Learning Cataract Surgery: expected and unexpected experience in a single center, single teacher and single surgeon setting

Purpose To examine the learning behaviour of surgeons undergoing cataract surgery training in an ambulant, single-centre, single-teacher setting. Methods This was a retrospective study to examine the process quality. Cataract surgeries were performed at an eye clinic in Bruchsal, Germany, using manual phacoemulsification technique under local anesthesia or sedation. Surgeon training involved stepwise instruction and practice on porcine eyes and surgical simulators before progressing to complete surgeries. Length of procedure, complication rates and visual outcomes were analysed to assess the effectiveness of the training. Shewhart control charts to assess process quality and detect systematic errors. Results The study included 413 surgeries performed by two trainee surgeons over one year and compared their outcomes with those of an experienced supervisor. Operator A showed a typical learning trajectory, stabilising after 100 operations, whereas Operator B faced challenges, possibly exacerbated by disruptions caused by the COVID-19 pandemic. Both operators showed comparable visual outcomes but differed in complication trends. Conclusions The study highlights the importance of a consistent practice environment and suggests the integration of cataract surgery training into the ambulatory setting to reduce the training burden and increase accessibility.