A Database Evaluation of Complication Rates and Visual Outcomes of Cataract Surgery Performed by Trainees versus Independent Surgeons
Rickels, Kaersti Elhusseiny, Abdelrahman Chauhan, Muhammad Toma, Joseph Ellabban, Abdallah
Rickels, Kaersti
Elhusseiny, Abdelrahman
Chauhan, Muhammad
Toma, Joseph
Ellabban, Abdallah
Glos Author
Date
2025-10-22
Journal Title
Subject
Type
Journal Article
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Abstract
Purpose:
To compare complication rates and visual outcomes of cataract surgery performed by trainees vs. independent surgeons.
Setting:
Eight United Kingdom clinical centers
Design:
Retrospective multicenter clinical database study
Methods:
We evaluated 15-year data of 35,558 cataract surgeries undertaken by trainees and 77,131 by independent surgeons for the rate of operative complications with emphasis on posterior capsule rupture (PCR) and logarithm of the minimum angle of resolution (logMAR) distance VA (defined as best available value of uncorrected or corrected VA) at 4 to 12 weeks. Recording of intraoperative complications was robust using a predetermined list of cataract surgery complications in the electronic medical record.
Results:
Trainees operated on less complex eyes, with lower rates of advanced cataracts and poor pupillary dilation (p<0.001). Trainee surgeries had a significantly higher rate of PCR (2.4% vs. 1.3%) compared to independent surgeons. Junior trainees had the highest PCR rate at 3.87%, compared to senior trainees at 2.12%. Using the funnel plot methodology, most surgeons appeared to approach the overall mean of PCR, 1.9%, at a surgical volume of approximately 150 cases. At 4 to 12 weeks postoperatively, there was no significant difference in the mean logMAR VA between both groups (0.197 vs. 0.200, Snellen equivalent ∼ [20/30], p= 0.095).
Conclusion:
PCR should be the primary metric for assessing the quality of trainee-performed cataract surgery rather than VA outcomes. Funnel plot representation of PCR provides an equitable approach for monitoring trainees' surgical progress and peer-to-peer comparisons.
Citation
Rickels, K. L., Elhusseiny, A. M., Chauhan, M. Z., Toma, J., Ellabban, A. A., & Sallam, A. B. (2025). A Database Evaluation of Complication Rates and Visual Outcomes of Cataract Surgery Performed by Trainees versus Independent Surgeons. Journal of cataract and refractive surgery, 10.1097/j.jcrs.0000000000001812. Advance online publication. https://doi.org/10.1097/j.jcrs.0000000000001812