الفهرس 
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Abstract
Cataract is one of the most frequently occuring visual impairments among the ocular diseases in the world. Cataract in very elderly patients can cause progressive painless vision loss.9 Because of the demographic shift in developed countries toward older age, the prevalence over the whole population has increased.
The visual outcomes and potential complications after cataract surgery performed by ophthalmology residents have been evaluated in many studies allover the world.19-51
This study aimed to: (i) evaluate the postoperative visual acuity (VA) outcomes and determine the incidence of complications of cataract surgery performed by residents; (ii) determine the risk factors for intraoperative complications in resident-performed cataract surgery and the effect of complications on postoperative visual acuity; and (iii) Finally, to give important recommendations to improve the results and lessen the incidence of complications of resident-performed cataract surgery.
In this study, 100 cases with adult cataract admitted at the Ophthalmology Department, Sohag University Hospital along a period between March 2011 and February 2012, and operated upon by the ophthalmology residents, were evaluated for the visual outcome and complications.
According to age, the incidence of cataract was high in older age (70%).
According to sex, a higher incidence was seen among females. According to residence, the study showed a higher incidence in rural areas 82 cases (82%) than in Urban areas 18 cases (18%).
According to the risk factors, aging was the most common risk factor for cataract as 70 cases of cataract (70%) were > 59 years and 30 cases (30%) were < 60 years; followed by ultraviolet radiation as 82 cases (82%) were in rural areas (more exposure to sunlight) and 18 cases (18%) in urban areas. Diabetes was a common risk factor as 17 cases were diabetics (17%), and 26 cases (26%) were hypertensives. One case with retinitis pigmentosa and one case with chronic glucoma on treatment were seen .
According to the type of cataract, mature cataract were seen in 78 cases (78%), and immature cataract in 18 cases.
Complications of cataract surgery done by the ophthalmology residents in this study included:
Retrobulbar haemorrhage occurred in 4 cases (all were hypertensive). Rupture of posterior capsule occurred in 12 cases (12%), 9 cases of them during the step of irrigation aspiration. Dropped nucleus occurred in two cases (2%); the nucleus was large with small cataract incision. Corneal oedema (striate keratopathy) was seen clearly in 28 cases (28%) which indicated excessive intraocular manipulations and endothelial trauma. Residual lens or cortical matter was seen in 17 cases (17%) which indicated inadequate aspiration particularly in immature cataract. The pupil was irregular in about 71 cases (71%); 17 of them with oval pupil which indicates excessive iris trauma , rupture of pupillary sphincter during delivery of the nucleus and posterior synechia. IOL decentration was noticed in 8 cases (8%), 2 of them with one haptic anterior to the iris, one of them with iris capture. Dislocated IOL into the vitreous was seen in one case after one month of follow-up. The IOP increased postoperatively in three cases due to severe keratitis and iritis. Cystoid macular oedema was diagnosed in 3 cases with ruptured posterior capsule which indicated bad outcome to patients with ruptured posterior capsule . Posterior capsular opacification was noticed in 29 cases (29%) during the 3 months follow up period .
Recommendations:
1. There must be a general training protocol system for the ophthalmology residents during the 1st, 2nd, and 3rd years of residency.
2. The Ophthalmology residents should not be allowed to do cataract surgery alone except after an adequate period of training under the supervision of their senior colleagues with a good assistance.
4. A good selection of the first cataract cases for residents should be done, with clear cornea (avoid cases with corneal opacity), normal IOP, and normal depth of anterior chamber.
5. Adequate corneal incision should be done to avoid rupture of the posterior capsule with its sequelae e.g. dropped nucleus or vitreous loss.
6. Adequate irrigation /aspiration should be done to avoid residual cortical or lens matter with its sequelae e.g. postoperative uveitis and increased IOP.
7. Regular reformation of the AC during surgery with viscoelastic substance prevents its collapse which leads to corneal endothelial trauma and posterior capsule rupture.
8. A good capsulotomy or capsulorrhexis should be done as remnants of the anterior capsule may lead to rupture of the posterior capsule during aspiration .
9. Avoid excessive intraocular manipulations which lead to trauma to the corneal endothelium with severe postoperative corneal oedema; iris trauma with postoperative irregular pupil and iritis; and rupture of posterior capsule.
10. In cases with ruptured posterior capsule and vitreous loss, you should perform a good anterior vitrectomy.
11. Be sure of a good IOL centration at the end of surgery to avoid complications related to IOL displacements after surgery.
12. Regular postoperative follow up.