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Trabeculectomy: a training dilemma.

R Troutbeck1, G A Lee, P Sanfilippo

  • 1Royal Brisbane Hospital, Brisbane, Australia.

Eye (London, England)
|December 6, 2005
PubMed
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Ophthalmology trainees performed 33% of trabeculectomies, but only 30% of patients achieved target intraocular pressure (IOP). Improved surgical training is needed to enhance trabeculectomy outcomes.

Area of Science:

  • Ophthalmology
  • Surgical Training
  • Glaucoma Surgery

Background:

  • Trabeculectomy incidence is declining due to advanced medical treatments.
  • This leads to reduced surgical experience for ophthalmology trainees.
  • A need exists to evaluate trainee performance in trabeculectomy.

Purpose of the Study:

  • To audit primary trabeculectomy procedures performed by trainees versus consultants.
  • To analyze the rates and outcomes of trabeculectomies at major teaching hospitals.
  • To assess the impact of trainee involvement on surgical success.

Main Methods:

  • Retrospective consecutive case review.
  • Analysis of 290 primary trabeculectomies from May 1996 to May 2002.
  • Comparison of outcomes between trainee and consultant-performed surgeries.

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Main Results:

  • Ophthalmology trainees performed 33% (95/290) of procedures.
  • Postoperative complication rates were similar between trainee and consultant groups.
  • Only 30% of patients achieved an intraocular pressure (IOP) of 15 mmHg or less without medication.

Conclusions:

  • Trabeculectomy technique requires improvement.
  • Enhanced training, potentially including wet-lab simulations, may be necessary.
  • Without improved training, trabeculectomy may become limited to glaucoma subspecialists.