<p>Surgical Grade and Repeat Laser Peripheral Iridotomy Procedures with Risk Stratification and Educational Considerations</p>

Abstract

Background/Aims Peripheral laser iridotomy (PLI) is a commonly performed procedure. While effective, repeat procedures (RPs) may be required for a variety of causes. We report the causes and rate of RP PLI and whether surgical grade is a risk factor. Methods Two years of retrospective data from 282 patients who had undergone PLI at a single UK ophthalmology department were retrieved using an electronic medical record system (Medisoft, Leeds, UK). Results A total of 253 patients underwent analysis with 20 requiring RPs. Our data identified a correlation between experience of the operating surgeon and an increase in RP rate, with statistical significance ( p =0.036) observed between consultants and registrars. No other statistically significant risk factors were identified from our study. Prescriber preference for iopidine was observed. From our findings and the current literature, prognostic factors that appear to influence RP rate include surgical grade, patient compliance, Asian ethnicity, and anticoagulation. Conclusion RP rate increases in PLI when a junior surgeon is performing the procedure, and thus cases with established prognostic factors for RPs should have senior input. Formal and standardized YAG-laser training should be implemented alongside risk stratification of patients to improve both trainee education and patient care.

Evaluation of the learning curve of laser peripheral iridectomy: the 20th case reaches the turning point

“…The Accreditation Council for Graduate Medical Education requires all ophthalmology residents to perform LPI before graduation. Riley et al [13] illustrated that the RP rate for LPI procedures was associated with the experience of the operating surgeon.…”

“…LPI is indispensable for glaucoma treatment [11][12] . It was reported that the rate of repeat procedures (RPs) for LPI was related to the operating surgeon's level of experience [13] . However, the parameters of LPI were not included in the study to explore how the level of experience contributed to the rate of RPs.…”