title: Resident-performed Ex-PRESS shunt implantation versus trabeculectomy.
abstract: OBJECTIVE
  To compare outcomes between resident-performed trabeculectomy and Ex-PRESS shunt implantation.
  
  
  METHODS
  A consecutive cohort of 36 Ex-PRESS shunt implantations and 57 trabeculectomies (1 eye/patient) performed by resident surgeons in their third year of ophthalmic training at the University of California, San Francisco and at the San Francisco Veterans Administration Hospital, under the supervision of a single glaucoma fellowship-trained surgeon were included in this study. Eyes with < 6 months of follow-up or previous glaucoma surgery were excluded. Preoperative and postoperative intraocular pressure (IOP), preoperative and postoperative number of ocular antihypertensive medications and complication rates were compared between the 2 procedures retrospectively.
  
  
  RESULTS
  No difference was found in postoperative IOP (all, P≥0.099) or proportional decrease in IOP (all, P≥0.092) between the trabeculectomy and Ex-PRESS shunt groups at all follow-up points. On average, the Ex-PRESS shunt group required significantly less ocular antihypertensive medication to control IOP at 3 months postoperative (P=0.01), but no difference was found at 6 months or 1 year (all, P≥0.28). A larger proportion of Ex-PRESS shunt patients had good IOP control without medication at 3 (P=0.057) and 6 months (P=0.076) postoperatively. No difference was found in the rates of sight-threatening complications between groups (all, P≥0.22).
  
  
  CONCLUSIONS
  In the hands of ophthalmology residents in their third year of training, the trabeculectomy and Ex-PRESS shunt implantation procedures perform comparably in terms of postoperative IOP control, reduction in patient dependence on ocular antihypertensive medications, and risk of complication in our population.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, CA, USA. seiderm@vision.ucsf.edu
authors.forename: Michael I
authors.initials: MI
authors.lastname: Seider
authors.forename: Soraya
authors.initials: S
authors.lastname: Rofagha
authors.forename: Shan C
authors.initials: SC
authors.lastname: Lin
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stamper
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007429:Intraocular Pressure / Q000502:physiology; D053685:Laser Therapy; D008297:Male; D009885:Ophthalmology / Q000193:education* / Q000592:standards; D018918:Phacoemulsification; D012189:Retrospective Studies; D013524:Surgical Flaps; D014130:Trabeculectomy; D016896:Treatment Outcome