title: Long-term outcomes of resident- versus attending-performed primary trabeculectomy with mitomycin C in a United States residency program.
abstract: OBJECTIVE
  To evaluate long-term outcomes of primary trabeculectomy with mitomycin C performed by ophthalmology residents.
  
  
  METHODS
  Cohort study and case-matched comparison.
  
  
  METHODS
  setting: Residency program. population/intervention: A cohort of glaucoma patients at a Veterans Administration hospital (VAH) and private patients of attending physicians ("attendings") who underwent primary trabeculectomy between 2003 and 2012 with ≥6 months of postoperative follow-up. Qualified surgical success was defined as intraocular pressure (IOP) ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery. A subgroup of VAH patients with resident-performed trabeculectomy was case-matched to private patients with attending-performed trabeculectomy. outcome measures: Success rate, IOP, glaucoma medication number, visual acuity, complications, and additional glaucoma surgery.
  
  
  RESULTS
  Eighty-five eyes (85 patients) underwent resident-performed primary trabeculectomy at the VAH with mean follow-up duration of 45.2 ± 28.1 months. Cumulative survival rates were 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up. The complication rate was 9.4%. Patients in the resident group had more severe preoperative visual field defects, poorer long-term postoperative visual acuity, and a lower rate of cataract surgery performed after trabeculectomy than those in the attending group.
  
  
  CONCLUSIONS
  Glaucoma patients at a VAH with primary trabeculectomy performed by residents under attending supervision had similar success and complication rates as patients who underwent attending-performed trabeculectomies. However, the visual outcomes of patients with trabeculectomy performed by residents were worse in the long term, which might be attributable to a more advanced glaucoma disease stage or a lower rate of cataract surgery performed in the VAH patients.
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California.
authors: Allen
authors: A
authors: Kwong
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California. Electronic address: law@jsei.ucla.edu.
authors: Simon K
authors: SK
authors: Law
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California.
authors: Robert R
authors: RR
authors: Kule
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors: Kouros
authors: K
authors: Nouri-Mahdavi
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors: Anne L
authors: AL
authors: Coleman
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors: Joseph
authors: J
authors: Caprioli
authors: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, California.
authors: JoAnn A
authors: JA
authors: Giaconi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009885:Ophthalmology / Q000592:standards*; D012189:Retrospective Studies; D014130:Trabeculectomy; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin