Comparison of the trabeculotomy -W -external results between resident doctors and monitoring ophthalmologists using tendency factor -Matching

Of the 443 eyes that pay off a property in our hospital between April 2016 and December 2022, 248 eyes were included in this study. Operation for 95 eyes was carried out by experienced ophthalmologists, while the residents were carried out for 153. Exclusion criteria included the patients' eyes with the following properties: observation time <3 months; Iodine evaluation with other methods than by Goldmann -Applanation -Eony; an anamnesis of intraocular surgery as a cataract surgery; intraoperative vitreous bodies or other complications; Age <20 years; And a diagnosis of a traumatic, neovascular glaucoma or pediatric glaucoma.

The eye drop score was defined as one and two points for a component or a combination of solid dose. Mouth IOP reduction was regarded as a component with a score of one point. The most corrected visual acuity measured directly before the operation was used for visual sharpening and converted into Logmar Visual Acuity for statistical analysis. For the assessment of preoperative fields using Humphrey facial field tests, cases with an average deviation value ≥-6 dB were regarded as mild, those with mean values ​​between 6 and 12 dB were moderate, intermediate 12 and 20 dB were serious and cases with <-20 dB were referred to as an end stage. The rotation area of ​​the metal-U-shaped probes (Rotom; Nagatas Trabeculotomy probe Inami, Tokyo, Japan) was determined by inserting the rotom into the channel of Schlemm. In the case of improper insertion, however, there cannot be enough rotation for an appropriate cut. In some cases, only one side of the rotom was turned to complete the procedure. The surgical records were converted in minutes from the surgical records.

Glaucomatic types were largely classified as primary open-angle glaucoma, pseudo-sexfoliation glaucoma, secondary glaucoma (with the exception of pseudo-exfoliation glaucoma) and eye hypertension. Monitoring ophthalmologists, who were defined as doctors with a board certification in ophthalmology (three doctors), were classified as superiors. In contrast, local doctors were classified as residents without a board certification (12 doctors). The experience of almost all residents was between 1 and 3 years. In Japan, the certification of the Ophthalmic Board needs 5 years of experience for the ophthalmologist and some surgical experiences that have been decided by the Japanese eye society. The surgical data was layered into two groups: Supervisor Group (plots of land, which were carried out by Ophthalmologists of the supervisor) and the local group (plots of land, which were carried out by the local doctors).

For the postoperative assessment, IOP and eye drops scores were rated postoperatively at 1, 3, 6, 9, 12, 18 and 24 months, whereby changes from the underlying were calculated at each examination point. The postoperative complications included the front chamber bleeding> 1 mm and a temporary iodine height (spike). Spike was defined within the first postoperative month as an increase in the iodine of 10 mmHg or more from the base. The survival analysis was also carried out, with death being defined as two consecutive IOP reductions <20% or additional glaucoma operation.

This study was approved by the Ethics Committee of the Tenri Yorozu Consultation Center Hospital (approval number: R23-10). The requirement of a declaration of consent was dispensed with due to the retrospective type of study and the use of anonymized data. Details on study design, target patients, data use and main researchers can be found on the official hospital website. This study adhered to the principles of explaining Helsinki for clinical research with human participants.

Surgical technology

The surgical technology for Lot from Externo included a two -layer sculeral flap. The first rag that measures 4 mm × 4 mm was broken down to present a smaller flap, which enabled access to the outer wall of the Schlemm Canal. The rotoms were then inserted into the channels of the upper and lower navigation and turned into the front chamber to check the aqueous humor backflow. The second flap was removed and the sinusotomy was carried out^® (Inami) in the center of the first flap. Finally, the first flap was secured with two 10 – 0 nylonna seams, and the conjunctiva was closed with 8 – 0 Vicryl sutures to complete the process. Some patients had cataracts with glaucoma. In cases in which a property was carried out in addition to the cataract surgery, the patients were carried out on the 10- and 2 o'clock positions using an anesthesia (4% xylocaine) on the ophthalmia anesthesia (4% xylocaine) using a microvitreoretinal knife, and the room was cleaned in the corner Sodium hyaluronate/sodium -chondroitin -Sulfate (viscoathyaluronate/sodium chondroitian sulfate (viscoat) secured. Toranomon, minato -ku, Tokyo). The cataract surgery was carried out by a 2.2 mm corn cutting using phacoemulsification and intraocular lens in the BAG.

Postoperatively, all patients received 1.5% and 0.1% Betamethason eye drops during the hospital stay. When unloading, betamethasone was replaced by 0.1% fluorometholone eye drops. Bromfenac -Natrium hydrate was also administered to patients who underwent a simultaneous cataract surgery.

During the study

The primary endpoints were a comparison of the survival rates between the supervisor and the local groups, which corresponded to background factors, the investigation of the factors in connection with the survival rates and a comparison of changes in the iodine and eye drop values ​​from their underlying values ​​up to 12 months after the operation. The secondary endpoints included comparisons of iOP and eye drops scores from the basic line values ​​to their corresponding values ​​at any measuring point, incidence of the front chamber bleeding and transient iodine increase and surgical period.

Statistical analyzes

The man -Whitney U The exact test of test and fisher was carried out for the basic analysis. Significant differences that were identified from these analyzes were further examined using the logistical regression, with relevant postoperative result factors as covariates. Subsequently, covariates were determined as significant. The Wilcoxon signed-rank-total test was used to analyze matching continuous variables. The survival analysis was carried out on the two matching groups to create Kaplan-Meier curves compared using the log-rank test. The statistical significance was defined as two -sided P-Werbärder <0.05. IBM SPSS Statistics Ver22.0 (IBM Ltd., Japan) and EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R (the R -base for statistical computing, Vienna, Austria), were used for statistical analysis. More specifically, the software is a modified version of R Commander, with which statistical functions are to add that are often used in biostatistics.