June 30, 2023

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Author(s): Mário Lima-Fontes (1), Ana Faria-Pereira (1), Mariana Leuzinger-Dias (1), Marta Inês Silva (1), João Barbosa-Breda (1,2,3), Joana Araújo (1,4), Sérgio Estrela-Silva (1,4), António Benevides-Melo (1,4), Flávio Alves (1), João Tavares-Ferreira (1)

PRCIS: Resident-performed trabeculectomies present higher intraocular pressure and lower complete success rate at 1 year.

PURPOSE: To compare the 1-year outcomes of ab externo trabeculectomy between residents in training and staff ophthalmologists.

PATIENTS AND METHODS: This retrospective study included all consecutive eyes submitted to ab externo trabeculectomy between January 2015 to June 2020. A 1-year complete success rate was considered using all the following criteria: intraocular pressure (IOP)≤21 mm Hg and ≥6mm Hg without ocular hypotensive medications; IOP reduction≥30%; without loss of light perception, phthisis bulbi, and further glaucoma surgery (excluding suture lysis and bleb needling).

RESULTS: One hundred and ten eyes from 99 patients were included. Thirty percent (n=33) of the trabeculectomies were performed by residents. There were no significant preoperative differences between groups, apart from age at surgery, which was higher in the residents' group (72.39±6.83 vs. 62.00±15.07 years, P<0.001), and visual field index (Humphrey Field Analyzer), which was lower in the ophthalmologists' group (51.81±34.74% vs. 32.04±33.83%, P=0.013). IOP at 1-, 3-, 6 months, and 1 year after surgery was significantly higher in the resident's group (P<0.05). Resident-performed trabeculectomies achieved a significantly lower complete success rate when compared with the ophthalmologists' group (39.39% vs. 64.94%, P=0.013). The overall rate of the postoperative complications and reintervention did not differ between groups, but the occurrence of a shallow anterior chamber was more frequent in the residents' group (15.15% vs. 4.05%, P=0.037).

CONCLUSIONS: Resident-performed trabeculectomies present significantly higher postoperative IOP levels and a lower complete success rate when compared with staff ophthalmologists. It is, therefore, fundamental to adopt strategies to change this gap, improve patient safety, and strengthen resident confidence.

PMID: 36989506 DOI: 10.1097/IJG.0000000000002168

NGP Papers manager: Carlo Cutolo