Clinical Outcomes and Intraoperative Complication Rates In Mass-Setting Cataract Surgery Performed By Ophthalmology Resident Trainees

AUDREY NEVTASHA B P, dr. Indra Trimahayana, Ph.D, Sp.M; dr. Reny Setyowati, Sp.M; Prof. dr. Suhardjo, S.U., Sp.M(K)

2022 | Skripsi | S1 KEDOKTERAN

Latar Belakang: Salah satu faktor yang mempengaruhi hasil operasi katarak massal bakti sosial adalah operator yang melakukan operasi. Operator bisa merupakan dokter mata maupun residen ophthalmology (mata); Oleh karena itu, karakteristik residen dapat mempengaruhi hasil operasi. Karakteristik residen meliputi semester residensi, pengalaman bedah, dan teknik bedah. Namun, evaluasi mengenai apakah karakteristik residen mempengaruhi proses dan hasil operasi katarak massal masih terbatas di Indonesia. Tujuan: Untuk mengevaluasi hasil operasi katarak massal yang dilakukan oleh residen selama masa pelatihan mereka dan untuk menentukan apakah karakteristik residensi berkorelasi dengan proses dan hasil operasi katarak massal yang dilakukan oleh tim RSUP Dr. Sardjito. Metode: Audit klinis studi kohort retrospektif menggunakan rekam medis pelaksanaan operasi katarak massal yang dilaksanakan pada tahun 2020 - 2021 dengan total 110 pasien dan database residen yang melakukan operasi katarak massal di RSUP dr. Sardjito Hasil: Hanya 88 kasus operasi katarak yang dapat diproses. Mayoritas residen yang berpartisipasi dalam operasi katarak massal berada di semester sembilan, melakukan rata-rata 35.85 operasi, SICS lebih banyak digunakan dibandingkan teknik Fakoemulsifikasi (58.0% vs 42.0%). Komplikasi intraoperatif terjadi pada 45 kasus (51.1%) dengan PCR sebagai jenis yang paling umum (28.41%). Rata-rata IOC menggunakan fakoemulsifikasi (41.9%) lebih tinggi dibandingkan SICS (39.0%). Mahasiswa residen semester tujuh (62.5%) memiliki persentase kejadian IOC yang lebih tinggi menggunakan SICS, sedangkan IOC pada fako lebih banyak terjadi pada mahasiswa semester enam. Rata-rata PCR dengan fako (21.9%) jauh lebih tinggi dibandingkan dengan SICS (19.4%). Baik PCR di SICS dan fako lebih banyak terjadi pada kasus yang dilakukan oleh residen semester ketujuh (56.3% dan 100.0%). 33 kasus (49.2%) memiliki hasil pengelihatan yang baik (logMAR 0.0-0.50). Kesimpulan: Tidak ada hubungan antara karakteristik residen, seperti jumlah semestral dan operasi katarak, dengan adanya komplikasi intraoperatif; tidak ada hubungan antara karakteristik residen dengan BCVA sebagai luaran klinis operasi katarak; namun, terdapat hubungan antara adanya komplikasi intraoperatif dengan BCVA sebagai luaran klinis operasi katarak.

Background: One of the factors which affect the outcome of mass-setting cataract surgery is the operator who performs the surgery. The operator can be an ophthalmologist or ophthalmology resident; therefore, the resident characteristics might influence the surgery outcome. Resident characteristics include residency semestral, surgical experiences, and surgical techniques. However, the evaluations of whether resident characteristics affect the process and outcome of mass cataract surgery remains limited in Indonesia. Objective: To evaluate the outcomes of mass-setting cataract surgery performed by resident trainees during their training experience and to determine whether the characteristics of residency are correlated with the processes and outcome of mass-setting cataract surgery conducted by the RSUP Dr. Sardjito team. Method: A clinical audit with retrospective cohort study, approached by using medical records of the implementation of mass-setting cataract surgery carried out in 2020 - 2021 on a total of 110 patients and resident trainees' database who performed mass-setting cataract surgery at RSUP Dr. Sardjito. Results: Only 88 cataract surgery cases that can be processed. Majority of residents participated in this mass-setting cataract surgery were in ninth semester, performed an average of 35.85 operations, in this study SICS were used more as compared to Phacoemulsification (58.0% vs 42.0%). Intraoperative complications occurred in 45 cases (51.1%) with PCR as the most common type (28.41%). The average of IOC using phacoemulsification technique (41.9%) were higher compared to SICS (39.0%). Seventh semester resident trainees (62.5%) were having higher percentage in IOC occurrences by SICS, meanwhile IOC in phaco mostly happened in sixth semester residents. The average of PCR by phaco (21.9%) were much higher compared to SICS (19.4%). Both PCR in SICS and phaco mostly occurred in surgical cases performed by the seventh semester of resident trainees in this study (56.3% and 100.0%). 33 cases (49.2%) were having good vision results (logMAR 0.0-0.50). Conclusion: There was no association between resident characteristic, such as semestral and cataract surgical experiences, with the existence of intraoperative complications; no association between resident characteristic with BCVA as a clinical outcome of cataract surgery; however, there was an association between the existence of intraoperative complications with BCVA as a clinical outcome of cataract surgery.

Kata Kunci : clinical outcomes, intraoperative complication rates, mass-setting cataract surgery, ophthalmology resident, clinical audit