Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident

J Cataract Refract Surg. 2004 Apr;30(4):839-43. doi: 10.1016/S0886-3350(03)00648-5.


Purpose: To assess the risk factors for endothelial cell loss after phacoemulsification cataract surgery performed by a junior resident.

Setting: Ophthalmic teaching hospital, Dublin, Ireland.

Methods: This prospective study included 40 eyes having divide-and-conquer phacoemulsification cataract surgery by a junior resident under the supervision of an experienced surgeon. Nine variables were examined to assess the risk for corneal endothelial cell loss postoperatively.

Results: The mean overall endothelial cell loss was 11.6%. Longer surgery time, longer absolute and effective phaco time, higher mean ultrasound power, and higher cataract density were significantly associated with endothelial cell loss on univariate analysis. Multivariate analysis identified a grade 3 nucleus (severely dense) and long absolute phaco time as independent predictors for endothelial cell loss, with longer absolute phaco time the stronger predictor.

Conclusions: Divide-and-conquer phacoemulsification cataract surgery was a safe technique in the hands of an ophthalmic trainee. This study supports advice to junior surgeons to choose cases with less dense cataracts as this will help reduce the absolute phaco time and thus minimize endothelial cell loss.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Cell Survival
  • Education, Medical, Graduate*
  • Endothelium, Corneal / pathology*
  • Female
  • Humans
  • Internship and Residency*
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Ophthalmology / education*
  • Phacoemulsification / education*
  • Postoperative Complications*
  • Prospective Studies
  • Risk Factors