Outcomes of Retinal Surgery Performed by Supervised First-Year Vitreoretinal Fellows-in-Training

Abstract

To review the outcomes of vitreoretinal surgery (VRS) performed by supervised first-year fellows-in-training. Methods: A retrospective review was performed of consecutive VRS cases performed by 4 consecutive first-year fellows under direct attending supervision in a tertiary-care teaching hospital. Main outcomes were rates of surgical complications including vitreous hemorrhage (VH) and retinal detachment (RD). Results: One hundred thirty-five cases were reviewed. Common indications for surgery included rhegmatogenous retinal detachment (RRD, 31.9%), VH (26.7%), tractional retinal detachment (TRD, 25.9%), and combined TRD/RRD (5.2%). The mean logarithm of the minimal angle of resolution visual acuity improved from preoperative 1.48 to 0.98 (P < .0001). Forty-three cases were performed for RRD repair. Grade C proliferative vitreoretinopathy was present preoperatively in 34.9% (15 of 43). The mean duration of symptoms prior to RD repair was 40.1 days. The primary reattachment rate was 81.4% (35 of 43). Sixty-six vitrectomies were performed for proliferative diabetic retinopathy. Eleven (16.7%) patients experienced early VH, and 9 (13.6%) had delayed VH. Postoperative RD occurred in 6 (9.1%) patients all of whom initially presented with TRD. Outcomes of surgeries performed by beginning fellows (months 1-4) were compared to those performed by more experienced first-year fellows (months 5-12). Complication rates were found to be similar between the groups. Conclusion: With appropriate supervision, VRS can be safely performed by beginning fellows-in-training. Despite complex pathology, surgical outcomes of the first-year fellow cases compare favorably to published results.