Outcomes of trabecular microbypass surgery: Comparison of resident trainees and attending surgeons

doi:10.1016/j.jcrs.2019.07.021

Journal of Cataract & Refractive Surgery

Volume 45, Issue 12, December 2019, Pages 1704-1710

$Journal of Cataract & Refractive Surgery$

Presented as a poster at the annual meeting of the Association for Research in Vision and Ophthalmology, Vancouver, Canada, May 2019.

https://doi.org/10.1016/j.jcrs.2019.07.021 Get rights and content

Purpose

To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons.

Setting

Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Design

Retrospective case series.

Methods

Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed.

Results

Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy.

Conclusion

Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.

Section snippets

Patients and methods

Institutional review board approval from Wills Eye Hospital was obtained for this retrospective study. The research adhered to the tenets of the Declaration of Helsinki and was performed in accordance with the regulations set forth by the U.S. Health Insurance Portability and Accountability Act.

A computerized search of the billing database was performed for all patients with Current Procedural Terminology code for trabecular microbypass stent or iStent surgery (0191T) from 2013 to 2018. A chart

Results

A microbypass stent was successfully implanted in 32 eyes of 23 patients by a resident and 92 eyes of 74 patients by an attending surgeon on the same day a resident case was performed. One resident case was excluded for lack of follow-up data after 1 week postoperatively; thus, 31 eyes were included in the analysis. The resident group attempted to implant another microbypass stent but was unable to do so (discussed below); this patient data was not included in the analysis. All microbypass

Discussion

As trabecular microbypass surgery has become increasingly popular over the past few years, teaching residents how to implant the stent and how to perform other MIGS surgery will gradually become more widespread. To our knowledge, this is the first study assessing resident outcomes after iStent implantation. Our analysis showed that resident-performed and attending-performed microbypass stent surgery had similar efficacy and safety.

There was no statistically significant difference in visual

First author:

Cindy X. Zheng, MD

Wills Eye Hospital, Philadelphia, Pennsylvania, USA

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First author:

Cindy X. Zheng, MD

Wills Eye Hospital, Philadelphia, Pennsylvania, USA

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ArticleOutcomes of trabecular microbypass surgery: Comparison of resident trainees and attending surgeons

Purpose

Setting

Design

Methods

Results

Conclusion

Section snippets

Patients and methods

Results

Discussion

J Surg Educ

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Am J Ophthalmol

Ophthalmology

J Cataract Refract Surg

J Cataract Refract Surg

Ophthalmology

Risk factors for return to the operating room after resident-performed cataract surgery

Semin Ophthalmol

Article
Outcomes of trabecular microbypass surgery: Comparison of resident trainees and attending surgeons