Outcomes and complication rates of primary resident-performed cataract surgeries at a large tertiary-care county hospital

Abstract

Purpose: To identify the preoperative risk factors, intraoperative events, and postoperative complications increasing the risk for poor visual outcomes in resident-performed cataract surgeries at a tertiary-care county hospital.

Setting: Ben Taub General Hospital, Houston, Texas, USA.

Design: Retrospective case series.

Methods: Resident-performed cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity (CDVA), which were correlated with preoperative demographics, intraoperative and postoperative events, and resident training level. The data were subdivided into cases without events and cases with events to determine which complications led to poor visual outcomes.

Results: The study analyzed 1290 resident-performed cataract surgeries. The mean visual acuity improved significantly after surgery in all patients (P < .001), with 80.5% of patients without complications and 70.7% with complications attaining a CDVA of 20/40 or better (P < .002). Poor visual outcomes were associated with α-antagonist use (P = .043) and pseudoexfoliation syndrome (P = .001). The most common intraoperative complications were vitreous loss (6.7%) and posterior capsule tear (7.0%). The mean postoperative visual acuity did not vary by trainee year, and the rate of dropped nucleus during surgery declined as residents progressed in training (P < .05). All other complication rates were similar between levels of training.

Conclusion: Despite more complicated cataracts and advanced comorbidities, primary resident-performed cataract surgery in a tertiary-care county hospital system achieved visual outcomes and complication rates similar to those found in other training hospitals.