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Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal

Received: 13 November 2013     Published: 10 December 2013
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Abstract

Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors’ intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst post-operative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors’ intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer’s Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.

Published in Journal of Surgery (Volume 1, Issue 5)
DOI 10.11648/j.js.20130105.11
Page(s) 63-69
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Cataract, MSICS, Trainee Ophthalmologist, Learning Curve

References
[1] Gogate P, Deshpande M, Nirmalan PK. Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology. 2007; 114(5): 965-968.
[2] Ashok G. Clinical Significance and Relevance of Small Incision Cataract Surgery in the 21st Century Era. In: Ashok G, Amulya S, Franscisco J, Carlos I. Keiki RM, Dhull CS, editors. Master’s Guide to Manual Small Incision cataract surgery (MSICS). Japee, India 2009. p. 3-9.
[3] Khanna R, Pujari S, Sangwan V. Cataract surgery in developing countries. Curr Opin Ophthalmol 2011; 22:10–14
[4] Aravind H, David F, Mascarenhas R, Madhu S. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg 2012; 38:1360–69
[5] Muhammad HQ. Non Phaco Sutureless Cataract Surgery with Small Scleral Tunnel Incision Using Rigid PMMA IOLS. Pak J Ophthalmol 2007; 23(1):1-5.
[6] Thomas R, Navin S, Parikh R. Learning micro incision cataract surgery without the learning curve. Indian J Ophthalmol 2008; 56(2):135-7.
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[8] Spaeth GL. Phacoemulsifcation: A senior surgeon's learning curve. Ophthalmic Surg. 1994;25: 504-9.
[9] Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004; 11:369–80
[10] Albrecht H. Sutureless Non-phaco Cataract Surgery: A Solution to Reduce Worldwide Cataract Blindness? Comm Eye Health 2003; 16: 51-52
[11] Blumenthal M, Ashkenazi I, Assia E, Cahane M. Small incision, manual extracapsular cataract extraction using selective hydrodissection. Ophthalmic Surg 1992;23:699-701.
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[16] Hennig A. Nucleus management with Fishhook. Indian J Ophthalmol 2009; 57: 35-7.
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Cite This Article
  • APA Style

    Emmanuel Olu Megbelayin, Ashok Rangarajan, Sreedhar Pindikura. (2013). Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal. Journal of Surgery, 1(5), 63-69. https://doi.org/10.11648/j.js.20130105.11

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    ACS Style

    Emmanuel Olu Megbelayin; Ashok Rangarajan; Sreedhar Pindikura. Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal. J. Surg. 2013, 1(5), 63-69. doi: 10.11648/j.js.20130105.11

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    AMA Style

    Emmanuel Olu Megbelayin, Ashok Rangarajan, Sreedhar Pindikura. Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal. J Surg. 2013;1(5):63-69. doi: 10.11648/j.js.20130105.11

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  • @article{10.11648/j.js.20130105.11,
      author = {Emmanuel Olu Megbelayin and Ashok Rangarajan and Sreedhar Pindikura},
      title = {Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal},
      journal = {Journal of Surgery},
      volume = {1},
      number = {5},
      pages = {63-69},
      doi = {10.11648/j.js.20130105.11},
      url = {https://doi.org/10.11648/j.js.20130105.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20130105.11},
      abstract = {Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors’ intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst post-operative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors’ intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer’s Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.},
     year = {2013}
    }
    

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  • TY  - JOUR
    T1  - Learning Curve of a Trainee Ophthalmologist in Manual Small Incision Cataract Surgery: A Self-Appraisal
    AU  - Emmanuel Olu Megbelayin
    AU  - Ashok Rangarajan
    AU  - Sreedhar Pindikura
    Y1  - 2013/12/10
    PY  - 2013
    N1  - https://doi.org/10.11648/j.js.20130105.11
    DO  - 10.11648/j.js.20130105.11
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 63
    EP  - 69
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20130105.11
    AB  - Purpose: To appraise the learning pattern in Manual Small Incision Cataract Surgery (MSICS) of a trainee ophthalmologist. Setting: Sankara Eye Hospital, Pammal, Chennai, India. Design: Retrospective study. Methods: Case files of patients who underwent MSICS during the training were reviewed. Surgical complications, nucleus density, extent of supervisors’ intervention in surgeries and visual acuity were either tabulated or graphically presented. Two-way ANOVA and multiple regressions were used to compare dependent variables. Results: There were 123 eyes of 123 patients {males 49 (39.8%), females 74 (60.2%)}. The mean age was 63.19 + 6.6 years with a range of 40-80 years. The worst post-operative visual acuity (VA) was in the first month of training. With an overall complication rate of 30.9%, posterior capsular rent (PCR) was most prevalent in eyes operated in the first month of training (3 of 18 eyes, 16.7%). Supervisors’ intervention in surgeries was highest in the first month of training and declined as training progressed. Fischer’s Exact test for intraoperative complications and extents of supervision showed a statistically significant (P = 0.012). Multiple logistic regression analysis showed that density of nucleus was statistically significant (P = 0.02). Conclusions: Three months appear sufficient for learning the surgical rudiments of MSICS for a trainee with a modest competence in Extra-capsular Cataract Extraction (ECCE), especially if surgeries are performed on a continuous basis during the period.
    VL  - 1
    IS  - 5
    ER  - 

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Author Information
  • Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria

  • shok Rangarajan, FRCS, Sankara Eye Hospital, Sankara Nagar, Pammal, Chennai, Tamil Nadu, India

  • Tulsi Chanrai Foundation, General Hospital, Calabar, Nigeria

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