NEWS & OPINION EWAP JUNE 2022 33 by Andrea C. Arteaga, MD, Maria Soledad Cortina, MD, Peter MacIntosh, MD Contact information Arteaga: aartea7@uic.edu MacIntosh: pmacint1@uic.edu Review of Refractive and keratometric outcomes of supervised novice surgeon-performed limbal relaxing incisions: 1-year results’ Modern cataract surgery requires the surgeon to deliver not only visual improvement but also excellent refractive outcomes. Spectacle independence has become part of the goal after surgery for many patients. The correction of visually significant astigmatism is therefore extremely important to achieve desired outcomes. It’s been reported that 50% of patients have significant corneal astigmatism and up to 10% have more than 2 D. 1,2 Even 0.5 to 0.75 D can cause undesirable outcomes and subjective visual symptoms that can worsen the visual quality, particularly in patients undergoing multifocal lens implantation. There are multiple options available to reduce astigmatism during cataract surgery. Toric intraocular lenses are highly effective in treating astigmatism. Limbal relaxing incisions (LRI) have been shown to reduce mild to moderate astigmatism with good long-term outcomes. Manual LRIs are a safe option, although under correction is the norm in most cases. During training, residents must learn conventional cataract surgery but should also in time become familiar with astigmatic correction techniques. Most residency programs will have toric intraocular lenses as the main option for astigmatic correction. According to an ASCRS survey, 50% of senior residents had not done LRIs before graduation and 70% thought that they had inadequate experience after graduation. 3 To address this resident sentiment, the authors designed a surgical curriculum to introduce in a stepwise approach astigmatic keratotomies (AK) to residents. Methods This was a retrospective study of patients who underwent cataract surgery performed by senior residents as primary surgeons from three classes. Patients included had visually significant cataract, astigmatism less than 2.5 D, non-perforated LRI, and at least 1 year of follow-up. The surgical curriculum consisted of three different phases, each one with unique objectives, teaching methods, and assessment methods. The first phase included didactics covering fundamentals of LRIs such as patient selection, calculations, and practice in the wet lab with direct feedback and evaluations. In the second phase, residents would calculate the LRI and assist and observe while the attending physician performed the surgery. In the third phase, the resident would complete every step of the surgery from preoperative calculation to performing the LRI. Every step would be supervised and objectively graded by an attending physician using the Extracapsular Cataract Extraction International Council of Ophthalmology (ICO) Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) form. Results and discussion A total of 118 eyes were included in the final analysis. Mean preoperative corneal astigmatism was 1.36 D. At postoperative month 1 (POM1), 90% of the eyes achieved best corrected visual acuity (BCVA) of 20/25 or better and 77% for postoperative month 12 (POM12). Regarding astigmatism, 34% and 36% of eyes achieved a refractive cylinder of 0.5 D or less at POM1 and POM12, respectively. Patients were divided into groups for the analysis depending on the steep meridian location (with-the-rule, against-the-rule, or oblique astigmatism) and depending on the magnitude of the astigmatism (<1 D, 1–2 D, and >2 D). All groups demonstrated This article originally appeared in the April 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
RkJQdWJsaXNoZXIy Njk2NTg0