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.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma

“…The surgery outcome did not demonstrate any statistically significant difference regarding perforation ( P = 0.06), regardless of whether it was performed by a fellow or expert; most procedures were conducted by fellows under close supervision. This finding is consistent with previous research, suggesting that surgeon experience is not associated with the outcomes of this procedure and may challenge the commonly held belief that difficulties are inevitable while learning NPDS with appropriate supervision [ 16 ].…”

“…Compared with other glaucoma surgeries, NPDS avoids perforation and reduces complications [ 5 , 15 ]. However, accidental trabeculodescemetic window (TDW) perforations can occur, especially while learning the procedure [ 14 , 16 ]. In deep sclerectomy, microperforation refers to a controlled, small-scale perforation of the trabeculo-Descemet membrane (TDM) during the surgical procedure.…”