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  • Title: Long-term outcomes of resident- versus attending-performed primary trabeculectomy with mitomycin C in a United States residency program.
    Author: Kwong A, Law SK, Kule RR, Nouri-Mahdavi K, Coleman AL, Caprioli J, Giaconi JA.
    Journal: Am J Ophthalmol; 2014 Jun; 157(6):1190-201. PubMed ID: 24531023.
    Abstract:
    PURPOSE: To evaluate long-term outcomes of primary trabeculectomy with mitomycin C performed by ophthalmology residents. DESIGN: Cohort study and case-matched comparison. METHODS: setting: Residency program. population/intervention: A cohort of glaucoma patients at a Veterans Administration hospital (VAH) and private patients of attending physicians ("attendings") who underwent primary trabeculectomy between 2003 and 2012 with ≥6 months of postoperative follow-up. Qualified surgical success was defined as intraocular pressure (IOP) ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery. A subgroup of VAH patients with resident-performed trabeculectomy was case-matched to private patients with attending-performed trabeculectomy. outcome measures: Success rate, IOP, glaucoma medication number, visual acuity, complications, and additional glaucoma surgery. RESULTS: Eighty-five eyes (85 patients) underwent resident-performed primary trabeculectomy at the VAH with mean follow-up duration of 45.2 ± 28.1 months. Cumulative survival rates were 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up. The complication rate was 9.4%. Patients in the resident group had more severe preoperative visual field defects, poorer long-term postoperative visual acuity, and a lower rate of cataract surgery performed after trabeculectomy than those in the attending group. CONCLUSION: Glaucoma patients at a VAH with primary trabeculectomy performed by residents under attending supervision had similar success and complication rates as patients who underwent attending-performed trabeculectomies. However, the visual outcomes of patients with trabeculectomy performed by residents were worse in the long term, which might be attributable to a more advanced glaucoma disease stage or a lower rate of cataract surgery performed in the VAH patients.
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