Major intraoperative complications in low-risk cataract surgery: A comparative analysis of senior residents and attending surgeons

Objective To compare major intraoperative complication (MIC) rates in low-risk cataract surgeries performed by senior residents versus attending surgeons and evaluate complication characteristics. Methods A total of 1,316 low-risk senile cataract cases operated between March 2023-March 2024 at the University of Health Sciences Beyoglu Eye Training and Research Hospital were retrospectively reviewed for MICs. MICs included posterior capsule rupture, vitreous loss, zonular dialysis, nucleus drop. High-risk cases were excluded. Surgeons were classified as the senior resident group (>80 independent surgeries) or the attending surgeon group. Results MICs were identified in 25 of 819 cases (3.05%) in the senior resident group and 5 of 497 cases (1.0%) in the attending surgeon group ( p < 0.05). Relative risk (RR) analysis showed a 3-fold higher MIC risk for the senior resident group (RR = 3.034; 95% CI: 1.169–7.875). Among the 25 cases with MICs in the senior resident group, posterior capsule rupture (24 cases) and vitreous loss (22 cases) were the most frequent, occurring predominantly during cortical cleanup (16 cases) ( p < 0.05). Among complicated cases in the senior resident group, mixed-type cataracts were the most frequently represented morphology. The most common management steps for complicated cases were anterior vitrectomy and sulcus IOL implantation. Postoperative visual acuity significantly improved in both groups ( p < 0.05). Conclusion Surgical experience was associated with MIC rates even in low-risk cases. Stratifying surgical training according to case difficulty may enhance patient safety.