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Steven Tucker, Allison Weinstock, George Papachristou, Christine Callahan; Comparison of Outcomes of Resident- vs. Attending-Performed Baerveldt Glaucoma Drainage Device (GDD) Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2698.
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Outcome data reviewing the efficacy and safety of resident-performed GDD surgeries is lacking. This retrospective cohort study compared the success and complications of resident- to attending-performed Baerveldt GDD surgery at a US residency program.
A retrospective review was performed of patients who underwent Baerveldt GDD surgery at Penn State Hershey Eye Center from Jan. 2010 to July 2014. Inclusion criteria into the resident-performed group consisted of age>18, pre-operative diagnosis of glaucoma or ocular hypertension warranting surgical intervention, and majority of surgery performed by resident under direct attending supervision. The same criteria applied for the attending group except the attending performed the majority of the surgery. A total of 115 GDD cases were performed during the study period. 35 met the criteria for inclusion into the resident group and were compared to 35 attending cases. Qualified success was defined as an intraocular pressure (IOP) of 6-21mmHg or a reduction of 25%, no reoperations, with or without glaucoma drops. Complete success met the same criteria but without the use of drops. Post-operative IOP, visual acuity, number of glaucoma drops, surgical success, and complications were compared between the two groups using student t-tests.
There was no difference in pre-operative age(p=.46), gender(p=.46), race(p=.37), or lens status(p=.49) between the groups. The complete success rates were 19 vs 12% at 3 months(p=.22), 22 vs 14% at 6 months(p=.23), and 24 vs 10% at 1 year(p=.12) for the resident and attending groups, respectively. The qualified success rates were 94 vs 82% at 3 months(p=.08), 87 vs 86% at 6 months(p=.47), and 94 vs 86% at 1 year(p=.21) for the resident and attending groups, respectively. There were no statistical differences in postoperative IOP, number of glaucoma drops, and visual acuity at the follow-up dates. The most common cause of failure in both groups was uncontrolled IOP. The incidence of complications was similar in both groups with the most common complications being corneal edema, synechia, and hyphema.
Resident-performed Baerveldt GDD surgery was equally safe and effective compared to cases performed by attending surgeons. This study offers validation to patients and residency programs that supervised resident-performed surgeries can be performed safely with positive outcomes.
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