Allen Kwong1, Simon K Law2, Robert R Kule1, Kouros Nouri-Mahdavi3, Anne L Coleman3, Joseph Caprioli3, JoAnn A Giaconi1. 1. Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California. 2. Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California. Electronic address: law@jsei.ucla.edu. 3. Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Abstract
PURPOSE: To evaluate long-term outcomes of primary trabeculectomy with mitomycin C performed by ophthalmology residents. DESIGN: Cohort study and case-matched comparison. METHODS: setting: Residency program. population/intervention: A cohort of glaucoma patients at a Veterans Administration hospital (VAH) and private patients of attending physicians ("attendings") who underwent primary trabeculectomy between 2003 and 2012 with ≥6 months of postoperative follow-up. Qualified surgical success was defined as intraocular pressure (IOP) ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery. A subgroup of VAH patients with resident-performed trabeculectomy was case-matched to private patients with attending-performed trabeculectomy. outcome measures: Success rate, IOP, glaucoma medication number, visual acuity, complications, and additional glaucoma surgery. RESULTS: Eighty-five eyes (85 patients) underwent resident-performed primary trabeculectomy at the VAH with mean follow-up duration of 45.2 ± 28.1 months. Cumulative survival rates were 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up. The complication rate was 9.4%. Patients in the resident group had more severe preoperative visual field defects, poorer long-term postoperative visual acuity, and a lower rate of cataract surgery performed after trabeculectomy than those in the attending group. CONCLUSION: Glaucoma patients at a VAH with primary trabeculectomy performed by residents under attending supervision had similar success and complication rates as patients who underwent attending-performed trabeculectomies. However, the visual outcomes of patients with trabeculectomy performed by residents were worse in the long term, which might be attributable to a more advanced glaucoma disease stage or a lower rate of cataract surgery performed in the VAH patients. Published by Elsevier Inc.
PURPOSE: To evaluate long-term outcomes of primary trabeculectomy with mitomycin C performed by ophthalmology residents. DESIGN: Cohort study and case-matched comparison. METHODS: setting: Residency program. population/intervention: A cohort of glaucomapatients at a Veterans Administration hospital (VAH) and private patients of attending physicians ("attendings") who underwent primary trabeculectomy between 2003 and 2012 with ≥6 months of postoperative follow-up. Qualified surgical success was defined as intraocular pressure (IOP) ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery. A subgroup of VAHpatients with resident-performed trabeculectomy was case-matched to private patients with attending-performed trabeculectomy. outcome measures: Success rate, IOP, glaucoma medication number, visual acuity, complications, and additional glaucoma surgery. RESULTS: Eighty-five eyes (85 patients) underwent resident-performed primary trabeculectomy at the VAH with mean follow-up duration of 45.2 ± 28.1 months. Cumulative survival rates were 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up. The complication rate was 9.4%. Patients in the resident group had more severe preoperative visual field defects, poorer long-term postoperative visual acuity, and a lower rate of cataract surgery performed after trabeculectomy than those in the attending group. CONCLUSION:Glaucomapatients at a VAH with primary trabeculectomy performed by residents under attending supervision had similar success and complication rates as patients who underwent attending-performed trabeculectomies. However, the visual outcomes of patients with trabeculectomy performed by residents were worse in the long term, which might be attributable to a more advanced glaucoma disease stage or a lower rate of cataract surgery performed in the VAHpatients. Published by Elsevier Inc.
Authors: A Walkden; J Huxtable; M Senior; H Lee; S Naylor; S Turner; K Ivanova; J Koppens; B Todd; A Macleod; F Sii; N Anand; P Shah; A King; D C Broadway; J F Kirwan; A McNaught; A Bhan-Bhargava Journal: Eye (Lond) Date: 2018-03-12 Impact factor: 3.775
Authors: Roxanne Annoh; Lena Morgon Banks; Stephen Gichuhi; John Buchan; William Makupa; Juliet Otiti; Agrippa Mukome; Simon Arunga; Matthew J Burton; William H Dean Journal: J Surg Educ Date: 2021-05-11 Impact factor: 2.891