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P. Khator, A. Beck, V. John; Outcome of Trabeculectomy Surgeries Performed by Residents. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4162.
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To evaluate the outcomes of trabeculectomy surgeries performed by residents at a teaching institution.
A retrospective chart review of trabeculectomy surgeries performed by third year ophthalmology residents at a county hospital was performed. One hundred and fifty four cases from 147 eyes between 1998 and 2007 were reviewed. All surgeries were trabeculectomies with adjunctive mitomycin C performed under the supervision of an attending physician. Success was defined as (1) IOP less than 21 mmHg on two consecutive visits or (2) IOP reduction of greater than or equal to 20% below baseline on two consecutive visits. Failure was defined as an inability to meet above criteria as well as (1) IOP less than or equal to 5 on two consecutive visits or (2) a reoperation for glaucoma.
The average length of follow up was 23.2 (SD ± 14.0) months. The success rate according to above criteria was 82% with an 18% failure rate. The IOP (mean ± SD) preoperatively was 33.5 ± mmHg and postoperatively was 14.5 ± 6.3 mmHg. The number of meds (mean ± SD) preoperatively was 3.8 ± 0.5 and postoperatively was 1.8 ± 1.7. Complications were divided into early (within 1 month of the surgery) or late (at least 1 month after surgery). Early complications included 7 cases each of epithelial defects, bleb leaks, and hypotony; 3 cases of choroidals and 2 shallow chambers with 1 requiring reformation; and one case each of non patent iridectomy, iris in ostia, dellen, and hyphema. Late complications included 1 case each of hyphema and endophthalmitis; 3 of rebound inflammation; 2 of hypotony; 5 encapsulations; 6 bleb leaks; and 8 cataracts. Reoperations performed included 11 aqueous tube shunts and 1 repeat trabeculectomy with mitomycin C for failed filters; and 4 wound revisions, 3 for persistent bleb leaks and one for overfiltration.
Primary trabeculectomies performed by resident surgeons at a teaching hospital can be effective and safe, with similar rates of success and complications as primary trabeculectomies performed by community ophthalmologists and attending surgeons at teaching institutions (Gedde SJ et. al. Treatment Outcomes in the Tube versus Trabeculectomy Study After One Year of Follow-up. Am J of Ophthalmol. 2007 Jan;143(1):9-22.)
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