September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Resident-Performed Laser Peripheral Iridotomy in Primary Angle Closure, Angle Closure Suspects and Angle Closure Glaucoma
Author Affiliations & Notes
  • Jason P Kam
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
  • Emily M Zepeda
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
  • Leona Ding
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
  • Joanne C Wen
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
  • Footnotes
    Commercial Relationships   Jason Kam, None; Emily Zepeda, None; Leona Ding, None; Joanne Wen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6525. doi:
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    • Get Citation

      Jason P Kam, Emily M Zepeda, Leona Ding, Joanne C Wen; Resident-Performed Laser Peripheral Iridotomy in Primary Angle Closure, Angle Closure Suspects and Angle Closure Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6525.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To investigate power use and complication frequency of resident-performed argon-Nd:YAG LPI.

Methods : Retrospective analysis was conducted in consecutive 172 eyes from 98 patients diagnosed as primary angle closure suspects (n = 118), primary angle closure (n = 24) or angle closure glaucoma (n = 30) undergoing YAG LPI procedure from 1/1/10 to 4/30/15, at Harborview Medical Center, Seattle, WA by resident physicians. Data was collected on pre/post–laser IOP, race, laser parameters and complications. Complications included elevated post-laser IOP at 30-45 minutes (≥ 8 mmHg), hyphema of any amount, aborted procedures, lasering non-iris structures, and repeated procedures. Mean power use and frequency of complication were evaluated.

Results : The mean total power used for all residents was 80.5±69.6 mJ per eye. Power use for first year trainees was significantly higher than second and third year trainees (107.3±76.2 mJ versus 73.7±76.0 mJ and 70.7±56.4 mJ, respectively, p = 0.011). The total complication rate was 26.1% (45/172) including: hyphema or microhyphema in 19.1% (33/172), IOP spikes in 5.2% (9/172), aborted procedures in 1.1% (2/172) and lasering non-iris structures 0.5% (1/172). LPI was repeated in 23.8% of cases (41/172). Complication rates did not differ with increased training (p = 0.20).

Total power, used as a surrogate for procedural efficiency, decreased with increased level of training and fell within values reported in the literature for attending-performed LPIs. Complication rates did not change with level of training. However, the incidences of hyphema and IOP spike, for all 3 years of trainees were comparable to reported attending-performed LPIs. The higher incidence of repeat procedure warrants further investigation and indicates an area where additional resident training is needed.

Conclusions : Resident performed LPIs have a comparable incidence of complications as reported attending-performed LPIs. Total power used for LPI decreased with increased resident training and may serve as an indicator of LPI proficiency.

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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