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Camila Zangalli, Raymond Clifford, Lalita Gupta, Michael Hsieh, George L. Spaeth, Mohsin Ali; A Comparison Of Post-operative Outcomes Of Glaucoma Surgeries Performed By Residents Vs. Attending Physicians. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5933. doi: https://doi.org/.
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To determine whether surgical glaucoma procedures performed by residents result in equivalent surgical outcomes as compared to procedures performed by attending physicians.
The records of 91 patients who underwent trabeculectomy and phacotrabeculectomy in a resident clinic (n=43) and at a private glaucoma practice (n=48) at Wills Eye Institute between 2007 and 2009 were reviewed. The following data was collected: patient demographics, diagnosis, best corrected visual acuity (BCVA), intraocular pressure (IOP) and number of glaucoma medications at 1 week, 4 weeks, 6 months and 1 year, postoperatively. Single-factor analysis of variance and 2-tailed student t tests were used to determine the statistical significance of differences in visual acuity, intraocular pressure, and glaucoma medications over time. A P-value of 0.05 or less was considered significant.
The two groups differed regarding demographic characteristics. Patients in the resident clinic group were more likely to be younger and black. Both groups were similar regarding glaucoma diagnosis. Phacotrabeculectomy was performed in 53.5% of patients in the resident’s group and 44.2% in the attending physician’s group (p= 1.00) Mean preoperative logMAR equivalent BCVA was 0.77±0.69 in the residents’ group and 0.37± 0.49 in the attending physician’s group (p=0.002). Mean visual acuity differed significantly at 1 week, 4 weeks and 6 months but was similar at one-year follow-up. The mean preoperative IOP was 23.67±8.67 mmHg and 22.83±11.46 mm Hg, respectively (p=0.69). The mean IOP at 6 months was 13.93±4.87 in the resident group and 14.71± 5.43 in the attending physician group (P =0.47) and at 1 year was 14.52±5 and 14.49±4.79, respectively (p=0.97). There was no significant difference in the number of glaucoma medications preoperatively and postoperatively between the 2 groups. Complications were rare and no significant difference was found between groups.
Our findings show that 1 year postoperatively, trabeculectomies and phacotrabeculectomies performed by residents result in outcomes comparable to those of attending physicians. However, prospective studies are needed to confirm this conclusion.
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