Journey of a 1 ^st -year ophthalmology resident through first 50 manual small incision cataract surgeries

Objectives: In a country with a largely sub-optimal status of ophthalmology training in post-graduation courses, this article analyses the surgical outcome of a 1st-year post graduate (PG) resident in the first 50 cases to ascertain the utility of a well-rounded surgical training programme. The aim of this study was to assess the outcome of a methodical surgical training programme in the surgical development of a 1 st -year resident. Materials and Methods: (1) Setting: This is a retrospective observational study conducted at a tertiary care eye hospital and training institute in north India. (2) Study Population: The first 50 patients operated on by the trainee were included in the study. The personal identification of the patients has not been revealed in the study. (3) Observation procedures: The data relevant for the study was retrospectively collected from the surgical logbook of the trainee and partly from the hospital’s electronic medical record. (4) Main outcome measures: The post-operative visual outcome, intraoperative complication rate, time taken for surgery and need for trainer intervention were analysed. Results: The mean age of presentation of patients in this study was 66.18 years. Out of 50, 20 were male (40%) and 30 were female (60%). Twenty-five out of 50 patients (50%) had mature cataract (total white cataract), two (4%) had brown cataract and the rest (46%) were immature senile cataract of grade nuclear sclerosis 2–3. The time taken for surgery ranged from 30 to 89 mins. Out of 50, in 22 cases (44%), intervention of the trainer was required and 28 cases (56%) were done independently. Out of 50, 32 patients (64%) gained final best-corrected visual acuity (VA) of 6/12 or better, 6 (12%) gained 6/18, 5 (10%) gained 6/24, 2 (4%) gained 6/36 and 1 patient (2%) was recorded to have VA of 2/60 at post operative day (POD) 6 weeks. Three patients had VA 6/60 or less at final follow-up. One patient had no light perception. There were two complications (complication rate = 4%), both posterior capsular rent – one with vitreous loss and one without. Conclusion: Our study suggests that having a methodical training program is a simple yet effective way to make residents capable of performing independent cataract surgery in the duration of residency itself, thereby preventing the loss of time, resources and energy in the future. This is reflected by the reducing time taken by the trainee to complete the surgery, decreasing need for the trainer to intervene and post-operative outcomes that are comparable to that of other training institutes in the country.