Purchase this article with an account.
Yen Hsia, Qi Cui, Jay Stewart, Naseri Ayman, Ying Han; Early Reoperation Rate and Outcomes in Resident-Performed Glaucoma Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2660.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Glaucoma filtering surgeries are part of surgical training in ophthalmology residency. The surgeries are challenging and carry a relatively high risk of vision loss. The aims of this study are to examine the rates and the clinical outcomes of reoperation after resident-performed glaucoma surgeries within the 90 days post-operative period.
A retrospective cohort analysis of resident-performed glaucoma surgeries (trabeculectomy with mitomycin C, Ex-PRESS shunt, and Ahmed valve) at the San Francisco Veterans Affairs Medical Center from the period of 1999 to 2014 was performed. Patients requiring reoperation within 90 days of initial surgery were included in our study. Primary outcomes were reoperation rates between the three surgeries. Statistical difference were analyzed using the Fisher’s exact test. Preoperative and postoperative ocular data were recorded.
A total of 202 resident-performed glaucoma surgeries were completed, with eight reoperations within the 90 days post-operative period, resulting in a 4.0% reoperation rate for all glaucoma surgeries. Reoperation rate for trabeculectomy with MMC was 3.03% (1/33); 3.9% for Ex-PRESS shunt placement (4/102), and 4.5% for Ahmed valve placement (3/67). There was no statistical difference between the reoperation rates (p = 1.0). Four out of eight patients had permanent decrease in vision of greater than 3 lines on Snellen visual acuity after reoperation. Four out of eight patients required the same or greater number of glaucoma medications following reoperation. Two post-Ex-PRESS patients and one post-Ahmed patient required Ahmed valve placements for intraocular pressure control.
Third year ophthalmology residents demonstrated reoperation rates comparable to those of experienced glaucoma specialists. Reoperation rates were similar between the trabeculectomy with MMC, Ex-PRESS shunt, and Ahmed valve. Patients who required early reoperation due to post-operative complications were more likely to have poor surgical outcomes with worse final visual acuity, persistently elevated IOP, and a need for additional glaucoma surgery.
This PDF is available to Subscribers Only