Assessment of perceived difficulties by residents in performing routine steps in phacoemulsification surgery and in managing complications

Objective: To analyze the perceived difficulties of residents in performing the routine steps of phacoemulsification surgery and in managing complications. Design: Cross-sectional questionnaire-based study. Participants: Thirty-six residents performing phacoemulsification during their learning curve. Methods: On an 8-point Likert scale, residents noted comfort levels with various steps of cataract surgery and with managing complications. Results: The respondents were grouped into Group I (second-year residents, n=19) and Group 2 (third-year residents, n= 17). Residents in Group 2 had greater surgical experience than residents in Group I (p=0.001). The most difficult step in cases of phacoemulsification for Group I was loading a foldable intraocular lens (IOL) (mean score 6.05, SD 1.57), and for Group 2 it was nuclear emulsification (mean score 3.59, SD 1.42). Both second-and third-year residents found capsular bag dialysis the most difficult complication (mean scores 6.0 [SD 1.9] and 5.75 [SD 2.14], respectively). The second-year residents had significantly more difficulty with errant capsulorrhexis, anterior chamber IOL placement, and repeated iris prolapse as compared with third-year residents. Group 2 residents reported that mature, senile cataracts were the most difficult cases for them to manage (mean score 6.23, SD 1.56). Conclusions: This study identifies perceived difficulties that residents experience in routine cases of cataract surgery, highlighting specific areas in which they may benefit from additional training and practice.