscopy . Blood pressure was measured and complete systemic work up including cardio-respiratory status was done. Blood and urine investigations were ordered including complete blood count and random blood sugar. History of drugs including Tamsulosine was documented.

 The pre operative preparation was done as per protocol .The surgery was carried out  in the operation theatre .The student must have assisted at least 1000 phacoemulsification surgeries and performed few steps of phacoemulsification under guidance in at least 10 surgeries in conjugation with one Assistant Professor. A thorough knowledge of pharmacodynamics was essential for the student.

We use a standard phacoemulsification technique . A temporal clear corneal incision is made. Two side ports are constructed. Capsulorrhexis and hydroprocedures are performed. Koch’s stop and chop technique is employed at our institute. 3 Nuclear emulsification is followed by cortical removal. Foldable intraocular lens is then inserted followed by viscoelastic  wash and closure. Every step of the surgery was closely supervised by one Assistant Professor. All  intraoperative complications and their management were  documented. Postoperative visual acuity was documented at first day post operative, one week  and six weeks. Best corrected visual acuity was documented at six weeks. Postoperative complications were documented .

All patients were given topical antibiotics, steroids and lubricating drops postoperatively for six weeks as per protocol.

 Results:

Residents were able to perform phacoemulsification under guidance. They were able to perform incision, capsulorrhexis, hydroprocedures, trench making. Initially help was needed in the first cracking of the nucleus. Later they were able to chop and emulsify the nucleus pieces. Irrigation aspiration was supervised though complications were common if resident was not careful. Intraocular lens insertion went successfully. The coordinated management of resident and assistant professor were able to give good postoperative results. We concentrated on teaching the residents  one step in every surgery ,taking over the other steps as per the case to achieve good post operative results.

Twenty resident phacoemulsification cases were documented. Posterior capsular rent was noted in one case while emulsifying the last nuclear segment. It was managed with anterior vitrectomy, followed by intraocular lens implantation. Subsequently  cortical and viscoelastic removal was done in a supervised manner. There were no major intraoperative complications in nineteen cases.

The postoperative best corrected visual acuity as documented at six weeks was 6/6 in seventeen cases. Three cases had best corrected visual acuity of 6/18, 6/24, 6/18 due to dry age related macular degeneration.

There were no major post operative complications. Mild corneal edema was noted in eight cases which resolved at one week postoperative with topical steroids.

Discussion:

We report good visual outcome with very few complications of resident performed phacoemulsification  cases under close supervision.

Randleman JB reported quality visual outcomes of resident performed phacoemulsification cases. They reported intraoperative complications in 5% cases with significant reduction in vitreous loss rates after the first eighty resident cases. Surgical competency improves significantly with increasing surgical experience.4

Thomas R et al reported an acceptably low rate of surgical complications and good visual outcomes by residents learning phacoemulsification in a supervised manner.5

Conclusion:

Resident performed phacoemulsification cases had good visual outcome with few intraoperative and postoperative complications. We conclude that phacoemulsification can be performed safely by third year residents in a supervised manner with good visual outcomes and few complications.

Acknowledgement

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles journals and books from where the literature for this article has been reviewed and discussed.

Ethical Clearance: Taken

Informed Consent: Taken

Source of funding : None

Conflict of Interest: None

References:

  1. David Allen. Phacoemulsification. In: Yanoff M, Duker JS, editors. Ophthalmology.4th Ed. China: Elsevier Saunders;2009. p 361-365.
  2. Jaffe NS, Jaffe MS, Jaffe GF. Machine Parameters. In: Jaffe NS, Jaffe MS, Jaffe GF. Cataract Surgery and its Complications. 6th Ed.Mosby;1997.p 57-64.
  3. Jaffe NS, Jaffe MS, Jaffe GF. Surgical Technique. In: Jaffe NS, Jaffe MS, Jaffe GF. Cataract Surgery and its Complications.6th Ed.Mosby;1997.p 65-131.
  4. Randleman JB, Wolfe JD et al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 2007;125(9):1215-1219.
  5. Thomas R, Naveen S, Jacob A, Braganza A. Visual outcome and complications of residents learning phacoemulsification. Indian J Ophthalmol 1997;45(4):215-219.

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
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A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
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A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
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A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
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A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
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A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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