title: Comparison of the Posterior Capsule Rupture Rates Associated with Conventional (Start to Finish) Versus Reverse Methods of Teaching Phacoemulsification.
abstract: OBJECTIVE
  Comparison of the rates of posterior capsule rupture (PCR) associated with conventional versus a reverse method of teaching phacoemulsification.
  
  
  METHODS
  Trainees were taught conventional (start-to-finish) phacoemulsification beginning with an incision (tunnel construction) to capsulorhexis, sculpting, nucleus cracking, segment removal, cortex aspiration, intraocular lens implantation, and viscoelastic removal. In the reverse method, after incision and capsulorhexis, the trainees were progressively taught viscoelastic wash, cortex aspiration, segment removal, nucleus cracking, sculpting, and intraocular lens implantation. Trainees from a Tertiary Eye Care Centre were classified as beginners, for their first 30 cases and then trainees for their next 70 surgeries. Data were collected on posterior capsular rent and vitreous loss during each step of training.
  
  
  RESULTS
  Thirty-two ophthalmic surgeons learning phacoemulsification surgery on 609 cataracts cases were supervised by 3 trainers. Fifteen beginners performed 287 surgeries using the conventional method, and 17 beginners performed 322 surgeries with the reverse method. The incidence of PCR was 18/287 (6.2%) with the conventional method and 15/322 (4.6%) with the reverse method (P = 0.38). PCR occurred during cortex aspiration (8/287, 2.8%) and segment removal (5/287, 1.7%) in the conventional method. PCR occurred during nucleus cracking, segment removal, and cortex aspiration (4/322 surgeries for each step, 1.2%). In the follow, 70 cases (trainees) there was no difference in PCR with either method (4.7% vs. 4.3%, P = 0.705).
  
  
  CONCLUSIONS
  Conventional and reverse method for training phacoemulsification were both safe in a supervised setting.
authors.affiliation: Department of Ophthalmology, Armed Forces Hospital, Muscat, Oman; Department of Ophthalmology, Bharti Vidyapeeth Medical College, Sangli, India; Lions National Association for the Blind Eye Hospital, Miraj, India.
authors.forename: Milind
authors.initials: M
authors.lastname: Suryawanshi
authors.affiliation: Department of Ophthalmology, Padmashri D. Y. Patil Medical College, Pimpri, Maharashtra, India; Dr. Gogate's Eye Clinic, Pune, Maharashtra, India.
authors.forename: Parikshit
authors.initials: P
authors.lastname: Gogate
authors.affiliation: Department of Ophthalmology, Bharti Vidyapeeth Medical College, Sangli, India; Lions National Association for the Blind Eye Hospital, Miraj, India; Dr. Kulkarni Eye Hospital, Miraj, India.
authors.forename: Anil N
authors.initials: AN
authors.lastname: Kulkarni
authors.affiliation: Lions National Association for the Blind Eye Hospital, Miraj, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Biradar
authors.affiliation: Lions National Association for the Blind Eye Hospital, Miraj, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Bhomaj
mesh_terms: D000368:Aged; D019923:Capsulorhexis; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007396:Internship and Residency; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification / Q000193:education* / Q000379:methods*; D057851:Posterior Capsular Rupture, Ocular / Q000453:epidemiology*; D013663:Teaching; D014792:Visual Acuity
keywords: Cataract Surgery; Intra-Operative Complication; Phacoemulsification; Surgical Training