title: Penetrating Keratoplasty Performed by Residents Compared With an Experienced Cornea Transplant Surgeon.
abstract: BACKGROUND
  Reports on keratoplasty by residents are rare compared to those on cataract surgery. The aim of this study was to compare the results and surgery time of penetrating keratoplasty performed by residents and an experienced cornea surgeon.
  
  
  METHODS
  The medical records and surgery videos of the first 5 penetrating keratoplasty procedures by 4 residents were reviewed and compared with those in 20 penetrating keratoplasty procedures by an experienced cornea surgeon. Patients underwent penetrating keratoplasty at the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. The main outcome measures are graft survival, best-corrected visual acuity, postoperative astigmatism, decreased rate of graft endothelial cell density, and details of surgery time.
  
  
  RESULTS
  Graft survival, best-corrected visual acuity, and postoperative astigmatism were not significantly different between residents group and the experienced surgeon group. The average decrease of graft endothelial cell density owing to surgery in residents and the experienced surgeon were 19.0 ± 17.5 and 18.5 ± 12.1%, respectively (p = 0.27, Mann-Whitney U test). The average surgery time taken by residents was 66.9 ± 18.1 minutes, and that by the experienced surgeon it was 28.2 ± 7.9 minutes (p = 0.0071, Mann-Whitney U test). Residents required the most time for running suture technique.
  
  
  CONCLUSIONS
  The results of keratoplasty by residents were similar with those done by the experienced surgeon. Surgery time was the only statistically significant difference (p = 0.0071), which did not influence surgical results.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, Japan; Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan. Electronic address: machiko@jichi.ac.jp.
authors.forename: Machiko
authors.initials: M
authors.lastname: Shimmura-Tomita
authors.affiliation: Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Shimmura
authors.affiliation: Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
authors.affiliation: Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: D000328:Adult; D002983:Clinical Competence; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006085:Graft Survival; D006801:Humans; D007396:Internship and Residency; D007564:Japan; D015948:Keratoplasty, Penetrating / Q000009:adverse effects / Q000193:education* / Q000379:methods; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014792:Visual Acuity
keywords: Patient Care; Practice-Based Learning and Improvement; corneal transplantation; penetrating keratoplasty; residents; surgical education