Glaucoma surgery: trainee outcomes and implications for future training: southeast Scotland

Abstract

Postoperative outcome of trainee glaucoma surgery compared with glaucoma specialist consultant surgery. Survey of Scottish consultant ophthalmologists' views on trainee surgery. Retrospective analysis of 128 trainee and 176 consultant trabeculectomies, with minimum postoperative follow-up of 2 years. Prospective postal survey of 80 Scottish consultant ophthalmologists. Trainees operated mainly on cases of chronic open angle glaucoma, while consultants operated on significantly more complicated glaucomas (P=0.0004). Trainee cases had more bleb leaks (P=0.01), hypotony (P=0.05), early (P=0.01) and late (P=0.03) return to theatre, and bleb interventions (P=0.01). Trainee mitomycin trabeculectomies were associated with higher rates of return to theatre (P=0.002), and cataract extraction within the first postoperative year (P=0.002). Trainee cases of pseudoexfoliation had more early complications (P=0.024), and trainee cases of low tension required more bleb interventions (P=0.05). There was no significant difference (P>0.05) between average intra-ocular pressure control (IOP) at postoperative visit year 1 between consultant (14.3 mm Hg) and trainee (13.9 mm Hg) cases. More than 50% of the 80 Scottish ophthalmology consultants surveyed, indicated that glaucoma surgery training requirements should be retained. Trainee trabeculectomy cases showed significantly higher rates of early complications, return to theatres, and bleb interventions compared with consultant cases. Satisfactory IOP control was achieved in both groups at postoperative year 1. Trainee cases require careful preoperative selection, avoiding complicated glaucomas including pseudoexfoliation and low tension, and those that require mitomycin. The majority of Scottish consultants wish to retain glaucoma surgery within the remit of generic training.