Surgical Traceculectomy Training - Are we safe at supervising?

Abstract

Purpose : UK Trainees glaucoma surgical exposure is limited due to constraints of service, the European working time directive and increasing subspecialisation. Limited knowledge exists on trainee trabeculectomy outcomes. Our study analyses outcomes of supervised trabeculectomy outcomes performed by trainees in a large cohort.

Methods : Retrospective case note review of all patients that had trabeculectomy surgery with mitomycin-C by Consultant and trainee surgeons between March 2011 and November 2013 across multiple UK centres. All eyes have 2-year follow-up. Data includes intraocular pressure (IOP) which is pre-operative, 1 and 2 years and Snellen acuities. Failure rate and surgical complications were recorded. Success was determined using WGA guidelines. Two-tailed p-values were obtained using Fisher’s exact test to ascertain statistical significance between groups.

Results : 324 eyes were reviewed. 6 cases (1.85%) were excluded due to incomplete follow up data, leaving 318 eyes for analysis. Mean age was 72.7 years (range 35-98 years). 211 (66.4%) cases were performed by Glaucoma Consultants. 107 (33.6%) cases were performed by trainee ophthalmologists with limited trabeculectomy experience. The modal diagnosis in each group was primary open angle glaucoma.

Post operative IOP control showed no significant difference between consultant and trainee groups at year 1 and year 2 (p=0.88 and 0.61 respectively). Success rates showed no significant difference between consultant and trainee cases (p=0.22, 0.52 respectively). Failure rates at year 1 showed a significant difference between the two groups (p=0.04). No significant difference was seen at year 2 (p=0.50).

Bleb leak and hypotony were the most common complications for both groups (n=15 for each) with the trainees having significantly more, compared with the Consultants (p=0.02). Snellen visual acuity change was not statistically significant between the two groups (p=0.41).

Conclusions : The 2 year outcomes of trainee trabeculectomy compare favourably with Consultants. Trainee cases had a higher rate of reintervention, but overall outcomes are good. These findings help guide informed consent for trainee surgery. It is possible to safely train the next generation of glaucoma surgeons.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.