Outcomes in resident-performed cataract surgeries with iris challenges: Results from the Perioperative Care for Intraocular Lens study

PURPOSE

To assess the outcomes of resident-performed cataract surgeries with iris challenges and to compare these outcomes with similar surgeries performed by attending surgeons.

SETTING

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.

DESIGN

Retrospective chart review.

METHODS

All cases of cataract extraction by phacoemulsification with intraocular lens implantation, performed by comprehensive ophthalmologists between January 1 and December 31, 2014, were reviewed. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome, were included for analysis. Visual outcomes and the rate of perioperative adverse events were compared between resident and attending surgeon cases. Factors predicting adverse events were also assessed.

RESULTS

In total, 1931 eye cases of 1434 patients were reviewed, and 65 resident cases and 168 attending surgeon cases were included. The mean logarithm of the minimum angle of resolution corrected distance visual acuity was better in the resident group 1 month after surgery (0.051 ± 0.10 [SD] versus 0.132 ± 0.30, P = .03); however, the difference was eliminated when controlling for macular disease. The mean operative time was 43.8 ± 26.5 minutes and 30.9 ± 12.6 minutes for cases performed by resident surgeons and attending surgeons, respectively (P  .0001). Residents utilized supplemental pharmacologic dilation or retraction more frequently than attending surgeons (98% versus 87% of cases, P = .008). The overall rate of adverse events was no different between residents and attending surgeons (P = 0.16). Dense nuclear sclerosis predicted adverse events in cataract cases with iris challenges (adjusted odds ratio, 1.86; 95% confidence interval, 1.17-2.94; P = .001).

CONCLUSION

Although requiring longer operative times and more surgical manipulation, residents who performed cataract surgeries with iris challenges achieved outcomes comparable to those performed by attending surgeons, and residents should be given the opportunity to operate on these eyes.

Wound dehiscence as a cataract surgery-associated postoperative complication in patients previously treated with alpha-1 blocker tamsulosin--a population-based study in Taiwan

PURPOSE

To compare the cataract surgery-related complications between patients with and without tamsulosin treatment.

DESIGN

A nationwide retrospective case-control study.

METHODS

Patients who had undergone cataract surgery were identified using the International Classification of Disease, Ninth Revision, Clinical Modification from a nationally representative dataset of 1 million people selected from the Taiwan National Health Insurance Research Database in 2000. Patients preoperatively treated with α1-blockers before cataract surgery were the treated group, and age-, sex-, and year of surgery-matched patients not preoperatively treated with α1-blockers were the control group. Patients treated with tamsulosin underwent subgroup analysis. A conditional logistic regression model was used to estimate surgery-related complications and interesting variables. The main outcome measures are cataract surgery-related complications.

RESULTS

A total of 4474 treated patients and 4474 controls were analyzed. The percentage of cataract surgery-related complications was 8.61% in the treated group and 8% in the control group (not significantly different). However, wound dehiscence was 3.81 times higher (95% confidence interval: 1.24-11.67, P = .0194) in the tamsulosin-treated group.

CONCLUSIONS

Patients treated with tamsulosin have a higher risk of wound dehiscence after cataract surgery. Carefully taking a history of tamsulosin use before cataract surgery is advised so that some strategies can be used to prevent complications and additional costs.