Joshi Rajesh S, Raza Nida, Wadekar Preeti, Patil Nivedita, Tamboli Sonali, Surwade Tanmay, Bansode Namrata, Turankar Avinash
Department of Ophthalmology, Government Medical College, Nagpur, Maharashtra, India.
Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
Saudi J Ophthalmol. 2023 Mar 9;37(1):15-19. doi: 10.4103/sjopt.sjopt_135_21. eCollection 2023 Jan-Mar.
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.
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 (JR2) and 3-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.
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%) ( = 0.0001). The rate of PCR was not significantly different in JR2 (7.5%) and JR3 (8.8%).
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.
评估连续环形撕囊（CCC）的学习曲线，并评估研究生教学机构中住院医师掌握该技术所需的手术数量。
本前瞻性观察性研究基于10名住院医师第二年（JR2）和第三年（JR3）使用各种技术进行CCC的完成时间和并发症发生率。在253只眼中，使用截囊刀、撕囊镊或联合方法进行CCC，其中160只眼（63.2%）由JR3操作，93只眼（36.8%）由JR2操作。研究了与囊膜延伸数量、后囊膜破裂（PCR）、悬韧带断裂、高级手术辅助需求和核脱失相关的并发症发生率。
完成CCC所需的平均时间为412±90.5秒。住院医师向前房注入粘弹剂的平均次数为6.9±1.4次。CCC的平均大小为7±0.66毫米。扩大的CCC是最常见的并发症。JR2有47只眼（50.5%）需要高级外科医生的协助，而JR3有39只眼（24.4%）需要协助（P = 0.0001）。JR2（7.5%）和JR3（8.8%）的PCR发生率无显著差异。
CCC是实习生难以掌握的一步。专注于这一步骤并进行练习将有助于减少并发症并最大限度地提高熟练程度。掌握CCC大约需要6 - 8次手术。
