July 2018

RESIDENTS

EyeWorld journal club
An updated cataract surgery complexity stratification score for trainee ophthalmic surgeons


Paul Nderitu, MBChB, Paul Ursell, MD

J Cataract Refract Surg. 2018;44(6). Article in press.

Purpose: We devised a comprehensive cataract surgery complexity score for the selection of appropriate cases for trainees and consultants. This evidence-based complexity score utilizes validated risk factors of posterior capsular rupture (PCR), patient-specific factors and complexity stratification recommendations according to surgeon competence. It aims to minimize complications, optimize outcomes, and maximize patient safety.
Setting: Patients undergoing primary phacoemulsification cataract surgery from 1 Jan 2011 until 31 Dec 2016 at Epsom and St Helier University NHS Trust, UK were included; combined corneal, glaucoma or posterior segment procedures were excluded.
Design: Retrospective cohort study
Methods: Anonymized data on demographics, pupil size, pupil expander use, intra/postoperative complications and postoperative best distance visual acuity (BDVA) were extracted. Patients were stratified by complexity score and surgeon grade (consultant, junior, intermediate, senior trainee and fellow).
Results: From 11,468 included cases, 8,200 (71.5%) had a complexity score. Small pupil, pupil expander use, iris-phaco damage, zonular dialysis, postoperative raised intraocular pressure and corneal edema (OR: 3.17 [95% CI: 2.05–4.92]) were significantly associated with increasing complexity score. Use of appropriate complexity grade allocation per surgeon grade resulted in no association between PCR and complexity group. Increasing complexity score was associated with lower postoperative BDVA.
Conclusions: The updated, evidence-based comprehensive cataract complexity score is a useful tool for the stratification of case complexity and guides appropriate case selection to match trainee experience. Higher complexity scores are associated with greater intraoperative and postoperative complications and lower postoperative BDVA. Patients with higher scores should be made aware of the guarded prognosis when obtaining consent.

An updated cataract surgery complexity stratification score for trainee ophthalmic surgeons An updated cataract surgery complexity stratification score for trainee ophthalmic surgeons
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2018-06-25T15:10:28Z
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