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  • Manual cataract extraction taught less but still needed

    Cataract/Anterior Segment

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    This letter to the editor reports the results of a survey showing that the large majority of ophthalmologists in both academia and private practice strongly support continued surgical education in manual extracapsular cataract extraction (ECCE) and even manual small incision cataract surgery (MSICS).

    The authors surveyed ophthalmologists to determine the current status of teaching ECCE and MICS and the extent to which ophthalmologists consider ECCE/MSICS an important skill for ophthalmology residents to master.

    Of the 191 respondents, 80 percent learned ECCE during residency training. This group performed an average of 57 ECCEs as the primary surgeon and observed an average of 71 cases.

    Of the 164 respondents who expressed an opinion, 91 percent stated ECCE should be taught during residency. They felt that observing an average of eight cases and performing an average of 14 cases was needed to become competent at ECCE. Roughly half of them thought ECCE should be taught before phacoemulsification. Although no residency required MICS, 85 percent believed that MICS should be taught in residency.

    The authors write that this survey points to a shift in the training of cataract surgery away from ECCE. ECCE is performed before phacoemulsification in less than one-third of the residency programs, and the number of ECCEs required to graduate averaged two cases per resident. In contrast, a survey of program directors published in 2002 showed that 73 percent of residents began their cataract training with ECCE and more than half were required to complete five or more ECCE cases before proceeding to phacoemulsification.

    The authors conclude that there are still instances in which primary or conversion to manual ECCE may be the preferred procedure, such as in cases with a dense hard nucleus, corneal opacification, zonular loss or dialysis, lens subluxation, or posterior capsular tears. However, a lack of cases and/or competent instructors could be an obstacle to teaching these procedures.