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Heather Broyles, Victoria Ly, Ronald Braswell; Outcomes of Minimally Invasive Glaucoma Surgery in a Veteran Population. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3430.
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To examine the outcomes of combined phacoemulsion and minimally invasive glaucoma surgeries (MIGS) performed by residents and attendings in a veteran population. Eye care is the third busiest clinical service in the VA system, with an increasing prevalence of gluacoma as a result of extended life-span in this population. There is currently no data that exists on the use of MIGS in the veteran population.
Retrospective chart review based on CPT codes of patients who underwent combined phacoemulsification and MIGS procedure from 2015 to 2020. Inclusion criteria involved veterans of all races, aged 18 or older, male or female, currently taking at least one anti-hypertensive eye drop medication, with the diagnosis of either ocular hypertension, glaucoma suspect, open angle glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma, or mixed mechanism glaucoma. Excluded were all patients with previous glaucoma surgery, except for cataract extraction or laser surgery, and any patients with the diagnosis of severe glaucoma.
The study comprised 55 eyes of 40 veterans with a mean age of 72 ± SD years. In conjunction with phacoemulsion, 10 (18%) eyes received endoscopic cyclophotocoagulation, 21 (38%) eyes underwent Kahook Dual Blade goniotomy, 7 (13%) eyes underwent gonioscopy-assisted transluminal trabeculotomy, 9 (16%) eyes received iStent, and 8 (15%) eyes had a combination. IOP was reduced by 22% on average at 1-year follow-up. The number of required IOP-lowering eye drop medications decreased for 24 eyes (44%). 9 (16%) eyes required no drops after MIGS. The overall rates of complications and failure were 12% and 16%, respectively. There was no statistically significant difference in the rates of operative complications (p = 0.302) and treatment failure (p = 0.149) between residents and attendings.
MIGS are safe with low rates of adverse events, and have the potential to decrease IOP and medication burden in veterans. This is in alignment with the current literature regarding MIGS in the civilian population. MIGS outcomes do not differ between resident surgeons and attending surgeons. To our knowledge, this is the first study that has compared MIGS performed by residents to those performed by attendings.
This is a 2021 ARVO Annual Meeting abstract.
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