An evaluation of the learning curve and complication rate of phacoemulsification in India

Purpose: In India 3.8 million new persons develop cataract blindness yearly, but only 2 million cataract operations are performed. Phacoemulsification (phako) can be both quicker and require less postoperative care than extracapsular surgery (ECCE), decreasing the backlog of blindness. Methods: We prospectively evaluated the first 300 phakos performed with the Alcon Universal between 6/1/95 and 7/31/95, by 3 different experienced (over 20,000 cases each) ECCE surgeons. We analyzed preoperative variables, surgical variables, intraoperative complications; and the results on the first postoperative day. Results: Mean age was 57.4 ± 9.3 years. Preoperative vision was <20/400 in 186 (51.9%) eyes. Mean surgical and phako times were 15.8± 3.7 minutes and 131± 88 seconds, respectively. Complications occurred in 65 (21.7%) eyes. The most common was a rent in the posterior capsule 40 (13.3%) eyes. There was a significant variation in complication rates and surgical time between surgeons (p=0.0001). The complication rate (p=0.015) and these specific complications, significantly decreased with increasing experience: zonular dehiscence, central corneal edema, and inflammation. Conclusions: This is the first prospective study evaluating the learning curve among a large number of consecutive patients from different experienced surgeons and the first done in a developing nation. Phako was done quickly and safely. There is a definite learning curve and variability among surgeons.