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Trabeculectomy: the limitations for registrar training.

Lisa L Sun¹, Graham A Lee

¹Royal Brisbane and Women's Hospital City Eye Centre University of Queensland, Brisbane, Queensland, Australia.

Clinical & Experimental Ophthalmology

|June 21, 2012

Summary

Glaucoma surgery outcomes were similar between trainees and consultants, but declining trainee exposure may impact surgical competency. Further research is needed to ensure adequate training in trabeculectomy.

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Area of Science:

Ophthalmology
Surgical Education

Background:

Analysis of trainee experience in glaucoma surgery compared to consultant outcomes.
Focus on primary trabeculectomy procedures.

Purpose of the Study:

To compare the outcomes of primary trabeculectomy performed by surgical trainees versus consultant ophthalmologists.
To assess complication rates and intraocular pressure control in glaucoma surgery performed by trainees.
To evaluate visual field progression in patients undergoing trabeculectomy by trainees and consultants.

Main Methods:

Retrospective review of 248 primary trabeculectomy cases (2003-2010) at two tertiary teaching hospitals.
Comparison of complication rates, intraocular pressure control (≤21 mmHg and ≤15 mmHg), and visual field progression.
Analysis of trabeculectomy rates per trainee per year.

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Main Results:

Trainees performed 59% of cases (145/248), with a lower rate of 1.1 operations per trainee per year compared to previous years.
Postoperative complication rates in the first week were similar between trainees and consultants.
Similar rates of achieving intraocular pressure ≤15 mmHg (46.9% trainees vs. 45.3-50% consultants) and visual field progression (19.5% trainees vs. 21.3% consultants) were observed.

Conclusions:

Despite similar surgical outcomes, the declining rate of trabeculectomy surgery performed by trainees suggests reduced exposure.
This reduction in exposure may hinder the development of surgical competency among trainees.
Addressing trainee numbers and exposure is crucial for maintaining surgical expertise in glaucoma procedures.