Sir,

High volume cataract surgery is being performed by an increasing number of post-CCST (certificate of completion of specialist training) surgeons. Our study demonstrates that national complication rates may be more suited to trainee surgeons than to consultant surgeons.

Case report

Cataract surgery is the most common elective surgical procedure performed in the United Kingdom.1 Guidelines have been created to safeguard practice by allowing surgeons to audit their surgical performance against national and international standards. Studies have shown that the more experienced surgeon has a lower complication rate.2 Current national standards do not take into account the different rates of complications for trainees at different stages in their training, and all complication rates are grouped together as a single figure.

We look at the outcomes of cataract surgery performed by post-CCST ophthalmologists. Using quantitative analysis of data, we compare their outcomes and complication rates against the national and international standards.

A retrospective review of case notes was performed for all patients who underwent phacoemulsification surgery between 1 November 2007 and 31 October 2008 at Moorfields Eye Hospital. Surgery was performed by either a consultant ophthalmic surgeon or an experienced cataract fellow about to gain his CCST.

With the exception of two cases, the visual acuity improved or stayed the same postoperatively compared with preoperative readings (Figure 1).

Figure 1
figure 1

Comparison of the preoperative and postoperative visual acuities of 152 patients.

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A total of 119 (25.7%) difficult cases were identified from the 462 cases (difficult cases included myopia >5 D, hypermetropia >4 D, vitrectomised eyes, dense white/brunescent cataracts, pseudoexfoliation, small pupils, gross head movements intraoperatively, and patients on Tamsulosin (Table 1)). The complication rate was calculated as 2.60% based on 462 cases. These included zonular dehiscence, anterior vitrectomy, posterior capsular tear, and vitreous prolapse.

Table 1 Number of patients with high-risk ocular comorbidities
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Surgical complications can be minimised by careful planning and identification of risk factors.3 For post-CCST surgeons, we should expect a lower rate of posterior capsular tears and zonular dehiscence than the current rate given by the Royal College of Ophthalmologists (RCO).4 The American Academy of Ophthalmology (AAO) rate of zonular dehiscence and/or posterior capsular rupture is 2.6%:5 exactly the same as our results. We feel that the lower AAO (2.6%) complication rate is a better target for post-CCST surgeons, and the higher RCO rate (4.4%) is more suitable for a trainee ophthalmologist.