Aaronson Alexander, Viljanen Antti, Kanclerz Piotr, Grzybowski Andrzej, Tuuminen Raimo
Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Ann Transl Med. 2020 Nov;8(22):1541. doi: 10.21037/atm-20-845.
To evaluate the learning-curve in performing cataract surgery with respect to developments in technology and different teaching strategies by comparing the incidence of capsular bag-related complications to operator experience.
A review of the registry of 14,520 cataract surgeries carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, from August 8, 2009 to July 31, 2017.
We identified 144 cases with posterior capsule rupture and/or loss of capsular bag support (incidence 0.99% of all surgeries). The mean age of patients was 76.9±9.1 years and gender distribution ratio 29:71 male:female. Pseudoexfoliation syndrome (PXF; incidence 21%) and small pupil (incidence 14%) were over-represented in complication eyes, especially at the beginning of the study. Capsular bag-related complication rates were reported in 0.36% of surgeries for senior and 7.03% for resident surgeons at the beginning of the study, compared to 0.32% and 1.32%, respectively, at the end of the study. Best-corrected visual acuity at the final post-operative visit was 0.61±0.16 decimals at the beginning of the study, and 0.81±0.19 decimals at the end of the study. The mean number of post-operative visits was 4.3±2.7 and did not show trend over the study period.
Real-world evidence suggests PXF and small pupil as significant risk factors in cataract surgery. A gradual decline in the rate complications was noted with increasing surgical experience, also among residents over the follow-up period.
通过比较囊袋相关并发症的发生率与术者经验，评估白内障手术在技术发展和不同教学策略方面的学习曲线。
回顾2009年8月8日至2017年7月31日在芬兰科特卡屈米拉克索中央医院眼科进行的14520例白内障手术的登记记录。
我们确定了144例发生后囊破裂和/或囊袋支持丧失的病例（占所有手术的0.99%）。患者的平均年龄为76.9±9.1岁，性别分布比例为男性:女性=29:71。假性剥脱综合征（PXF；发生率21%）和小瞳孔（发生率14%）在并发症眼中的比例过高，尤其是在研究开始时。在研究开始时，高级外科医生的手术中囊袋相关并发症发生率为0.36%，住院医生为7.03%，而在研究结束时，分别为0.32%和1.32%。术后最后一次随访时的最佳矫正视力在研究开始时为0.61±0.16小数，在研究结束时为0.81±0.19小数。术后平均就诊次数为4.3±2.7次，在研究期间未显示出趋势。
实际证据表明PXF和小瞳孔是白内障手术中的重要危险因素。随着手术经验的增加，并发症发生率逐渐下降，在随访期间住院医生中也是如此。
