Visual and anatomical outcomes of phacoemulsification by residents at different training levels versus an attending surgeon

Background Surgical experience is an important determinant of cataract surgery outcomes; however, its impact on both refractive accuracy and corneal endothelial integrity across different levels of residency training remains incompletely characterized. This study aimed to evaluate whether surgeon training level is associated with differences in visual, refractive, and selected anatomical outcomes following phacoemulsification. Methods In this retrospective cohort study, patients undergoing phacoemulsification performed by an attending surgeon, senior residents, and junior residents were analyzed. Primary outcomes included postoperative best-corrected visual acuity (BCVA), refractive error, and endothelial cell density (ECD). Secondary outcomes included intraocular pressure (IOP), anterior chamber angle (ACA), and operative time. Results A total of 162 eyes were included. Preoperative characteristics were comparable among groups ( p > 0.05). Operative time differed significantly, being longest in the junior resident group ( p < 0.01). All groups demonstrated significant postoperative improvement in BCVA ( p < 0.001), with no statistically significant intergroup differences. Although the attending group showed numerically lower endothelial cell loss and slightly better refractive outcomes, these differences were not statistically significant ( p > 0.05). Multivariable regression analysis demonstrated that surgeon training level was not independently associated with endothelial cell loss after adjustment for age, operative time, and biometric parameters. Conclusions Phacoemulsification performed by residents under supervision yields visual and refractive outcomes comparable to those of attending surgeons. Observed differences in endothelial cell loss and refractive outcomes did not reach statistical significance, and surgeon training level was not independently associated with endothelial cell loss after adjustment for potential confounders. Further studies incorporating intraoperative metrics and case complexity are needed to better define the impact of surgical experience.