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.

Graphical Abstract

Keywords:

• pediatric glaucoma
• learning curve
• medical education
• surgical training
• intraocular pressure
• glaucoma surgery

Abbreviations

PCG, primary congenital glaucoma; IOP, intraocular pressure; NPDS, non-penetrating deep sclerectomy; C:D ratio, cup-to-disc ratio; CI, confidence interval; RR, risk ratio.

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author, GS, and after approval of the IRB Committee of King Khaled Eye Specialist Hospital. The data are not publicly available due to restrictions, their containing information that could compromise the privacy of research participants.

Acknowledgments

We thank the staff of the pediatric ophthalmology division, operation theatre, research department, and Health Information Management System (IT department) of King Khaled Eye Specialist Hospital and Rajiv Khandekar (Rajivkhandekar.com) for extending their support to this research. We would like to thank Editage for English language editing.

Author Contributions

Omar Abdallah Khan: First author; study conceptualization; acquisition of data; supervision; data curation; formal analysis; writing – original draft.

Gorka Sesma: Corresponding and Senior author; study conception; methodology; formal analysis; writing – original draft; critical reviewing; writing-reviewing editing; supervision.

Abeer Alawi: Co-author; investigation; acquisition of data; data curation; execution; writing – original draft.

Manal AlWazae: Co-author; investigation; acquisition of data; data curation; execution; formal analysis; writing – original draft.

All authors contributed to data analysis, drafting, or revising the article, have agreed on the journal to which the article will be submitted, reviewed and agreed on all versions of the article before submission, during revision, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.