Posters

One year outcomes of supervised trainee-performed trabeculectomy and phaco-trabeculectomy procedures at a UK district general hospital

Poster Details

First Author: R. Davie UNITED KINGDOM

Co Author(s):    A. Waldock                    

Abstract Details

Purpose:

To evaluate the one year safety and efficacy outcomes of trabeculectomy and phaco-trabeculectomy procedures performed by a trainee ophthalmic surgeon under supervision within the UK ophthalmology training program.

Setting:

Ophthalmology Department, Luton & Dunstable Hospital, Luton, England, a unit within a district general hospital serving a population of over 500,000.

Methods:

A retrospective consecutive case series analysis of 20 augmented (Mitomycin-C (MMC)) single-releasable suture trabeculectomy and 13 MMC phaco-trabeculectomy procedures performed by one trainee surgeon (year 4/5) during 2014. Twelve month data outcome measures are presented for the change in intra-ocular pressure (IOP), change in medications, change in visual acuity and visual field mean deviation, as well as per- and post-operative complications and post-operative interventions. Success rates (qualified and unqualified) defined as less than 18mmHg and less than 16mmHg are compared with local and national standards.

Results:

31 patients undergoing trabeculectomy (20 eyes) and phaco-trabeculectomy (13 eyes) demonstrated a mean IOP-lowering effect of 8.6mmHg (34%) for trabeculectomies and 4.2mmHg (16%) for phaco-trabeculectomies at 12 months. The qualified success rate was 70% for trabeculecomies and 77% for phaco-trabeculectomies. 90% of eyes remained off all topical medication at 12 months. Three eyes (9%) demonstrated one line loss of visual acuity, two of these eyes underwent cataract surgery. There was one case of choroidal effusion with short-term hypotony (<8mmHg), whilst there were two cases of conjunctival retraction requiring re-suturing. Six eyes received post-op 5-fluorouracil application and bleb needling.

Conclusions:

There was an initial suturing learning curve, as highlighted by all post-op complications occurring in the first 8 eyes. Trabeculectomies were more effective in lowering IOP, but phaco-trabeculectomies had better visual functional outcomes. The success rates for both types of operation are equivalent to local (Consultant performed surgery) and national standards. The complication and post-op intervention rates are low with no cases of hypotony or significant loss of visual function. Trainee ophthalmic surgeons competent in phaco surgery and with suturing skills are able to perform safe and effective glaucoma surgery with twelve month outcomes equivalent to national standards.

Financial Disclosure:

One or more of the authors has significant investment interest in a company producing, developing or supplying product or procedure presented, One or more of the authors is employed by a forNONEprofit company with an interest in the subject of the presentation