title: Early Reoperation Rate, Complication, and Outcomes in Resident-performed Glaucoma Surgery.
abstract: OBJECTIVE
  The purpose of the study was to examine reoperation rate and complications of resident-performed glaucoma surgeries within the first 90 postoperative days.
  
  
  METHODS
  A retrospective study of resident-performed glaucoma filtering surgeries at the San Francisco Veterans Affairs Medical Center between 2002 and 2014 was performed. Patients requiring reoperation within 90 days of the initial surgery were included in our study. Combined surgeries were excluded. Complications and the rates of reoperation within the first 90 days were evaluated. Clinical outcomes for those who needed reoperations were evaluated at the 1-year follow-up.
  
  
  RESULTS
  Total of 180 cases were reviewed [34 trabeculectomy, 85 Ex-PRESS shunt, and 61 Ahmed glaucoma valve (AGV)]. One hundred and four eyes developed complications, most commonly choroidal effusion (65.3%), followed by hypotony (45.2%) and wound leak (32.7%). Complications were comparable among the 3 groups, except that filtering surgery had significantly more wound leak than AGV (P<0.001). Seven (3.9%) cases required reoperation within first 90 days. There was no reoperation for trabeculectomy group. Reoperation rate was 4.7% for Ex-PRESS and 4.9% for AGV (P=0.74). Indications for reoperation were persistent wound leak (4 cases) and tube occlusion/revision (3 cases). For the 7 patients who required reoperations, their intraocular pressure at 1-year postreoperation was significantly decreased compared with intraocular pressure before the initial glaucoma surgery (P<0.001) with similar number of glaucoma medications and stable visual acuity.
  
  
  CONCLUSIONS
  Glaucoma incisional surgeries performed by third-year ophthalmology residents had acceptable and comparable reoperation rates and complication rates for patients with trabeculectomy, Ex-PRESS, and AGV. Clinical outcomes for the patients requiring reoperation were favorable.
authors.affiliation: Department of Ophthalmology, San Francisco School of Medicine, University of California, San Francisco, CA.
authors.forename: Yen C
authors.initials: YC
authors.lastname: Hsia
authors.forename: Jun Hui
authors.initials: JH
authors.lastname: Lee
authors.forename: Qi N
authors.initials: QN
authors.lastname: Cui
authors.forename: Jay M
authors.initials: JM
authors.lastname: Stewart
authors.forename: Ayman
authors.initials: A
authors.lastname: Naseri
authors.forename: Travis
authors.initials: T
authors.lastname: Porco
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stamper
authors.forename: Ying
authors.initials: Y
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007396:Internship and Residency; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology