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Gagan Kumar Sawhney, Parul Khator, Allen D Beck; Outcomes of Trabeculectomy with Adjunctive Mitomycin-C Performed by Resident Surgeons at a County Hospital. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3167.
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To evaluate the safety and efficacy of trabeculectomy surgeries performed by resident surgeons at Grady Memorial Hospital.
A retrospective chart review of trabeculectomy surgeries performed by ophthalmology residents from 2000 to 2010 was performed. All surgeries were performed with adjunctive mitomycin C. The primary outcome measure was success defined by (1) IOP less than 21mm Hg on two consecutive visits or (2) IOP reduction of greater than or equal to 20 percent below baseline on two consecutive visits if initial IOP was less than 21mm Hg. Failure was defined by (1) IOP>21mm Hg on 2 consecutive visits excluding the immediate post operative period, (2) IOP less than or equal to 5mm Hg on two consecutive visits excluding the immediate post operative period, or (3) a reoperation for glaucoma.
180 trabeculectomies were performed. The average age was 61 ± 10.7. 94 patients were men and 86 were female. 166 patients were black. 121 patients had a diagnosis of POAG. Preoperative IOP was 34.7 ± 11.6 mm Hg (range, 18.5 - 72). Patients were on 3.88 ± 0.58 (1-6) preoperative medications. The average followup was 46 ± 35 (0.33-157) months. The success rate at 1, 3 and 7 years was 85%, 65%, and 50% respectively. Postoperative IOP was 14.21 ± 6.40 mm Hg (1-47). Postoperative medications were 1.82 ± 1.80 (0-5). 31% of surgeries had an early complication: Bleb leak (27%), Hypotony (22%), Conjunctival Button Hole (14%), Choroidal Effusions (12%), Shallow Chamber (9%), and Epithelial Defect (9%). 24% of surgeries had a late complication: Encapsulation (31%), Bleb Leak (31%), Rebound Inflammation (20%), Blebitis (8%), Hypotony (4%), and Endopthalmitis (2%). Reoperations were performed in 38 eyes: 22 tube shunts, 5 trabeculectomies, 5 CE/IOL and trabeculectomies, 5 bleb revisions, and 1 cyclophotocoagulation.
Trabeculectomies performed by resident surgeons can be effective and safe, with similar rates of success and complications to community ophthalmologists and attending surgeons at teaching institutions. This study is comparable to the results of Fontana et al. (2006) where the success rate at 1 and 3 years was 85% and 62% respectively in open-angle glaucoma patients who underwent trabeculectomy with mitomycin c. This study also parallels the results of Gedde et al. (2009) where the failure rate of trabeculectomies at 1 and 3 years was 13.5% and 30.7% respectively.
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