Outcomes of Phaco-Emulsification Performed by Residents: A Systematic review and meta-analysis

Document Type : Original Articles

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Misr University for Science and Technology

Abstract

Introduction
Age-related cataract is the leading cause of visual loss worldwide, about 20 million procedures performed annually. Ideal cataract removal results make phaco-emulsification the best option. However, this technique is tough and requires extensive training. In residency programs, wet labs and simulators are used for phaco-emulsification training with a supervisor to avoid difficulties. Resident cataract surgery performance must be assessed to improve surgical results and training.

Methods
A PRISMA-compliant systematic review and meta-analysis were conducted. On August 19, 2024, PubMed, Web of Science, and Scopus were searched. Cross-sectional, cohort, and case-control observational studies on residents phaco-emulsifying patients were included. Excluded were protocols, conference abstracts, non-English studies, and RCTs. Data extraction risk of bias, primary and secondary outcomes, and study features were assessed using the Newcastle-Ottawa Scale (NOS). We used a random-effects model to reconcile between-study variation and sensitivity analysis to evaluate heterogeneity. Meta-analysis followed.

Results
The meta-analysis included four studies (n = 1905) from 51 publications found. The pooled complication rate estimate was 23.4% (95% CI: 16.1% to 30.7%), with considerable heterogeneity (I² = 87.42%). The pooled estimate showed a 65.4% (95% CI: 42.1% to 80.7%) surgery completion rate, with considerable heterogeneity (I² = 97.48%). The sensitivity analysis showed that eliminating one outlier study reduced heterogeneity, confirming the findings' robustness.

Conclusion
Residents complete 65.4% of phaco-emulsifications and 23.4% have complications. These results demonstrate the need for supervision and thorough training to improve results. Research is needed to identify factors that promote resident competency and reduce problems.

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