To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

Rajesh S Joshi; Nida Raza; Preeti Wadekar; Nivedita Patil; Sonali Tamboli; Tanmay Surwade; Namrata Bansode; Avinash Turankar

doi:10.4103/sjopt.sjopt_135_21

To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

Saudi J Ophthalmol. 2023 Mar 9;37(1):15-19. doi: 10.4103/sjopt.sjopt_135_21. eCollection 2023 Jan-Mar.

Authors

Rajesh S Joshi¹, Nida Raza¹, Preeti Wadekar¹, Nivedita Patil¹, Sonali Tamboli¹, Tanmay Surwade¹, Namrata Bansode¹, Avinash Turankar²

Affiliations

¹ Department of Ophthalmology, Government Medical College, Nagpur, Maharashtra, India.
² Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.

Abstract

Purpose: To evaluate the learning curve of continuous curvilinear capsulorhexis (CCC) and to assess the number of surgeries required to master it among residents in a postgraduate teaching institute.

Methods: The present prospective observational study was based on the completion time and complication rates related to CCC performed using various techniques by 10 students in the 2^nd (JR2) and 3^rd-year (JR3) of residency. CCC was performed either by a cystotome or capsulorhexis forceps or by a combined method in 253 eyes, of which 160 eyes (63.2%) were operated by JR3 and 93 (36.8%) by JR2. The complication rates were studied with respect to the number of capsular extensions, posterior capsular rent (PCR), zonular dehiscence, need for senior surgical assistance, and nucleus drop.

Results: The average time required for the completion of CCC was 412 ± 90.5 s. The average number of times residents required to fill the anterior chamber with viscoelastic was 6.9 ± 1.4. The average size of CCC was 7 ± 0.66 mm. Extended CCC was the most common complication. JR2 required assistance from a senior surgeon in 47 eyes (50.5%), whereas JR3 required assistance in 39 eyes (24.4%) (P = 0.0001). The rate of PCR was not significantly different in JR2 (7.5%) and JR3 (8.8%).

Conclusion: CCC is a difficult step to master in the trainee. Focusing and practicing on this step will help to reduce the complications and maximize proficiency. Approximately 6-eight surgeries are required to master CCC.

Keywords: Capsulorhexis; cataract surgery; complications of cataract surgery learning in residents; learning curve.