title: Results and safety profile of trainee cataract surgeons in a community setting in East Africa.
abstract: OBJECTIVE
  To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities.
  
  
  METHODS
  We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation.
  
  
  RESULTS
  Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%).
  
  
  CONCLUSIONS
  AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.
authors.affiliation: Department of Ophthalmology, Glaucoma Service, Moorfields Eye Hospital, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mavrakanas
authors.affiliation: Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania.
authors.forename: Kazim A
authors.initials: KA
authors.lastname: Dhalla
authors.affiliation: Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania.
authors.forename: Jerry
authors.initials: J
authors.lastname: Jecha
authors.affiliation: Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania.
authors.forename: Imani
authors.initials: I
authors.lastname: Kapesa
authors.affiliation: Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia.
authors.forename: Capucine
authors.initials: C
authors.lastname: Odouard
authors.affiliation: Institute of Ophthalmology, University College London, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Murdoch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D003153:Community Health Services; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D009885:Ophthalmology / Q000193:education*; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education* / Q000592:standards; D013636:Tanzania; D016896:Treatment Outcome