Evaluation of the World Health Organization outcome standards at the early and late post-operative visits following cataract surgery.

INTRODUCTION: This study was conducted to determine whether the World Health Organization (WHO) visual acuity standards are correlated between the early and late early post-operative periods following phacoemulsification (phaco) and small incision extracapsular cataract surgery (SICS). Secondary aims were to compare visual outcomes and complications following SICS and phaco. METHODS: Retrospective cohort study following phaco and SICS performed by one surgeon. Primary outcome measures included uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) at the early (≤72 hours) and late (≥21 days) post-operative visits. Secondary outcome measures included complications and astigmatism. RESULTS: 705 eyes were studied (509 phaco, 196 SICS). The correlation for UCVA between early and late follow-up examinations was higher for phaco (rs=0.58) compared to SICS (rs=0.45, p=0.04) while correlation for BCVA was similar (phaco,rs=0.52; SICS, rs=0.47; p=0.44). At the early post-operative visit, a higher proportion in the phaco group achieved ≥6/18 UCVA (81.5% phaco vs 64.8% SICS, p<0.0001) and BCVA (87.8% phaco vs 73.5% SICS, p<0.0001). At the late post-operative visit, a higher proportion following phaco also achieved ≥6/18 UCVA (93.9% phaco vs 85.2% SICS, p=0.0004) and BCVA (96.9% phaco vs 91.3% SICS, p=0.004). After exclusion of eyes with pre-existing ocular comorbidities, a similar proportion had ≥6/18 late UCVA (98.9% phaco vs 96.9% SICS, p=0.22) and BCVA (100% phaco vs 99.2% SICS, p=0.27). CONCLUSIONS: Early and late post-operative WHO visual acuity levels are correlated, but not equivalent, following both phaco and SICS. In eyes without comorbidities, similar final visual outcomes can be achieved after phaco and SICS.

Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery.

PURPOSE: To develop and test the validity of a surgical competency assessment tool for simulated small-incision cataract surgery (SICS). SETTING: Participating ophthalmologists contributed from 8 countries. DESIGN: Qualitative and quantitative development and evaluation of face and content validity of an assessment rubric, and evaluation of construct validity and reliability. METHODS: The SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR) was developed and assessed for face and content validity by an international group of experienced ophthalmologists. Groups of novice and competent surgeons from 4 countries were recorded performing surgery, and masked assessments were performed by 4 expert surgeons, to determine construct validity and reliability. RESULTS: The Sim-OSSCAR for SICS was assessed by a panel of 12 international experts from 8 countries. In response to the question, "Do you think the OSSCAR represents the surgical techniques and skills upon which trainees should be assessed?," all respondents either agreed or strongly agreed. Face validity was rated as 4.60 (out of 5.0). The content was iteratively agreed to by the panel of experts; final content validity was rated as 4.5. Interobserver reliability was assessed, and 17 of 20 items in the assessment matrix had a Krippendorff α correlation of more than 0.6. A Wilcoxon rank-sum test showed that competent surgeons perform better than novices (P = .02). CONCLUSIONS: This newly developed and validated assessment tool for simulation SICS, based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, has good face and content validity. It can play a role in ophthalmic surgical education.

Improved Refractive Outcomes of Small-Incision Extracapsular Cataract Surgery after Implementation of a Biometry Training Course.

PURPOSE: To determine whether a biometry training course could improve refractive outcomes of patients undergoing manual small-incision extracapsular cataract surgery (SICS). MATERIALS AND METHODS: This was a prospective, interventional, cohort study at the Pacific Eye Institute, Fiji. SICS refractive outcomes were evaluated before and after a structured biometry teaching course. Eyes that underwent evaluation and subsequent SICS with placement of a posterior chamber intraocular lens (IOL) were included. Axial length measurements were obtained using A-scan applanation ultrasound and keratometry with a handheld keratometer. Main outcome measures included mean absolute prediction error of IOL calculations, percentage of eyes within ±0.5 D and ±1.0 D of intended spherical equivalent, and proportion of eyes with ≥6/18 uncorrected visual acuity. RESULTS: A total of 240 eyes were analyzed: 120 eyes before and 120 eyes after the structured biometry training. The mean absolute prediction error was 50% lower following the training (1.13 ± 0.84 D pre vs. 0.56 ± 0.44 D post; P < 0.001). A higher percentage of the eyes had a postoperative spherical equivalent within ±0.5 D (26.7% pre vs. 52.5% post; P < 0.001) and ±1.0 D (55.0% pre vs. 90.0% post; P < 0.001) of the intended target. A higher proportion of the eyes achieved ≥6/18 uncorrected visual acuity (77.5% pre vs. 91.7% post, P = 0.004), while the proportion with ≥6/18 corrected visual acuity was similar (94.4% pre vs. 98.3% post; P = 0.28). CONCLUSIONS: A structured biometry training course may improve the accuracy of preoperative IOL calculations to achieve the postoperative refractive target. Ophthalmology training programs should include structured biometry teaching in their curricula.

Nucleus extraction in sutureless surgery: getting hooked!

Simple modifications to a readily available disposable 25 gauge cannula facilitate nucleus extraction in sutureless extracapsular cataract surgery. A case series using the modified cannula, and a temporal incision approach, are presented. Outcomes and complications attributable to the use of the cannula are discussed.