Evaluation of the learning curve of non-penetrating glaucoma surgery

Aslan, Fatih; Yüce, Berna; Oztas, Zafer; Ateş, Halil

doi:10.1007/s10792-017-0691-3

Cited by 11 publications

(23 citation statements)

References 31 publications

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“…Aslan et al found similar rates of perforation for DS performed by an experienced consultant with 10.9% in early cases to 4.3% in late cases. 9 They also found no significant differences between the perforation rate with different skilled operators (residents vs. consultant) ( p = 0.28). 9…”

Section: Discussionmentioning

confidence: 90%

“…9 They also found no significant differences between the perforation rate with different skilled operators (residents vs. consultant) ( p = 0.28). 9…”

Section: Discussionmentioning

confidence: 90%

“…The major intraoperative complication during DS is perforation of the trabeculo-descement's window during deep flap dissection with a reported rate of between 8 and 30% of cases in the early learning phase. 9,17 While with further experience with non-penetrating surgery (NPS) the rate of trabeculodescemetic membrane rupture was reduced to 3–5%. 17 Our study observed a low rate of perforation (10% micro-perforation and 1% macro-perforation) in the early cases.…”

Section: Discussionmentioning

confidence: 99%

“…DS is considered more challenging in technique compared to TE and requires a longer learning curve. 6,7,9 Surgical expertise is one factor that may influence the procedure's outcome, although this has not been studied in depth. Many of the studies on DS are performed by single surgeons and have not described the expertise of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…6 Direct comparison of surgical outcomes performed by fellows and consultants for DS are uncommon. 9…”

Section: Introductionmentioning

confidence: 99%

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Clear Cell Endometrial Carcinoma in a Postmenopausal Woman with Rapid Recurrence: A Rare Variant

Hui

Clement²

2017

Journal of Postgraduate Medicine, Education and Research

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Purpose This study aims to evaluate the early to the midterm efficacy of deep sclerectomy (DS) without an intra-scleral spacer for open-angle glaucoma (OAG) patients. Materials and methods Retrospective study of 99 eyes (88 patients) with open-angle glaucoma who underwent DS were recruited in a consecutive order following informed consent. Intraocular pressure (IOP) was collected up to 60 months post operation (mean 19.87 ± 15.13 months). Criteria of success were defined as the qualified success (QS) or complete success (CS) with IOP level less than 21, 18 and 15 mm Hg and a reduction of more than 20% IOP from baseline. QS includes additional medication post-DS, while CS requires no other medications or surgery post-DS. Further analysis includes comparing the criteria of success based on several factors. The data were analyzed using statistical package for social sciences (SPSS version 21) statistical software. Results The QS at 60 months for IOP less than 21, 18 and 15 mm Hg is 71.3% (45.12 ± 2.46), 63.9% (40.41 ± 2.75) and 48.7% (35.62 ± 2.85), respectively. The CS at 60 months for IOP less than 21, 18 and 15 mm Hg are 69.3% (47.51 ± 2.77), 57.9% (40.41 ± 2.75) and 45.2% (35.62 ± 2.85), respectively. There was no significant difference between QS and DS post-DS based on the level of experience of the surgeons; intraoperation complication; age and gender. There was a significant reduction in IOP post operation ( p < 0.001). Conclusion DS is observed to be an effective surgical method with a favorable safety profile to manage patients with open-angle glaucoma. It has a better safety profile compared to trabeculectomy (TE) and can be performed by surgeons of different experience safely and successfully. Clinical significance To our knowledge, this is the first report of DS in an Australian population with up to 60 months of follow-up. It is an effective procedure for IOP control in patients with OAG and has fewer complications compared to TE. DS is less popular than TE primarily due to a perceived steep learning curve, but most of the literature on DS describe single surgeon results. Our study compared the outcome of five surgeons with a variety of experience and found no significant differences in the rate of success for all levels of IOP. How to cite this article Hui MM, Clement CI. Evaluation of the Early to Mid-term Efficacy and Safety of Deep Sclerectomy without an Intrascleral Spacer for Open-angle Glaucoma in an Australian Population. J Curr Glaucoma Pract 2018;12(3):107-112.

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Section: Discussionmentioning

confidence: 90%

“…9 They also found no significant differences between the perforation rate with different skilled operators (residents vs. consultant) ( p = 0.28). 9…”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…6 Direct comparison of surgical outcomes performed by fellows and consultants for DS are uncommon. 9…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clear Cell Endometrial Carcinoma in a Postmenopausal Woman with Rapid Recurrence: A Rare Variant

Hui

Clement²

2017

Journal of Postgraduate Medicine, Education and Research

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Multi-scale CNN based on region proposals for efficient breast abnormality recognition

Bakkouri

Afdel

2018

Multimed Tools Appl

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A Comparison of Deep Sclerectomy Trainer Versus Trainee Outcomes

Karaconji

Mercieca

Romera

et al. 2019

Journal of Glaucoma

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Purpose: The aim of this study was to compare the results of deep sclerectomy (DS) and combined deep sclerectomy with phacoemulsification (phaco-DS) performed by clinical fellows with those by an experienced glaucoma surgeon and DS trainer. Patients and Methods: This is a retrospective nonrandomized study of 266 eyes of 226 consecutive patients who had DS or phaco-DS between March 2014 and December 2016 which were included from a database of all glaucoma surgery performed in our department. A minimum of 9 months follow-up was required. The cases were recorded as to whether a fellow or consultant performed the entire procedure. Overall, 114 surgeries were performed by the consultant and 164 surgeries were performed by the fellow, in which 91 cases received no assistance from the consultant. Intraocular pressure (IOP) success criteria were: (A) IOP<22 mm Hg and/or 20% decrease from baseline off any glaucoma medications and (B) IOP<16 mm Hg and/or 30% drop from baseline off any glaucoma medications. Results: No statistically significant difference was noted by any criteria (P<0.05) between the 2 groups. The Kaplan-Meir IOP success rates at 2 years with criteria B (IOP<16 mm Hg without medications) were 64% for consultant, 76% for independent surgeries done by a fellow and 72% for surgeries with assistance from the consultant trainer (P=0.15). There were no significant differences between measured IOPs at any time after surgery. Intraoperative perforation of trabeculo-Descemet membrane was noted in 4 cases (3.5%) done by the consultant and 12 cases (7.3%) performed by fellows (Fisher exact P=0.19). Conclusions: IOP outcomes of DS and phaco-DS were not adversely affected if fellows performed surgery, whether under supervision or independently.

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Evaluation of the learning curve of non-penetrating glaucoma surgery

Abstract: Humanistic and conventional training models under control of an experienced surgeon are safe and effective for senior residents who manage phacoemulsification surgery in routine cataract cases. Senior residents can practice these surgical techniques with reasonable complication rates.

Cited by 11 publications

References 31 publications

Clear Cell Endometrial Carcinoma in a Postmenopausal Woman with Rapid Recurrence: A Rare Variant

Clear Cell Endometrial Carcinoma in a Postmenopausal Woman with Rapid Recurrence: A Rare Variant

Multi-scale CNN based on region proposals for efficient breast abnormality recognition

A Comparison of Deep Sclerectomy Trainer Versus Trainee Outcomes

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