Evaluating continuous curvilinear capsulorhexis proficiency via video analysis.

PURPOSE: Continuous curvilinear capsulorhexis (CCC) quality affects posterior capsule opacification and visual outcomes after cataract surgery. We developed a novel metric, the Capsulotomy Proficiency Index (CPI), to objectively evaluate the CCC manipulation during cataract surgery. METHODS: We developed a self-design code using MATLAB software to outline the motion trail of the capsulorhexis forceps, the surgical field motion amplitude, the CCC profile (circularity, deviation, decentration), the number of grasps and the total and effective CCC operating time, etc. Considering the weight of each parameter, an integrated CPI value was used to evaluate each CCC surgical video. A Mann-Whitney U test was used to compare the mean CPI from the two groups. RESULTS: This study included two surgeons with different total cataract surgery volumes (group A: a surgeon with experience of less than 500 cases, group B: a surgeon with experience of more than 1000 cases). 15 CCC videos from each surgeon during the same working period were randomly selected. Group A demonstrated a significantly lower CPI mean value than group B (0.47±0.32 and 0.89±0.23), indicating a significant difference in surgical level. CONCLUSIONS: Based on the objective CCC surgical video evaluation, the CPI could reflect the surgical level difference in CCC manipulation.