title: Outcome of penetrating keratoplasty performed by cornea fellows compared with that of an experienced staff surgeon.
abstract: 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.
authors.affiliation: University of Toronto, Ontario, Canada.
authors.forename: Dena S
authors.initials: DS
authors.lastname: Hammoudi
authors.forename: Fani
authors.initials: F
authors.lastname: Segev
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdolell
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: 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