Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents

Abstract

Purpose:To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians.Methods:This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. All residents performed surgeries under direct supervision of an attending physician. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Patients' demographics, primary surgeon, use of conjunctival autograft (CAU) or amniotic membrane graft (AMG), recurrence of pterygium, follow-up length, and complications were recorded.Results:This study included 240 eyes of 229 patients with a mean age of 55.6 ± 12.3 years (range, 28–91 years). Of these eyes, 100 surgeries were performed by attending physicians (including 87 with CAU and 13 with AMG) and 140 surgeries by trainee residents (including 119 with CAU and 21 with AMG). There were no significant differences between the 2 groups of patients regarding age, sex, and surgical technique (CAU vs. AMG). Patients were followed up for an average of 19.8 ± 15.2 months. No statistically significant differences were found in comparing the rate of pterygium recurrence between attending physicians and residents when using CAU (6.8% vs. 10.0%, respectively; P = 0.42) and AMG (69.2% vs. 47.6%, respectively; P = 0.22). Moreover, there were no significant differences in other postoperative complications between the groups.Conclusions:Pterygium recurrence rates were similar between attending physicians and supervised trainee residents. Thus, acceptable outcomes can be expected when pterygium surgery is performed by a supervised ophthalmology resident.

Reply

“…We thank Dr. SC Kaufman for his interest and comments on our study “Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents.” 1 As he mentioned, in our study, we noted a higher rate of pterygium recurrence with amniotic membrane graft (AMG) than with conjunctival autograft (CAU). Although this finding was not the purpose of our study, we did highlight it in our discussion as “in our study, the rate of pterygium recurrence after AMG was higher than that after CAU for both trainee residents and attending physicians.…”

“…Although this finding was not the purpose of our study, we did highlight it in our discussion as “in our study, the rate of pterygium recurrence after AMG was higher than that after CAU for both trainee residents and attending physicians. Although amniotic membrane has antiinflammatory and antiscarring effects and promotes epithelialization, it is known that it has less favorable outcome for pterygium surgery compared with CAU, making the CAU the gold standard for pterygium surgery.” 1 We also stated that “in those cases with AMG, adjunctive use of mitomycin C is recommended, which was not used in our patients.” 1 We emphasized that “in our study, the overall recurrence rate after surgery with AMG (55.9%) was higher than those reported in most studies mentioned earlier. Such higher number may be because only those with more complex disease were assigned to this group,” 1 and mentioned that “furthermore, preponderance of the Hispanic patients in South Texas may also play a role because this population is known to have a higher risk of pterygium recurrence after surgery.” 1…”

Comment on: Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents

“…I read with great interest the recent article by Thompson et al 1 The primary conclusion of the study stated “pterygium recurrence rates were similar between attending physicians (APs) and supervised trainee residents.” However, I believe that an important finding was not emphasized in the article.…”