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Robert Allan Sharpe, Elizabeth Sharpe; A Retrospective Analysis of Outcomes of Resident-Performed Glaucoma Surgery at a Veterans Affairs Medical Center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6132.
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The purpose of this study is to compare outcomes of 3 primary glaucoma surgeries performed by residents-in-training at a Veterans Affairs Medical Center (VAMC): trabeculectomy (trab) with mitomycin C (MMC), phacoemulsification-trabeculectomy (phaco-trab) with MMC, and Ahmed valve surgery.
Data were collected through a retrospective review of the records at the Ralph H Johnson VAMC. Patients with no history of glaucoma surgery were included who underwent trab, phaco-trab, or Ahmed valve surgery performed by a PGY-4 resident under a single fellowship-trained glaucoma surgeon from 2005-2012. The primary outcome measured was rate of complications within the first year. Complications included overfiltration, underfiltration, leak, flat anterior chamber, tube malposition, hyphema, choroidal effusion, corneal sequelae, cataract, synechiae, visual loss, dry eye, vein occlusion, excessive inflammation, blebitis, and reoperation. Additionally, intraocular pressure (IOP), number of medications, visual acuity, and cup-to-disc (C:D) ratio were compared pre- and post-operatively to evaluate treatment outcomes.
Of 274 glaucoma surgeries identified, 153 met all inclusion criteria: trab (n=59), phaco-trab (n=49), and valve (n=45). Rates of intra-op complications were 8.5% trab, 6.1% phaco-trab, and 0% Ahmed. For each group respectively, 35.6%, 40.8%, and 42.2% of patients experienced at least 1 immediate post-op complication. The majority of these were due to underfiltration in the trab (63%) and phaco-trab (83%), while hyphema predominated in the valve group (46%). For each group respectively, 18.6%, 16.3%, and 22.2% experienced at least 1 complication from 3-12 months post-op. The majority of these were due to cataract (31%) in trab, synechiae (20%) in phaco-trab, and underfiltration (42%) in the Ahmed. Although pre-op IOP differed among groups at 24.5, 20.9, and 35.2 mmHg, respectively (p<0.01), the number of medications averaged 3.2-3.4 (p=0.2). All groups produced significant reductions in IOP and number of medications by 1 year (p<0.01).
When performed by senior residents in training at a VAMC, both trabs and phaco-trabs have similar outcomes over 1 year.
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