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Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China

Authors

  • Wenyong Huang MD,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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    • Drs Huang and Ye contributed equally to this work.
  • Ronghua Ye BA,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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    • Drs Huang and Ye contributed equally to this work.
  • Bin Liu MD,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • Qianyun Chen MSc,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • Guofu Huang MD,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • Yizhi Liu MD,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • David S Friedman MD PhD,

    1. Wilmer Eye Institute and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    2. Helen Keller International, New York, New York, USA
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  • Nathan G Congdon MD MPH,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
    2. ORBIS International, New York, New York, USA
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  • Jin Ling MS,

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • Mingguang He MD PhD

    Corresponding author
    1. Helen Keller International, New York, New York, USA
    • State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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  • Conflict/competing interest: No stated conflict of interest.
  • Funding sources: Starr Foundation (New York, USA) through Helen Keller International (New York, USA). Dr Congdon is supported by a grant from the Thousand Man Plan programme of the Chinese government.

Correspondence: Professor Mingguang He, Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou 510060, China. Email: mingguang_he@yahoo.com

Abstract

Background 

To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme.

Design 

Retrospective study.

Participants 

Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals.

Methods 

Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively.

Main Outcome Measures 

Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity < 6/18)

Results 

Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1 ± 8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was ≥6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity ≥ 6/18 and 38 eyes (10.2%) had pinhole visual acuity < 6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity < 6/60 (n = 23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment.

Conclusions 

The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes.

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