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Benjamin Penaud, Esther Blumen-Ohana, Thibault Rodallec, raphael ADAM, Oliver LAPLACE, Jad AKESBI, Jean-Philippe NORDMANN; Learning curve in non-penetrating deep sclerectomy.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6504.
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© ARVO (1962-2015); The Authors (2016-present)
Non-penetrating deep sclerectomy (NPDS) has emerged gradually as the reference in the surgery of open angle glaucoma. Control of IOP is comparable to trabeculectomy, with a lower rate of post-operative complications. The inner wall of Schlemm's canal must be peeled off the underlying trabeculum to allow good filtration of aqueous humor. This surgery is difficult and requires a learning curve. The goal of this study was to compare postoperative results between experienced surgeons (ES) and fellows (FE).
We conducted a retrospective study on 373 consecutive patients who underwent a NPDS between 2010 and 2014. The procedure consisted in a deep sclerectomy alone or combined with a phacoemulsification. Mitomycin C was systematically used. Patients were operated by ES or by FE. We compared the two groups postoperative outcomes and per and postoperative complications.
Of the 373 patients, 190 were operated by ES 183 by FE. Patients operated by FE were significantly younger (61.2 vs 66.6 y., p = 0.03), were more often male (sex ratio: 1.17 vs 0.79) and had more history of filtration surgery (20 (11%) vs 5 (2.5%), p <0.005). Intraoperative complication rate was significantly higher for FE, there was 17 penetrating trabeculectomy conversions (9.2%) for FE against 6 for ES (3.1%) and 38 microperforations (20.7%) for FE against 8 for ES (4.2%, p <0.005). Postoperative complications in the short and medium term were more frequent for FE including more iris incarceration (7% vs 2.5%, p <0.005), more revision surgery (3.2% vs 0.5 %, p<0.005). The goniopuncture was performed more frequently (41.5% vs 30.4%) and earlier (6.9 months vs 8.1 months) for FE. Postoperative IOP at 3 months was similar between the 2 groups (13.2 (ES) vs 12.78 mmHg (FE)). The complication rate was equivalent between the two groups when the fellow had achieved more than 20 surgeries.
Learning the NPDS is difficult and fellows expose the patient to more complications. However, the postoperative IOP obtained is comparable between fellows and experienced surgeons. It seems that the realization of some twenty acts allows better control of the surgical technique.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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