IMPORTANCE: Expected outcomes from endokeratoplasty may vary with surgeon experience. BACKGROUND: It was explored whether a surgeon learning curve exists for Descemet stripping endothelial keratoplasties (manual or automated) performed in Australia. DESIGN: This is a prospective cohort study, with various clinical settings. PARTICIPANTS: There were 2139 recipients of 2615 endothelial grafts, registered by 85 surgeons between January 2006 and December 2013. METHODS: Kaplan-Meier survival analyses and Cox proportional hazards regression were used to examine longitudinal graft survival. Manual and automated Descemet stripping endothelial keratoplasties were analysed together. Pearson chi-squared analyses were performed to examine differences amongst groups. Continuity correction was used for 2 × 2 tests, and statistical significance was set at P < 0.05 (two-sided). MAIN OUTCOME MEASURE: The main parameter measured was endothelial graft survival. RESULTS: Survival of the first 56 registered grafts was significantly poorer than survival of subsequent grafts (χ2 = 8.83, df = 1, P = 0.003), when data were combined for all surgeons. Surgeon workload influenced graft survival significantly (P < 0.001). This variable was retained in multivariate analysis designed to investigate independent factors influencing graft survival. Primary non-functioning grafts were significantly less likely to be reported for endokeratoplasties performed by surgeons with more than 56 registered grafts, compared with those registering 56 or fewer grafts (4.3% vs. 8.5%; χ2 = 18.38, df = 1, P < 0.001). CONCLUSIONS AND RELEVANCE: Our findings suggest that for less experienced or low-volume surgeons, longitudinal graft survival improved once 56 or more endokeratoplasties had been performed, indicative of a learning curve. The learning curve was less apparent for surgeons with 57 or more Descemet stripping endothelial keratoplasties and/or Descemet stripping automated endothelial keratoplasties registered during the 8-year study period. Different learning curves may be anticipated for these two groups of surgeons.
IMPORTANCE: Expected outcomes from endokeratoplasty may vary with surgeon experience. BACKGROUND: It was explored whether a surgeon learning curve exists for Descemet stripping endothelial keratoplasties (manual or automated) performed in Australia. DESIGN: This is a prospective cohort study, with various clinical settings. PARTICIPANTS: There were 2139 recipients of 2615 endothelial grafts, registered by 85 surgeons between January 2006 and December 2013. METHODS: Kaplan-Meier survival analyses and Cox proportional hazards regression were used to examine longitudinal graft survival. Manual and automated Descemet stripping endothelial keratoplasties were analysed together. Pearson chi-squared analyses were performed to examine differences amongst groups. Continuity correction was used for 2 × 2 tests, and statistical significance was set at P < 0.05 (two-sided). MAIN OUTCOME MEASURE: The main parameter measured was endothelial graft survival. RESULTS: Survival of the first 56 registered grafts was significantly poorer than survival of subsequent grafts (χ2 = 8.83, df = 1, P = 0.003), when data were combined for all surgeons. Surgeon workload influenced graft survival significantly (P < 0.001). This variable was retained in multivariate analysis designed to investigate independent factors influencing graft survival. Primary non-functioning grafts were significantly less likely to be reported for endokeratoplasties performed by surgeons with more than 56 registered grafts, compared with those registering 56 or fewer grafts (4.3% vs. 8.5%; χ2 = 18.38, df = 1, P < 0.001). CONCLUSIONS AND RELEVANCE: Our findings suggest that for less experienced or low-volume surgeons, longitudinal graft survival improved once 56 or more endokeratoplasties had been performed, indicative of a learning curve. The learning curve was less apparent for surgeons with 57 or more Descemet stripping endothelial keratoplasties and/or Descemet stripping automated endothelial keratoplasties registered during the 8-year study period. Different learning curves may be anticipated for these two groups of surgeons.
Authors: Michael J Fliotsos; Jack A Campbell; Ximin Li; Marie B Engstrom; Christopher G Stoeger; Cathy McClory; Michael S Titus; Patrick Johnson; Kara B Johnston; Tim Fischer; Lisa K Brooks; Monty M Montoya; David B Glasser; Esen Karamursel Akpek; Divya Srikumaran Journal: Cornea Date: 2021-08-05 Impact factor: 3.152
Authors: Marc B Muijzer; Chantal M van Luijk; Antoon J van den Bogaerdt; Piet J Kruit; Esther Groeneveld-van Beek; Gerrit R J Melles; Robert P L Wisse Journal: Acta Ophthalmol Date: 2019-02-25 Impact factor: 3.761
Authors: Fang-Chi Hsiao; Po-Yuan Chen; Yaa-Jyuhn James Meir; Hsin-Yuan Tan; Ching-Hsi Hsiao; Hsin-Chiung Lin; David Hui-Kang Ma; Lung-Kun Yeh; Wei-Chi Wu; Hung-Chi Chen Journal: Int J Environ Res Public Health Date: 2019-11-17 Impact factor: 3.390