Samar A Al-Swailem1, Michael D Wagoner. 1. Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia.
Abstract
PURPOSE: To determine the complication rates and visual outcome of laser-assisted in situ keratomileusis (LASIK) that is performed by anterior segment fellows and to compare their results with the results of their experienced faculty supervisors. DESIGN: A single-center, retrospective, interventional, nonrandomized, comparative case series. METHODS: Chart review of the initial 50 LASIK procedures that were performed by each of 10 anterior segment fellows and the first 50 inclusion criteria-matched, contemporaneously performed cases of four faculty members at the King Khaled Eye Specialist Hospital between March and December 2003. RESULTS: There were no statistically significant differences between fellow and faculty cases with respect to complication rates and final visual outcomes. The fellows were significantly more likely to experience microkeratome-related flap complications during their first 25 cases, compared with their second 25 cases (4.8% vs 1.2%; P = .03). Fellows were significantly more likely to perform enhancements (8.0% vs 2.0%; P = .0002), after which the eyes in their group were more likely to be within 1 diopter of the intended refractive target than those in the faculty group (96.0% vs 91.0%; P = .01). Although not statistically significant, eyes in the fellow group were four-fold (2.0% vs 0.5%) more likely to lose two or more lines of best spectacle corrected visual acuity than those in the faculty group. CONCLUSION: To minimize the adverse impact of complications during the learning curve of novice LASIK surgeons, the introduction of this procedure in a well-structured, supervised setting (such as a subspecialty fellowship training program) is recommended.
PURPOSE: To determine the complication rates and visual outcome of laser-assisted in situ keratomileusis (LASIK) that is performed by anterior segment fellows and to compare their results with the results of their experienced faculty supervisors. DESIGN: A single-center, retrospective, interventional, nonrandomized, comparative case series. METHODS: Chart review of the initial 50 LASIK procedures that were performed by each of 10 anterior segment fellows and the first 50 inclusion criteria-matched, contemporaneously performed cases of four faculty members at the King Khaled Eye Specialist Hospital between March and December 2003. RESULTS: There were no statistically significant differences between fellow and faculty cases with respect to complication rates and final visual outcomes. The fellows were significantly more likely to experience microkeratome-related flap complications during their first 25 cases, compared with their second 25 cases (4.8% vs 1.2%; P = .03). Fellows were significantly more likely to perform enhancements (8.0% vs 2.0%; P = .0002), after which the eyes in their group were more likely to be within 1 diopter of the intended refractive target than those in the faculty group (96.0% vs 91.0%; P = .01). Although not statistically significant, eyes in the fellow group were four-fold (2.0% vs 0.5%) more likely to lose two or more lines of best spectacle corrected visual acuity than those in the faculty group. CONCLUSION: To minimize the adverse impact of complications during the learning curve of novice LASIK surgeons, the introduction of this procedure in a well-structured, supervised setting (such as a subspecialty fellowship training program) is recommended.