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Alfred A. White, Jay Brown, Aravinda Rao; Postoperative outcomes in attending versus fellow-performed macular hole surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5078.
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© ARVO (1962-2015); The Authors (2016-present)
There is apprehension among surgical retina faculty concerning trainee participation in the more technically challenging aspects of macular hole repair, such as internal limiting membrane peeling. As training requirement and guidelines become more stringent, it is imperative for fellows to accurately document each of the cases they perform in full. Hence, complete participation in all aspects of surgery and corresponding documentation is essential to standardize training. This is a retrospective study that compares outcomes in fellow-performed versus attending-only performed ILM peels in macular hole surgery.<br />
We performed a retrospective review of medical records and SD-OCTs of all macular hole surgeries scheduled for one attending with or without senior retina fellow participation from November 2011 to July 2014. Cases were assigned randomly with stage 1-3 holes equally distributed between groups. Only patients with pre and post-op OCTs and 3 months follow-up were included in the analysis. Primary outcome measures included closure rate, mean lines of UCVA gained, and best post-operative UCVA. Baseline demographics (e.g. age and gender) and selected preoperative data were compared between groups using Chi-square analysis and student’s t-test. Closure rate was determined by SD-OCT review. Outcome measures were analyzed using Chi-square and student’s t-test.<br />
49 macular hole surgeries were performed with 19 in the attending group and 18 in the fellow group meeting inclusion criteria. Closure rate in attending-only cases was 94.7% compared to 94.4% in the fellow-assisted group, p=0.97. Mean lines gained was 1±5.022 in the attending-only group versus 1.06±9.879 in the fellow group, p=0.98. Best mean logMAR visual acuity was 0.900±0.591 (20/160 uncorrected) in the attending only group compared to 0.995±0.839 (20/200 uncorrected) in the fellow group, p=0.44. <br />
Based on the outcome measures, there was no statistical difference in closure rate, lines gained, or best post-operative visual acuity in attending only-cases compared to those performed by a senior fellow. Although the sample size is small, these results suggest senior retina fellow participation in ILM peeling did not negatively affect patient outcomes.<br />
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