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  • Trabeculectomy in the hands of trainees

    Glaucoma

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    Supervising glaucoma faculty, rest assured. You are not doing a disservice to patients by assigning a trainee surgeon to perform trabeculectomy.

    This analysis of data from the Veterans Affairs Medical Center shows that trabeculectomy performed by a resident or fellow under attending supervision resulted in success and complication rates consistent with those reported in the literature.

    As the population ages and the rate of glaucoma increases, the pressure to graduate more comprehensive ophthalmologists with greater comfort in surgical glaucoma procedures is likely to increase. Studies such as this, reinforcing the safety of trainee-performed trabeculectomy, may further promote glaucoma surgical education. In my experience, glaucoma drainage devices are more frequently “turned over” to trainees as compared to trabeculectomy. Studies such as this may help change this practice.

    Subjects included 160 patients who underwent trabeculectomy performed by supervised trainees over a 10-year period. Complete success was defined as IOP of 21 mm Hg or less without medication; partial success, IOP of 21 mm Hg or less with medication. Failure was defined as IOP greater than 21 mm Hg on 2 consecutive visits, loss of light perception vision, IOP less than 5 mm Hg on 2 consecutive visits with associated visual acuity loss of more than 2 lines or need for surgical intervention. 

    Average IOP before surgery was 21.4 mmHg. Complete success was achieved by 41%; partial success, 35%. Kaplan-Meier analysis of 60 months of follow-up estimated a trabeculectomy survival rate of 28.9% for complete success and 63.7% for qualified success.

    This study has several limitations, including its retrospective design, the inclusion of multiple surgery types such as combined trabeculectomy/phacoemulsification and retrabeculectomy cases, and the fact that the surgeries were performed by members-in-training of different levels. Despite these potential confounders, which would be expected to decrease success rates, the success and complication rates were consistent with those reported in the literature.