Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Ophthalmology, University of California, San Francisco, United States.
Department of Ophthalmology, University of California, San Francisco; Department of Ophthalmology, University of Miami Bascom Palmer Eye Institute, Miami, FL, United States.
Indian J Ophthalmol. 2023 Oct;71(10):3344-3351. doi: 10.4103/IJO.IJO_285_23.
To evaluate visual acuity (VA) outcomes and complications from resident physician-performed cataract surgery in a diverse Veterans Affairs Hospital population.
A retrospective chart review was conducted for patients who underwent cataract surgery performed by resident physicians from 01/01/2013 to 12/31/2015 at the Veterans Affairs Medical Center. Intraoperative and postoperative clinical information, best-corrected VA (BCVA) (1 day, months 1, 2-3, and 6), and surgery complications were extracted. Univariable and multivariable linear regression models were performed for risk factors of BCVA change.
This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years. 1154 (97.5%) were males, 493 (41.7%) African-American, and 681 (57.6%) Caucasian. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months, and 0.14 (0.36) at 6 months. 1080 (91.3%) patients experienced VA improvement from baseline and 1023 (86.5%) patients achieved at least 20/40 BCVA at 1 month. There were 86 (7.3%) complications, most commonly including 47 (4.0%) posterior capsular tears and 64 (5.4%) vitreous loss. In multivariable analysis, younger age (P < 0.0001), worse baseline VA (P < 0.0001), and absence of iris prolapse (P < 0.001) were significantly associated with greater improvement in VA at 1 month.
In a diverse VAMC, resident-performed cataract surgeries achieved significant improvement in VA with a cumulative complication rate lower than previously reported. Resident physician education may benefit from specific focus on prevention of iris prolapse and better incision construction during surgery as these intraoperative events often led to delayed stabilization of visual outcome beyond 1 month.
评估在退伍军人事务部医院的多样化人群中，住院医师实施白内障手术后的视力（VA）结果和并发症。
对 2013 年 1 月 1 日至 2015 年 12 月 31 日期间在退伍军人事务医疗中心由住院医师进行白内障手术的患者进行回顾性图表审查。提取术中及术后临床信息、最佳矫正视力（BCVA）（术后 1 天、1 个月、2-3 个月、6 个月）和手术并发症。对 BCVA 变化的危险因素进行单变量和多变量线性回归模型分析。
本研究纳入 1183 例患者，平均（SD）年龄为 70.8（9.3）岁。1154 例（97.5%）为男性，493 例（41.7%）为非裔美国人，681 例（57.6%）为白人。基线时 logMAR 平均（SD）视力为 0.69（0.74），术后 1 个月时改善至 0.19（0.36），术后 2-3 个月时改善至 0.16（0.34），术后 6 个月时改善至 0.14（0.36）。1080 例（91.3%）患者从基线开始视力改善，1023 例（86.5%）患者在术后 1 个月时至少达到 20/40 BCVA。共有 86 例（7.3%）发生并发症，最常见的包括 47 例（4.0%）后囊破裂和 64 例（5.4%）玻璃体脱出。多变量分析显示，年龄较小（P < 0.0001）、基线视力较差（P < 0.0001）和无虹膜膨出（P < 0.001）与术后 1 个月时 VA 的显著改善显著相关。
在退伍军人事务部的多样化人群中，住院医师进行的白内障手术在 VA 方面取得了显著的改善，且总的并发症发生率低于先前报道。住院医师教育可能受益于特定的重点关注，以防止虹膜膨出和手术中更好的切口构建，因为这些术中事件往往导致视觉结果在 1 个月后延迟稳定。
