Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal
Journal of Surgery
Volume 1, Issue 5, December 2013, Pages: 63-69
Received: Nov. 13, 2013; Published: Dec. 10, 2013
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Authors
Emmanuel Olu Megbelayin, Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
Ashok Rangarajan, shok Rangarajan, FRCS, Sankara Eye Hospital, Sankara Nagar, Pammal, Chennai, Tamil Nadu, India
Sreedhar Pindikura, Tulsi Chanrai Foundation, General Hospital, Calabar, Nigeria
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Abstract
Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors’ intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst post-operative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors’ intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer’s Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.
Keywords
Cataract, MSICS, Trainee Ophthalmologist, Learning Curve
To cite this article
Emmanuel Olu Megbelayin, Ashok Rangarajan, Sreedhar Pindikura, Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal, Journal of Surgery. Vol. 1, No. 5, 2013, pp. 63-69. doi: 10.11648/j.js.20130105.11
References
[1]
Gogate P, Deshpande M, Nirmalan PK. Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology. 2007; 114(5): 965-968.
[2]
Ashok G. Clinical Significance and Relevance of Small Incision Cataract Surgery in the 21st Century Era. In: Ashok G, Amulya S, Franscisco J, Carlos I. Keiki RM, Dhull CS, editors. Master’s Guide to Manual Small Incision cataract surgery (MSICS). Japee, India 2009. p. 3-9.
[3]
Khanna R, Pujari S, Sangwan V. Cataract surgery in developing countries. Curr Opin Ophthalmol 2011; 22:10–14
[4]
Aravind H, David F, Mascarenhas R, Madhu S. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg 2012; 38:1360–69
[5]
Muhammad HQ. Non Phaco Sutureless Cataract Surgery with Small Scleral Tunnel Incision Using Rigid PMMA IOLS. Pak J Ophthalmol 2007; 23(1):1-5.
[6]
Thomas R, Navin S, Parikh R. Learning micro incision cataract surgery without the learning curve. Indian J Ophthalmol 2008; 56(2):135-7.
[7]
Thomas R, Naveen S, Jacob A, Braganza A. The visual outcome and complications of residents learning phacoemulsification. Indian J Ophthalmol. 1997; 45:215-19.
[8]
Spaeth GL. Phacoemulsifcation: A senior surgeon's learning curve. Ophthalmic Surg. 1994;25: 504-9.
[9]
Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004; 11:369–80
[10]
Albrecht H. Sutureless Non-phaco Cataract Surgery: A Solution to Reduce Worldwide Cataract Blindness? Comm Eye Health 2003; 16: 51-52
[11]
Blumenthal M, Ashkenazi I, Assia E, Cahane M. Small incision, manual extracapsular cataract extraction using selective hydrodissection. Ophthalmic Surg 1992;23:699-701.
[12]
Kansas P. Phacofracture. In: Rozakis GW, Anis AY, et al., editors. Cataract Surgery: Alternative Small Incision Techniques. Thorofare (N.J): Slack Inc; 1990. pp. p. 45-70
[13]
Ruchi G, Malik KPS. Nuclear Management. In: Ruchi G, Malik KPS editors. Manual of Small Incision Cataract Surgery. 2nd edn. Publisher, India 2012. Pg. 34-47.
[14]
Fry LL. The phaco sandwich technique. In: Rozakis GW (ed.), Cataract Surgery: Alternative Small incision techniques. Thorofare NJ Slack 1990; 91-110.
[15]
Srinivasan A. Nucleus Management with irrigating Vectis. Indian J Ophthalmol 2003; 15: 5-12
[16]
Hennig A. Nucleus management with Fishhook. Indian J Ophthalmol 2009; 57: 35-7.
[17]
Guzek JP, Ching A. Small-incision manual extracapsular cataract surgery in Ghana, West Africa. J Cataract Refract Surg. 2003; 29(1): 57-64.
[18]
Isawumi MA, Soetan EO, Adeoye AO, Adeoti CO. Evaluation of Cataract Surgery Outcome in Western Nigeria. Ghana Med J. 2009; 43(4):169–74.
[19]
Olawoye OO, Ashaye AO, Bekibele CO, Ajayi BGK. Visual Outcome after Small Incision Cataract Surgery in Southwestern Nigeria. Nig J Ophthalmol 2011;18(2):40-44.
[20]
Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, el al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007; 125(9):1215-19.
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