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      Effect of wet-laboratory training on resident performed manual small-incision cataract surgery

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          Abstract

          Purpose:

          The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS).

          Methods:

          We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups.

          Results:

          The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) ( P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% ( P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A.

          Conclusion:

          The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome.

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          Most cited references19

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          The resident surgeon phacoemulsification learning curve.

          To analyze outcomes of resident-performed phacoemulsifications and to assess the resident phacoemulsification learning curve. Retrospective chart review of resident-performed phacoemulsification cases at the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, from July 1, 1999, through June 30, 2002. Outcomes measured included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraoperative complications, and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). We analyzed 680 cases. Postoperative mean UCVA was 20/39, and mean BSCVA was 20/25 (> or = 20/20 in 44.0% of cases and > or = 20/40 in 97.8%). There were no differences in visual acuity outcomes over the course of residency training. Intraoperative complications occurred in 34 cases (5.0%), with a significant reduction in vitreous loss rates after the first 80 resident cases (5.1% vs 1.9%; P = .03). Mean adjusted phacoemulsification time was 0.68 minutes, with a significant reduction in adjusted phacoemulsification time after the first 80 cases (0.87 vs 0.52 minutes; P < .001). Quality visual outcomes after phacoemulsification can be attained throughout residency training; however, surgical competency, when measured by complication rates and phacoemulsification efficiency, continues to improve significantly with increasing surgical experience well beyond the first 80 resident phacoemulsification cases.
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            Influence of surgery simulator training on ophthalmology resident phacoemulsification performance.

            To determine whether the use of an eye-surgery simulator during ophthalmology residency training improves cataract surgery performance.
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              Is Open Access

              Current status of cataract blindness and Vision 2020: The right to sight initiative in India

              Background: India is a signatory to the World Health Organization resolution on Vision 2020: The right to sight. Efforts of all stakeholders have resulted in increased number of cataract surgeries performed in India, but the impact of these efforts on the elimination of avoidable blindness is unknown. Aims: Projection of performance of cataract surgery over the next 15 years to determine whether India is likely to eliminate cataract blindness by 2020. Materials and Methods: Data from three national level blindness surveys in India over three decades, and projected age-specific population till 2020 from US Census Bureau were used to develop a model to predict the magnitude of cataract blindness and impact of Vision 2020: the right to sight initiatives. Results: Using age-specific data for those aged 50+ years it was observed that prevalence of blindness at different age cohorts (above 50 years) reduced over three decades with a peak in 1989. Projections show that among those aged 50+ years, the quantum of cataract surgery would double (3.38 million in 2001 to 7.63 million in 2020) and cataract surgical rate would increase from 24025/million 50+ in 2001 to 27817/million 50+ in 2020. Though the prevalence of cataract blindness would decrease, the absolute number of cataract blind would increase from 7.75 million in 2001 to 8.25 million in 2020 due to a substantial increase in the population above 50 years in India over this period. Conclusions: Considering existing prevalence and projected incidence of cataract blindness over the period 2001-2020, visual outcomes after cataract surgery and sight restoration rate, elimination of cataract blindness may not be achieved by 2020 in India.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                June 2018
                : 66
                : 6
                : 793-797
                Affiliations
                [1]Department of Ophthalmology, Ramaiah Medical College, Bengaluru, Karnataka, India
                Author notes
                Correspondence to: Dr. Thanuja Gopal Pradeep, 705, Renaissance Park 2, Subramanyanagar, Malleswaram West, Bengaluru - 560 055, Karnataka, India. E-mail: thanugopal@ 123456yahoo.co.in
                Article
                IJO-66-793
                10.4103/ijo.IJO_1041_17
                5989499
                29785985
                fadaf2a0-c497-4b10-a486-3673534cbe25
                Copyright: © 2018 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 14 November 2017
                : 21 March 2018
                Categories
                Original Article

                Ophthalmology & Optometry
                complications,manual small-incision cataract surgery,resident performed surgery,visual outcome,wet-laboratory training

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