Abstract
Purpose :
To report safety and outcomes of resident performed Sion goniotomy at the time of cataract surgery (phaco-SION).
Methods :
We conducted a retrospective chart review of all patients that underwent resident-performed SION goniotomy at the time of cataract surgery at the University of Chicago from 9/1/2022 to 9/30/2023. All residents were in their PGY-3 or PGY-4 year. Eyes with prior traditional glaucoma surgery or cyclophotocoagulation were excluded. The primary aim was to determine whether resident-performed SION goniotomy demonstrated operating times and complication rates similar to those of Kahook Dual Blade goniotomy. A secondary aim was to report short-term outcomes (IOP and number of IOP-lowering medications at postoperative month 3).
Results :
There were 38 eyes from 35 patients that underwent resident-performed SION goniotomy at the time of cataract surgery. Demographic and clinical characteristics are shown in Table 1. The cataract surgery component was also performed by the resident in 13/38 (34%) cases. Of the 38 Sion cases, 36 (95%) were performed by PGY3 residents, and 2 (5%) by PGY4 residents. The average operating time for phaco-SION was 50.7 minutes. Hyphema occurred in 1 (3%) eye at post-operative day (POD) 1, 5 (13%) eyes at post-operative week (POW) 1, and 0 (0%) eyes at post-operative month (POM) 1. Of the 5 hyphemas at POW1, 2 were less than 0.5mm. Other complications included intraocular pressure (IOP) spike over 30 mmHg in 5 (13%) cases, cystoid macular edema in 3 cases (8%), and vitreous hemorrhage in 1 (3%) case. Of the 5 IOP spikes, 2 occurred on POD1, 2 on POM1, and 1 on POM2.5. IOP spikes were possibly related to use of durezol instead of prednisone. Vitreous hemorrhage was due to proliferative diabetic retinopathy. One eye underwent subsequent cyclophotocoagulation, and no eyes underwent subsequent incisional glaucoma surgery. There were 23/38 (61%) of eyes that reached 3 month follow-up to date. Preoperatively, the mean IOP was 16.0 mmHg on 2.8 medications; at POM3, mean IOP was 13.9 mmHg on 2.4 medications.
Conclusions :
Resident-performed SION goniotomy had a safety and short-term efficacy profile similar to what is reported in the resident-performed and attending-performed KDB goniotomy literature. SION goniotomy can be safely and effectively performed by PGY-3 and PGY-4 residents. Training residents in minimally invasive glaucoma surgery should be encouraged.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.