Outcome of penetrating keratoplasty performed by cornea fellows compared with that of an experienced staff surgeon.
OBJECTIVE
To compare the outcome of penetrating keratoplasty performed by supervised cornea fellows and an experienced staff surgeon.


METHODS
Retrospective review of cases of penetrating keratoplasty performed over a 4-year period with corneal topography performed on a clear graft. Overall, 202 cases from 184 patients were included: 108 performed by an experienced staff surgeon and 94 cases by 9 cornea fellows. Charts were reviewed for topographic astigmatism, other topographic indices, refractive astigmatism and best-corrected visual acuity (BCVA), all recorded after removal of the 10-0 sutures while the 11-0 suture remained in place. Graft clarity was assessed at final follow-up.


RESULTS
Mean postoperative topographic astigmatism was 4.60 +/- 2.7 diopters in the fellow group and 4.08 +/- 2.41 diopters in the staff group. The mean postoperative time at which corneal topography was obtained was 9.53 +/- 4.4 months in the fellow group and 9.22 +/- 4.6 months in the staff group. Mean refractive astigmatism was 3.77 +/- 1.97 diopters (fellows) and 3.49 +/- 1.93 diopters (staff). Mean surface asymmetry index (SAI) was 1.89 +/- 1.42 (fellows) and 1.61 +/- 1.08 (staff). Mean surface regularity index (SRI) was 1.43 +/- 0.72 (fellows) and 1.45 +/- 0.61 (staff). Mean BCVA was 0.49 logMAR (20/61) +/- 4.3 lines (fellows) and 0.47 logMAR (20/59) +/- 3.9 lines (staff). In the fellow group, 85 (90%) cases remained clear over a mean follow-up of 32 months and in the staff group 100 (93%) grafts remained clear over a mean follow-up of 38 months. Simple and multiple regression analyses indicated no difference between the 2 groups in all outcome measures.


CONCLUSIONS
Properly supervised cornea fellows in training achieved favorable penetrating keratoplasty results that were comparable to those of an experienced staff surgeon.
Hammoudi
Dena S
DS
University of Toronto, Ontario, Canada.
Segev
Fani
F
Abdolell
Mohamed
M
Rootman
David S
DS
D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002983:Clinical Competence; D003315:Cornea / Q000473:pathology; D019781:Corneal Topography; D005257:Fellowships and Scholarships; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity