Outcomes of Non-Penetrating Deep Sclerectomy for Primary Congenital Glaucoma Performed by Experienced versus Trainee Surgeons: A Cohort Study

Abstract

Purpose: To compare the outcomes of non-penetrating deep sclerectomy (NPDS) for primary congenital glaucoma (PCG) performed by experienced vs trainee surgeons.

Patients and methods: This retrospective cohort study was conducted in 2022 in Saudi Arabia. Consultants (Gr-1) and trainee pediatric ophthalmologists (Gr-2) performed NPDS on pediatric patients with PCG. Success was defined as an intraocular pressure (IOP) less than 21 mmHg at 6 months after surgery. Complications, glaucoma medications, and additional procedures were also observed in the two groups.

Results: Gr-1 and Gr-2 operated on 14 and 39 eyes with PCG, respectively. The absolute success rates were 90.9% (95% confidence interval [CI]: 73.9, 100) in Gr-1 and 96.7% (95% CI: 90.2, 100) in Gr-2 (odds Ratio=1.1; 95% CI: 0.87, 1.3; P=0.54). Survival analysis suggested that the failure rate in the first 6 months after NPDS was not significantly different between the two groups (hazard ratio=1.45; 95% CI: 0.13, 16.0; P=0.767). The complications included hypotony (2 cases), vitreous hemorrhage (1 case), and total flap penetration (1 case). Only one eye in Gr-2 needed glaucoma medication after surgery. There was no significant difference in the success rates of one surgeon before and after training (P=0.43). The age (P=0.59) and sex (P=0.77) of patients, type of surgeon (P=0.94), and preoperative IOP (P=0.59) were not significant predictors of a stable IOP at 6 months after NPDS.

Conclusion: At 6 months after NPDS surgery performed by experienced and trainee pediatric ophthalmologists, the outcomes (stabilization of IOP) were similar between the two groups.

Keywords: glaucoma surgery; intraocular pressure; learning curve; medical education; pediatric glaucoma; surgical training.

Graphical abstract

Figure 1

Intraocular pressure (IOP) before and after non-penetrating deep sclerectomy surgery performed by pediatric ophthalmologists and trainees to treat primary congenital glaucoma. The X axis denotes the operating surgeon groups and different times of IOP measurement. The Y axis denotes the IOP (mmHg). The boxplots denote the median IOP values of eyes operated upon by consultants (Orange) and trainee pediatric ophthalmologists (black). The upper and lower ends of the vertical bars denote the 75% and 25% quartiles of the median.

Figure 2

Kaplan–Meier survival curves of intraocular pressure being maintained under 21 mmHg after deep sclerectomy surgery without penetration, performed by pediatric ophthalmologist consultants (blue line) and trainee ophthalmologists (green line).