Aim To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures Methods Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 Â 4 mm, 16 mm 2 , n ¼ 12) or small scleral flaps (3 Â 2 mm, 6 mm 2 , n ¼ 9) were constructed over 0.76 mm 2 sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. Results Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n ¼ 8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n ¼ 8) flaps (unpaired t-test, P ¼ 0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD ¼ 12.7,.6%) for large and small flap groups, respectively (unpaired ttest, P ¼ 0.2). Conclusions Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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ImportanceImproving the representation of indigenous ophthalmologists in New Zealand.BackgroundMāori, indigenous to New Zealand/Aotearoa and Pacific Peoples indigenous to Pacific Island Nations living in New Zealand, experience poorer health outcomes across several ophthalmic conditions. The Royal Australian and New Zealand College of Ophthalmologists have identified indigenous workforce development as a priority.DesignMixed‐methods study, utilizing retrospective analysis of Medical Schools Outcomes Database and Longitudinal Tracking Project responses, and prospective interviews with Māori/Pasifika medical graduates.ParticipantsThis study involved 64 medical graduates from the University of Auckland (UoA) and the University of Otago, and six Māori/Pasifika medical postgraduates in New Zealand.MethodsRetrospective analysis of medical graduate responses who ranked ophthalmology among their top‐three preferred specialties in the Medical Schools Outcomes Database and Longitudinal Tracking Project. Prospective semi‐structured interviews with Māori/Pasifika medical postgraduates.Main Outcome MeasuresSpecialty training influencing factors and prevocational ophthalmology experience.ResultsA total of 64 (6.7%) out of 954 medical graduates from the UoA and University of Otago ranked ophthalmology among their top‐three preferred training specialties (2012‐2017). Of the 64 graduates, six (9.3%) identified as Māori/Pasifika. No significant difference in influencing factors between Māori/Pasifika and non‐Māori/Pasifika students was identified. Both groups ranked intellectual content, procedural skills, specialty exposure and mentorship as highly influential. Qualitative interviews with Māori/Pasifika graduates highlighted positive experiences in ophthalmology but limited exposure overall. Negative anecdotes and unclear training pathways discouraged Māori/Pasifika interest in Ophthalmology training.Conclusions and RelevanceMāori/Pasifika graduate interest in ophthalmology training was relatively low. Valuable insights include enhancing specialty exposure, mentor development, promoting Māori/Pasifika connections and clarifying training pathways for future graduates.

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