Al-Jindan Mohanna, Almarshood Abdullah, Yassin Sanaa A, Alarfaj Khalid, Al Mahmood Ammar, Sulaimani Naif M
Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Department of Ophthalmology, Qassim University, Qassim, Saudi Arabia.
Clin Ophthalmol. 2020 Jan 14;14:113-118. doi: 10.2147/OPTH.S241250. eCollection 2020.
To assess residents' performance of phacoemulsification surgery and determine which steps of the procedure are most difficult to learn, and to measure rate of intraoperative complications.
This was a prospective observational study.
Phacoemulsification surgery was divided into steps and each step was given a proficiency grade by the attending consultant. All intraoperative complications were recorded and analyzed.
200 cases performed by the Eastern Province ophthalmology program residents were evaluated. The most commonly encountered difficulty factors were hard nucleus (20.7%), small pupil (12.6%), and white cataract (10.3%). Capsulorhexis, nucleus disassembly and removal, and cortex removal were the most difficult steps to learn. General complication rate was 17.5%, and posterior capsular rupture was the most common complication (40%). Proficiency more than 90% of the time in each step was noted in residents with prior experience of more than 40 cases, except for nucleus disassembly.
The study showed that nucleus disassembly remained the major obstacle in the residents' exponential learning curve of phacoemulsification surgery. Majority of complications occurred at level of capsulorhexis and cortical removal steps.
评估住院医师的超声乳化手术操作表现，确定该手术过程中哪些步骤最难掌握，并测量术中并发症的发生率。
这是一项前瞻性观察研究。
将超声乳化手术分为多个步骤，由主治顾问对每个步骤给予熟练程度评分。记录并分析所有术中并发症。
对东部省份眼科项目住院医师实施的200例手术进行了评估。最常遇到的困难因素是硬核（20.7%）、小瞳孔（12.6%）和白色白内障（10.3%）。连续环形撕囊、核的分解与取出以及皮质清除是最难掌握的步骤。总体并发症发生率为17.5%，后囊膜破裂是最常见的并发症（40%）。除核的分解外，有超过40例手术经验的住院医师在每个步骤中超过90%的时间内操作熟练。
该研究表明，在住院医师超声乳化手术的指数学习曲线中，核的分解仍然是主要障碍。大多数并发症发生在连续环形撕囊和皮质清除步骤。
