Eyeworld

EW RESIDENTS 54 July 2018 EyeWorld journal club by Angela Verkade, MD, Rizwan Shaikh, MD, Rishabh Date, MD, Zaina Al-Mohtaseb, MD, and Mitchell Weikert, MD, Cullen Eye Institute, Baylor College of Medicine, Houston system. Their goal was to establish a quantifiable risk scoring system in order to better match patients in their clinic with the appropriate surgeon, thereby decreasing postop- erative/intraoperative complications such as PCR. In the study, 11,468 cases were reviewed and 8,200 (71.2%) of them were assigned a complexity score. The remaining patients served as controls in their retrospective cohort design. Regardless of complexity score, consultant surgeons per- formed 61–85% of cases. They found that grade 5 (highest) complexity carried a 10% incidence of having a smaller pupil but a 7-fold increase in pupil expander use compared to grade 1 cases. Intermediate level trainees used pupil expanding devic- es more often than consultants did during these more complex cases. Both postoperative corneal edema and elevated intraocular pressure were associated with more complex cases. Interestingly, the authors found that there was no increase in brunescent/white cataract, no view to fundus/vitreous opacities, pseudo- exfoliation/phacodonesis, reduced pupil size, axial length, use of alpha blockers, or inability to lie flat—that resulted in a higher risk of PCR. In addition to these factors, Nderitu et al. included other risk factors sugges- tive of intraoperative complications including postoperative corneal ede- ma, hearing impairment, and poor vision in the unoperated eye to their scoring system. The authors calculated a preop- erative composite risk score during their initial clinic appointment based on the risk factors listed above in order to stratify their patients to the appropriate surgeon based on operative experience. They com- pared PCR rates and other intraop- erative and postoperative compli- cations between surgeons. Surgeon training levels ranged from first year trainee surgeons to consultant surgeons with the most case experi- ence. The consultant surgeons oper- ated on the highly complex patients based on the quantified risk scoring P osterior capsular rupture (PCR) during cataract surgery and intraocular lens placement is one of the most feared resi- dent surgeon complications. In an attempt to minimize complications, trainee programs aim to select cases appropriate for each resident level. Varying cataract grading systems have been suggested, but unfortu- nately complications can still occur at all levels. 1,2,3,4,5 In "An updated cataract surgery complexity stratifi- cation score for trainee ophthalmic surgeons," Nderitu et al. suggest a new, more easily quantifiable scoring system that incorporates all of the most recently established risk factors for PCR as determined by the Cataract National Dataset (CND). The CND is a database that utilizes 55,567 operations compiled from the National Health Service (NHS) based in the United King- dom. 6 They analyzed risk factors for PCR and found 11 patient factors— increasing patient age, male gender, glaucoma, diabetic retinopathy, Review of "An updated cataract surgery complexity stratification score for trainee ophthalmic surgeons" Zaina Al-Mohtaseb, MD, associate residency program director, Cullen Eye Institute, Baylor College of Medicine Mitchell Weikert, MD, residency program director, Cullen Eye Institute, Baylor College of Medicine Is there a way to accurately score cataract case complexity preop- eratively for complication risk? I invited the Baylor residents to review this paper from the June issue of JCRS that proposes such a scoring system. —David F. Chang, MD, EyeWorld journal club editor Rishabh Date, MD, Angela Verkade, MD, and Rizwan Shaikh, MD Source: Baylor College of Medicine continued on page 56

• Blank Page
• Blank Page (1)