First Author: E.Kanonidou GREECE
Co Author(s): G. Karagiannidis-Stampoulis P. Kalouda D. Balatsoukas
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Difficulties encountered by ophthalmologists-in-training in performing cataract surgery and managing complications depend on their surgical expertise and the patients’ medical and ocular pathology. Specific ocular comorbidities, such as glaucoma and diabetic retinopathy, especially in the more advanced stages, are associated with increased complexity of cataract surgery. Cataract surgery risk assessment with the use of standard parameters aims to predict intraoperative complications in a more subjective way. Our purpose was to evaluate the contribution of coexisting glaucoma and diabetic retinopathy, in the involved difficulties during cataract surgery performed by ophthalmology residents according to their experience.
Department of Ophthalmology, ''Hippokrateion'' General Hospital of Thessaloniki, Thessaloniki, Greece.
Cataract surgery risk assessment was performed with the use of Cataract surgery risk score evaluation form from the Epsom and St Helier University Hospitals NHS Foundation Trust, Department of Ophthalmology, UK. The form was translated in Greek with the translation-back translation technique. Routine cases of cataract patients were evaluated during their scheduled visits in the cataract service of our hospital. The residents filled in the relevant form and calculated the Complexity Score, according to patients’ medical and ocular history and their findings from the ophthalmological examination.
355 consecutive patients (158 males) scheduled for cataract surgery participated in the study. Their mean age (MA) was 75.5 years old and their mean Complexity Score (MCS) was 6.6. 31 patients had glaucoma (MA:75.5 years old, MCS:6.8). 62 patients had diabetes, among them 25 had diabetic retinopathy (MA of the latter: 75.9 years old, MCS:7.3). According to the cataract surgery complexity index used, cases with scores below or equal to 7 should be performed by trainees who had already performed 101-250 surgeries and those with scores between 7.1 and 9 by trainees who had already performed 251-300 surgeries.
Cataract surgery in patients with glaucoma or diabetic retinopathy is often challenging and can result in intraoperative complications. Preoperative evaluation of patients’ history and findings through standardized evaluation forms might help residents to estimate the risks and undertake cases suitable for their expertise, so as to avoid frustration and assist their learning process through gradually more demanding procedures.