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AIM:To investigate the effectiveness of surgical simulator-based small-incision extracapsular cataract extraction training for young ophthalmologists.METHODS:Prospective and controlled study. A total of 48 young participants who had completed at least 3a standardized residency training or had obtained the attending certificate in the He Eye Specialist Hospital from 2020 to 2022 were enrolled. All the participants were randomly divided into simulator surgical operation training group(experimental group, n=24)and real animal eye operation training group(control group, n=24)after passing the theoretical training and assessment of small incision extracapsular cataract extraction. The participants in the experimental group and control group were trained with the surgical simulator and pig eyes respectively. After training, the overall effectiveness of training in both groups was rated using the simulator and pig eye operation was evaluated.RESULTS: The participants in the experimental group used less time than the participants in the control group on simulator assessment(all P<0.05). The scores of injecting viscoelastics during keratonyxis, nucleus delivery and hydrate the paracentesis site steps were not different on simulator assessment between the two groups(P>0.05). For the rest of the steps, the scores of experimental group were higher than those of the control group(all P<0.05). Participants in the experimental group had significantly higher scores than control group on pig eye operation assessment(all P<0.05). In the experimental group, the scores of the scleral groove dissection, tunnel dissection, continuous circular capsulorhexis, hydrodissection and hydro-prolapse and nucleus delivery steps had no significant difference between the surgical simulator and pig eye operation(P=0.068, 0.126, 0.960, 0.520, 0.206). The scores of injecting viscoelastics during keratonyxis, tunnel puncture into anterior chamber and hydrate the paracentesis site steps were significantly lower on simulator assessment than pig eye operation(P=0.007, 0.014, <0.01). The scores of the cortex removal and intraocular lens(IOL)implantation were significantly higher on simulator assessment than eye of real animal(P=0.035, <0.01).CONCLUSION:The application of surgical simulator on training small incision extracapsular cataract extraction skills for young ophthalmologists could significantly improve their skills in cataract surgery operation, providing a new mode and idea for the establishment of standardized cataract surgery training for young ophthalmologists.
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Objective To compare and analyze the visual outcome and safety of phacoemulsification with small incision non-phacoemulsification for cataract and provide a reference for the selection of surgery methods in Tibet.Methods A prospective cohort study was performed.Eighty eyes of 80 consecutive patients with age-related cataract were included in Titet Autonomous Region Tibetan Tradition Medicine Hospital from July to August 2016.The eyes were assigned to non-phacoemulsification extracapsular cataract extraction with small incision combined with intraocular lens (IOL) implantation group (small incision group) and phacoemulsification extracapsular cataract extraction combined with IOL implantation group (phacoemulsification group),with 40 eyes for each group.The uncorrected visual outcome and complications were compared between the two groups after surgery.Results There were no significant differences in gender,age,preoperative visual acuity,and lens nuclear hardness between the two groups (all at P＞0.05).The eyes in various post-operative uncorrected visual acuity outcome was not significantly different 1 day and 5 days after surgery between the two groups (both at P＞0.05).In the fifth day after surgery,the eye number in various post-operative uncorrected visual acuity outcome was not significantly different in the eyes with grade Ⅱ and Ⅲ nuclei between the two groups (Z =0.503,P =0.478;Z =0.952,P =0.329).The eye number of acuity ≥0.5 in the small incision group was significantly more than that in the phacoemulsification group in the eyes with grade Ⅳ nuclei (Z =4.501,P =0.034).The eye number with post-operative transiently ocular hypertension was increased in small incision group compared with phacoemulsification group.Conclusions Non-phacoemulsification surgery with small incision has comparable visual outcome with phacoemulsification surgery,and small incision nonphacoemulsification surgery combined with IOL implantation can serve as the preferred surgical method in basic level medical institutions of Tibet.
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Objective To explore the cataract surgery quality on blindness prevention and postoperative problems in village in short period. Design Population-based survey. Participants 251 cases(254 eyes) received operation and 131 cases(134 eyes)were surveyed 6-month postoperatively. Methods Patients were examined 6-month after the small incision extracapsular cataract extraction and intra ocular lens(IOL) implantation. Examinations were conducted by a special oculist including far vision, near vision, external in- spection, anterior segment, posterior segment, intraocular pressure. Main Outcome Measures Visual acuity, intraocular pressure, diopter, eye complications of surgery. Results Naked far vision of the operated eye more than or equal to 0.3 was 41.8%, naked far vi- sion of the eye more than or equal to 0.05 was 82.8%; corrected far vision more than or equal to 0.3 was 64.2%, corrected far vision more than or equal to 0.05 was 92.3%. Naked near vision more than or equal to 0.1 was 79.9%, corrected near vision more than or e- qual to 0.1 was 85.8%. The main postoperative complications were ametropia, posterior capsule opacification(PCO), deformed pupil, pupil displacement, pigments of IOL, eccentric IOL and intraocular hypertension. The chief reasons of eyes that could not be recovered were vitreous, retina or optic nerve diseases, the key factors that caused living vision less than 0.3 were ametropia, PCO, the disease of vitreous, retina and optic nerve. Conclusions The serious complications affecting the surgery result are limited in a low range. The most important factors of the eye corrected far vision less than 0.05 are the vitreous, retina and optic nerve diseases. In order to improve the visual sight, we should add equipment to calculate the IOL diopter accurately.