Novel system for distant assessment of cataract surgical quality in rural China.

BACKGROUND

This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings.

DESIGN

This paper applies a retrospective study.

PARTICIPANTS

Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals.

METHODS

Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers.

MAIN OUTCOME MEASURES

Mean score for the performance of each cataract surgical step rated by trainers.

RESULTS

Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039).

CONCLUSIONS

More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings.