Trabeculectomy: the limitations for registrar training

Trainee exposure to glaucoma surgery was analysed and outcomes compared with those of consultant cases.

Retrospective review was carried out at Princess Alexandra Hospital and Royal Brisbane and Women's Hospital, two major tertiary teaching hospitals in Brisbane, Queensland, Australia.

Two hundred and forty-eight consecutive public patients undergoing primary trabeculectomy surgery between 2003 and 2010.

The rate of trabeculectomy performed by trainees, the success and complication rates were examined and compared with those of consultant ophthalmologists.

Intraocular pressure was divided into two groups of ≤21 mmHg and ≤15 mmHg and visual field progression.

Two hundred and forty-eight primary trabeculectomy cases were performed between 2003 and 2010. Trainees carried out 145 cases (59%), making the rate of trabeculectomy operations 1.1 per trainee per year (16-17 trainees) as compared with 1.6 per trainee per year from 1996 to 2002 at the same institutions. Complications rates in the first postoperative week were similar between consultants and trainees, the most common being wound leak and hyphaema. An intraocular pressure of ≤15 mmHg without the use of topical medications was achieved in 25 out of 50 (50%) glaucoma-interest consultant, 24 out of 53 (45.3%) general consultant and 68 out of 145 (46.9%) trainee cases (P = 0.951). The rate of visual field progression was also statistically similar between trainees and consultants (19.5% and 21.3%), respectively.

With increasing trainee numbers, the rate of trabeculectomy surgery is declining compared with previous years, with less trainee exposure to trabeculectomy surgery and inability to achieve surgical competency levels.