Magyar Márton, Sándor Gábor László, Ujváry László, Nagy Zoltán Zsolt, Tóth Gábor
Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.
Int J Ophthalmol. 2022 Apr 18;15(4):586-590. doi: 10.18240/ijo.2022.04.10. eCollection 2022.
To compare the incidence of intraoperative complications during primary phacoemulsification (phaco) surgery between resident surgeons (residents) and staff surgeons (specialists) and to objectively determine the difficulty of stages in phaco surgery.
This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.
A total of 3272 cases were included; 7.4% (=241) of cases were performed by residents. The overall complication rate was 5.4% (=177). The intraoperative complication rate was significantly higher (<0.001) in residents (=33, 13.7%) than in specialists (=144, 4.8%). The most frequent complications were posterior capsule tear (=85, 2.6%), anterior capsule tear (=50, 1.53%), zonular fiber loss (=45, 1.38%), and dropped nucleus (=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66 (60.0%), capsulorhexis in 21 (19.1%), irrigation/aspiration in 13 (11.8%), hydrodissection in 9 (8.2%), and intraocular lens (IOL) implantation in 1 (0.9%) case.
Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.
比较住院医师（住院医生）和 staff 外科医生（专科医生）在原发性白内障超声乳化手术（phaco）期间术中并发症的发生率，并客观确定 phaco 手术各阶段的难度。
这项回顾性研究纳入了 2019 年 1 月至 12 月期间进行的 phaco 白内障手术病例。没有排除标准。对每位患者的人口统计学、临床病史、病例复杂性、外科医生类型和手术细节进行了回顾。主要结局包括术中并发症发生率以及住院医生和专科医生在手术步骤中难度的客观测量。
共纳入 3272 例病例；7.4%（=241 例）由住院医生完成。总体并发症发生率为 5.4%（=177 例）。住院医生（=33 例，13.7%）的术中并发症发生率显著高于专科医生（=144 例，4.8%）（<0.001）。最常见的并发症是后囊膜撕裂（=85 例，2.6%）、前囊膜撕裂（=50 例，1.53%）、悬韧带纤维丢失（=45 例，1.38%）和晶状体核掉落（=15 例，0.46%）。客观上，手术中最困难的步骤是超声乳化 66 例（60.0%）、撕囊 21 例（19.1%）、灌注/抽吸 13 例（11.8%）、水分离 9 例（8.2%）和人工晶状体（IOL）植入 1 例（0.9%）。
住院医生的术中并发症发生率高于专科医生。phaco 手术步骤客观难度顺序与其他调查的主观结果一致，表明 phaco手术最具挑战性的部分是超声乳化和撕囊。
