Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees

PURPOSE: To measure the relative difficulty of each stage of phacoemulsification surgery performed by basic surgical trainees. SETTING: Mater Misericordiae University Hospital, Dublin, Ireland. METHODS: This prospective study comprised 100 consecutive cases of phacoemulsification performed by 8 trainee surgeons over an 11-month period. The trainees completed a questionnaire at the end of surgery, rating the degree of difficulty of 8 individual stages of phacoemulsification on a 5-point scale from 1 (very easy) to 5 (very difficult). RESULTS: At the start of the study, trainees had spent a mean of 9.4 months training. The mean preoperative best corrected decimal visual acuity was 20/70. The most difficult stages were phacoemulsification and capsulorhexis with the highest mean scores of 3.32 +/- 1.00 (SD) and 3.30 +/- 1.24, respectively and the lowest completion rates of 66.7% and 74.4%, respectively. The first 3 stages of peribulbar blockade (1.72 +/- 0.75), draping the surgical field (1.35 +/- 0.70) and corneal incision (1.97 +/- 0.72) were easiest and had close to a 100% completion rate. Hydrodissection, irrigation/aspiration, and intraocular lens insertion had difficulty rates of 2.42 +/- 0.92, 2.80 +/- 1.10, and 2.58 +/- 1.08, respectively, and completion rates of 92.3%, 78.4%, and 83.1%, respectively. Posterior capsule tear occurred in 9%, including 4% with vitreous loss; there was 1 case of zonular dehiscence. CONCLUSIONS: Trainee surgeons found phacoemulsification and capsulorhexis the most difficult stages of cataract surgery early in the learning curve. More time can be dedicated to mastering these steps in the wet lab.