Abstract
Purpose :
Ophthalmology residents are required to become proficient at cataract and
glaucoma surgery during their residency training. The trabecular microbypass stent
(iStent) has emerged in recent years as an adjunct to traditional glaucoma surgeries,
but the outcomes of iStent surgery by residents has not been reported. The purpose
of the present study was to compare the outcomes of iStent surgery performed by
ophthalmology resident trainees to attending surgeons.
Methods :
Records of all patients who had iStent surgery by a resident at Wills Eye Hospital
were retrospectively reviewed. The attending-performed iStent group included any
patient who had an iStent implanted by an attending surgeon on the same day that a
resident case was performed. Patients with follow up of less than 3 months were
excluded.
Results :
Between 2016 and 2018, there were 31 iStents implanted by a resident. There were
93 iStents implanted by an attending surgeon on the same day that a resident case
was performed. The mean follow up time was 16.2 months. The baseline number of
hypotensive medicines was similar between the resident and attending groups (2.0
± 1.0 versus 1.9 ± 1.1, P=0.41). The mean IOP decreased from 16.0 ± 4.6 mmHg at
baseline to 13.8 ± 2.6 mmHg at the most recent follow up visit for the resident group
(P=0.02) and from 17.4 ± 4.8 mmHg to 15.0 ± 4.3 mmHg for attending group
(P<0.001). Compared to baseline, the decrease in IOP at the final follow up visit was
similar between the resident (2.2 ± 3.4 mmHg) and attending (2.4 ± 5.3 mmHg)
groups (P = 0.83). The final mean number of hypotensive medications was 1.6 ± 1.4
and 1.2 ± 1.2 for the resident and attending groups, respectively (P = 0.12). There
were 2 cases of hyphema in the attending group and 1 case of hyphema in the
resident group. The resident group had 1 case of iridodialysis, not requiring
additional surgery.
Conclusions :
Resident-performed iStent surgery had similar decrease in mean IOP and mean number of hypotensive medications compared to attending-performed surgery. Surgical implantation of iStents performed by resident trainees has similar efficacy and safety to attending surgeons.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.