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archana bhargava, Andrew Walkden, Nitin Anand, Andrew Ian McNaught, Suzy Turner, Katerina Ivanova, Martyn Senior, Sam Naylor, Hayun Lee; Surgical Trabeculectomy Training - Are we safe at supervising?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2717.
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Surgical exposure for trainees is limited due to service provision demands, the European working time directive and subspecialisation of glaucoma surgery. Limited knowledge exists on the outcomes of supervised glaucoma surgery. The aim is to determine the safety of supervised trabeculectomy surgery performed by trainee ophthalmologists.
Retrospective case note review of all eyes (n=233) that underwent trabeculectomy surgery with MMC by consultant and trainee surgeons between March 2011 and November 2013 across 3 UK centres. All eyes have 1-year follow-up. Data collection includes pre-operative IOP, IOP at 1 year, and snellen visual acuities. Failure rates and surgical complications were recorded. Two-tailed p-values were obtained using Fisher’s exact test to ascertain statistical significance between groups.
140 (60%) cases were performed by consultant ophthalmologists (mean age=67; range 44-89 years). Trainees performed: 93 (39.9%) cases mean age= 70; 37-89 range years). No statistical significance was observed between consultant and trainee eyes achieving IOP <21mmHg and <16mmHg. No statistical significance was observed between the two groups in terms of snellen acuity loss. No statistical significance was seen between consultant failure rate and supervised trainee failure rate or complication rate.
Both supervised trainee and consultant cases showed higher success rates than the success rate for trabeculectomy currently quoted by the RCOphth (approximately 60%). Reassuringly, IOP control was similar to the success rates previosly reported in the literature. Other authors also found there to be no significantly better IOP control at 1 year when comparing consultant and supervised trainee cases. Interestingly, our results did not show trainee cases to have significantly higher complication rates than consultant cases. These success rates can be discussed with the patient during the consenting process especially if their procedure is selected for a trainee surgeon. This may make trainee case selection easier and thus help gain surgical exposure. Although wet labs and innovative training tools are a fantastic learning resource, ‘hands on’ surgical exposure is crucial. We echo the thoughts of previous authors that trabeculectomy surgery should remain within the general training curriculum of ophthalmic trainees, especially as it has been shown to be performed safely under consultant supervision.
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