Joseph Da, Matthew Gillings, Shivani Kamat, Niraj Nathan
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Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (<i>p</i> = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (<i>p</i> < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (<i>p</i> = 0.43 and <i>p</i> = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively.</p><p><strong>Conclusion: </strong>Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious.</p><p><strong>Clinical significance: </strong>Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. IOP and medication reduction of MIGS/CE in the hands of trainees were overall lesser than reported values by attending surgeons.</p><p><strong>How to cite this article: </strong>Da J, Gillings M, Kamat S, <i>et al.</i> Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study. 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This study aims to examine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy and endocyclophotocoagulation (ECP) with cataract extraction (CE) done by residents and fellows.</p><p><strong>Methods: </strong>All cases of KDB or ECP performed with CE between 2012 and 2020 at Parkland were reviewed, excluding cases with multiple MIGS procedures or other procedures.</p><p><strong>Results: </strong>A total of 153 eyes of 136 patients who underwent KDB and 125 eyes of 124 patients who underwent ECP were included. Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (<i>p</i> = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (<i>p</i> < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (<i>p</i> = 0.43 and <i>p</i> = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively.</p><p><strong>Conclusion: </strong>Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious.</p><p><strong>Clinical significance: </strong>Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. 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引用次数: 0
摘要
目的和背景：随着微创或微创青光眼手术（MIGS）的使用不断扩大，研究其在受训者手中的效果很重要。本研究旨在检验由住院医师和研究员进行的Kahook Dual Blade（KDB）角度切开术和内循环光凝术（ECP）与白内障摘除术（CE）的疗效和安全性。方法：回顾了2012年至2020年间在帕克兰接受CE治疗的所有KDB或ECP病例，不包括采用多个MIGS程序或其他程序的病例。结果：共有136例患者中的153只眼接受了KDB，124例患者中有125只眼接受了ECP。KDB组的平均眼压（IOP）从基线时的17.2±5.2下降到术后（术后）12个月（POM）的15.4±5.5 mm Hg（p=0.02），ECP组的平均眼内压从基线时18.6±6.3下降到POM12时的15.1±4.9 mm Hg（p<0.001），两组受试者的IOP变化差异很大。两组的IOP在所有时间点的平均变化具有统计学意义。在KDB和ECP组中，POM 1、3和6的药物计数较基线减少，但没有减少12（分别为p=0.43和p=0.35）。严重并发症发生率很低；KDB和ECP最常见的并发症分别是囊样黄斑水肿（CME）（6例）和POM1以外的活动性炎症（15例）。结论：受训者进行的CE/MIGS联合手术是安全的，但与主治外科医生的文献报告结果相比，在降低眼压和药物方面效果较差，除了ECP/MIGS在降低眼压方面被发现同样有效之外。临床意义：白内障摘除术（CE）联合KDB或ECP在受训者手中可降低平均眼压，是安全的。受训人员的IOP和MIGS/CE的药物减少总体上低于主治外科医生的报告值。如何引用这篇文章：Da J，Gillings M，Kamat S等。在帕克兰纪念医院进行MIGS的受训者的结果：回顾性队列研究。青光眼临床杂志2023；17（3）:134-140。
Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study.
Aims and background: As the use of minimally invasive or microinvasive glaucoma surgery (MIGS) continues to expand, it is important to look at its outcomes in the hands of trainees. This study aims to examine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy and endocyclophotocoagulation (ECP) with cataract extraction (CE) done by residents and fellows.
Methods: All cases of KDB or ECP performed with CE between 2012 and 2020 at Parkland were reviewed, excluding cases with multiple MIGS procedures or other procedures.
Results: A total of 153 eyes of 136 patients who underwent KDB and 125 eyes of 124 patients who underwent ECP were included. Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (p = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (p < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (p = 0.43 and p = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively.
Conclusion: Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious.
Clinical significance: Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. IOP and medication reduction of MIGS/CE in the hands of trainees were overall lesser than reported values by attending surgeons.
How to cite this article: Da J, Gillings M, Kamat S, et al. Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study. J Curr Glaucoma Pract 2023;17(3):134-140.
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