Abstract
Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing
femtosecond laser assisted cataract surgery (FLACS).
Methods A retrospective chart review was conducted at the University of Wisconsin-Madison
from postgraduate year four residents performing FLACS between 2017 and 2019. Data
were also collected from residents performing manual cataract surgery, and attending
surgeons performing FLACS for comparison. Recorded data included patient demographics,
pre- and postoperative visual acuity, pre- and postoperative spherical equivalent,
nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens,
duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative
complications.
Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS
cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident
FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared
with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared
with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and
1-month after surgery among the three groups. Resident FLACS complications, which
included one case requiring an intraoperative suture to close the wound, two cases
with intraoperative corneal abrasions, two cases with postoperative ocular hypertension,
and one case with cystoid macular edema, were not significantly greater than attending
FLACS complications (p = 0.30).
Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to
FLACS performed by attending surgeons, and to manual cataract surgery performed by
resident surgeons. However, resident FLACS cases took significantly longer time to
complete, and they were associated with a higher CDE and minor complication rate compared
with attending FLACS cases. Introducing advanced technologies into surgical training
curricula improves resident preparedness for independent practice, and this study
suggests FLACS can be incorporated safely and effectively into resident education.
Keywords
femtosecond-laser assisted cataract surgery - phacoemulsification - resident training
- curriculum
