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D. H. Chu, T. Johnson, A. Lin, S. Orengo-Nania; Outcomes of Resident Trabeculectomy Surgery at a Veterans Hospital. Invest. Ophthalmol. Vis. Sci. 2009;50(13):169.
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To evaluate the safety and efficacy of resident-performed trabeculectomies, supervised by attending physicians, at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). To report trabeculectomy outcomes in a United States veterans population, which has not yet been described.
A retrospective analysis of all resident-performed trabeculectomies over a five year period from January 2002 to May 2007 at MEDVAMC was performed. Patients were excluded from the analysis if there was less than one year of follow-up, or if diagnosed with uveitic, neovascular, or traumatic glaucoma. The pre-operative and post-operative data of 193 eyes in 147 patients were evaluated. Primary clinical parameters included best corrected Snellen visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications. Surgical success was defined as having post-operative IOP less than 21mmHg with at least a 20% decrease from pre-operative IOP, with or without adjunctive topical medications. Surgery was considered a failure if there was any post-operative IOP less than 5mmHg, or if additional intraocular glaucoma surgery was performed, excepting a single bleb revision within the first post-operative month.
The average follow-up period after trabeculectomy was 34.0 ± 15.9 months. The average pre-operative acuity was 20/55, which decreased to 20/65 at most recent follow-up. The average pre-operative IOP was 22.0 ± 8.21 mmHg, which decreased to 12.0 ± 4.8 at most recent follow-up (p < 0.0001). The average number of pre-operative glaucoma medications was 3.5 ± 1.0, which decreased to 1.45 ± 1.6 (p < 0.0001). Surgical success was observed in 73.1% of eyes at last follow-up, with 36.8% not requiring any glaucoma medications. Argon laser suture lysis was performed in 60 cases (31.1%). Subsequent glaucoma surgery for bleb failure was performed in 6 cases (3.1%). Bleb leaks were noted in 11 patients (5.7%), for which revisions were performed in 6 cases (3.1%). Notable late complications included 11 cases of persistent hypotony (5.7%), 3 cases of blebitis and 1 case of endophthalmitis.
While attending-supervised trabeculectomies are not as widely performed by residents as cataract surgeries are, they yield a high success rate with complication rates similar to that in current literature. This information can be utilized for patient education when discussing the risks and benefits of surgery.
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