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G. W. Thompson, M. A. Rolain; Clinical Outcomes of Resident Refractive Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):563.
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Evaluate outcomes of all resident performed refractive surgery cases at a large suburban community hospital. Laser refractive surgery has been proven to be a safe and effective treatment to reduce spectacle dependence. William Beaumont Hospital has had a resident laser refractive surgery program since 2001, and we looked at outcomes of all the patients participating in this program.
Retrospective chart review of all patients undergoing laser refractive surgery in a resident refractive surgery clinic. All surgeries were performed by third year ophthalmology residents under the direct supervision of the Director of Refractive Surgery. There were a total of 15 resident surgeons since the inception of the program.
The surgeries were performed between June 2001, and June 2008. There were 46 patients, with 91 eyes reviewed for this study. 2 patients (4 eyes) had surface ablation, and the remaining 44 patients (87 eyes) had LASIK. All procedures were performed on a VISX excimer laser with an S3 or S4 program (AMO Inc, Santa Ana, CA). Corneal flaps were created with the Hansatome microkeratome (Bausch & Lomb, Rochester, NY). There were 70 of 91 eyes (77%) with uncorrected visual acuity of 20/20 or better, and 88 of 91 eyes (97%) with 20/40 or better uncorrected visual acuity.Only 1 of 91 eyes (1%) lost more than 2 lines of best corrected visual acuity. This was a patient who was only seen on the first post-operative day, and had significant SPK. The patient did not return for follow-up, which suggests there was improvement of the visual acuity with lubrication. The average follow-up was six months. There were a large number of patients (40 of 46, 87%) with less than 1 year of follow-up, 34 of whom (76%) had surgery more than 1 year ago, and can be considered lost to follow-up. There were 2 patients with DLK, both bilaterally. One patient had a slow healing epithelial defect after PRK leaving mild residual haze. Enhancements were required in 3 eyes. There were 2 cases of epithelial ingrowth, one of which was after an enhancement. Six patients were treated for persistent dry eye syndrome.
Refractive surgery is a safe procedure overall, and this study shows that to be true when residents are the primary surgeons as well. The fact that most patients did not return for one year follow-up is of some concern. We plan to institute a call-back program to try to rectify this and prevent it from occurring in future patients. If another residency program was planning on starting a refractive surgery program, this would be an issue to address.
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