A Comparison of Deep Sclerectomy Trainer Versus Trainee Outcomes

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Training

Background:

• Deep sclerectomy (DS) and combined deep sclerectomy with phacoemulsification (phaco-DS) are established glaucoma surgeries.
• Assessing the efficacy of surgical procedures performed by trainees versus experienced surgeons is crucial for surgical training programs.

Purpose of the Study:

• To compare the intraocular pressure (IOP) outcomes of DS and phaco-DS performed by clinical fellows versus an experienced glaucoma surgeon.
• To evaluate the impact of fellow-performed glaucoma surgery on patient outcomes.

Main Methods:

• Retrospective, nonrandomized study of 266 eyes from 226 patients undergoing DS or phaco-DS.
• Procedures were categorized by whether performed by a consultant or a fellow (independently or with assistance).
• Intraocular pressure (IOP) success defined by specific mmHg targets and medication reduction, with a minimum 9-month follow-up.

Main Results:

• No statistically significant difference in IOP outcomes between consultant- and fellow-performed surgeries.
• Kaplan-Meier 2-year success rates (IOP < 16 mmHg off medication) were 64% for consultant, 76% for independent fellow, and 72% for assisted fellow procedures (P=0.15).
• No significant differences in IOP at any postoperative time point; similar rates of intraoperative trabeculo-Descemet membrane perforation between groups.

Conclusions:

• Fellows can perform deep sclerectomy and combined deep sclerectomy with phacoemulsification effectively.
• Glaucoma surgery outcomes are not adversely affected when performed by fellows, whether supervised or independently.
• Findings support the efficacy of fellowship training in glaucoma surgery.