Comparing morphologic features and complications of main clear corneal incision between junior and senior residents observed using anterior segment optical coherence tomography

Abstract Background: Wound construction is a critical step in phacoemulsification. Using anterior segment optical coherence tomography (AS-OCT), we compared the morphological features and complications of main incisions made by junior or senior residents during phacoemulsification. Methods: This cross-sectional comparative study included eyes with senile cataracts that underwent uneventful phacoemulsification with a clear corneal incision made by seven senior and eight junior ophthalmology residents. All eyes underwent postoperative image acquisition using AS-OCT on day one and at three months, examining for morphological features and potential complications of the main incision. Results: We included ۵۰ eyes of ۵۰ patients with a male-to-female ratio of ۲۲ (۴۴%) to ۲۸ (۵۶%); ۲۶ (۵۲%) were operated on by junior residents and ۲۴ (۴۸%) by seniors. The mean geometric features of the main incisions and the frequency of early and late wound complications were comparable between the two groups (all P > ۰.۰۵). A significant correlation was found between the incision length and angle with the superior (r = + ۰.۸۰; P < ۰.۰۰۱ and r = - ۰.۶۳; P < ۰.۰۰۱, respectively) and inferior (r = + ۰.۸۴; P < ۰.۰۰۱ and r = - ۰.۶۸; P < ۰.۰۰۱, respectively) areas of the incision, as well as between the length and angle of incision (r = - ۰.۷۴; P < ۰.۰۰۱). The number of planes in the wound architecture was not significantly different according to senior or junior resident status (P > ۰.۰۵). Although the number of eyes with stromal hydration was significantly greater for junior residents than for seniors (P < ۰.۰۰۱), the corneal thickness at the entrance to the cornea or the anterior chamber, presence of endothelial wound gaping, and Descemet’s membrane detachment were comparable between eyes with and without stromal hydration (all P > ۰.۰۵). At three months, ۲۹ (۵۸%) patients returned for examination, in whom seven (۲۴%) had late wound complications. Conclusions: This study found no significant differences in the performances of junior and senior residents in terms of wound construction or its associated complications. However, considering the overall rate of some observed wound-related complications, we recommended revision of the resident educational curriculum concerning the structure and complications of the main incision.