Hammoudi Dena S, Segev Fani, Abdolell Mohamed, Rootman David S
University of Toronto, Ontario, Canada.
Cornea. 2005 May;24(4):410-6. doi: 10.1097/01.ico.0000151549.15528.07.
To compare the outcome of penetrating keratoplasty performed by supervised cornea fellows and an experienced staff surgeon.
Retrospective review of cases of penetrating keratoplasty performed over a 4-year period with corneal topography performed on a clear graft. Overall, 202 cases from 184 patients were included: 108 performed by an experienced staff surgeon and 94 cases by 9 cornea fellows. Charts were reviewed for topographic astigmatism, other topographic indices, refractive astigmatism and best-corrected visual acuity (BCVA), all recorded after removal of the 10-0 sutures while the 11-0 suture remained in place. Graft clarity was assessed at final follow-up.
Mean postoperative topographic astigmatism was 4.60 +/- 2.7 diopters in the fellow group and 4.08 +/- 2.41 diopters in the staff group. The mean postoperative time at which corneal topography was obtained was 9.53 +/- 4.4 months in the fellow group and 9.22 +/- 4.6 months in the staff group. Mean refractive astigmatism was 3.77 +/- 1.97 diopters (fellows) and 3.49 +/- 1.93 diopters (staff). Mean surface asymmetry index (SAI) was 1.89 +/- 1.42 (fellows) and 1.61 +/- 1.08 (staff). Mean surface regularity index (SRI) was 1.43 +/- 0.72 (fellows) and 1.45 +/- 0.61 (staff). Mean BCVA was 0.49 logMAR (20/61) +/- 4.3 lines (fellows) and 0.47 logMAR (20/59) +/- 3.9 lines (staff). In the fellow group, 85 (90%) cases remained clear over a mean follow-up of 32 months and in the staff group 100 (93%) grafts remained clear over a mean follow-up of 38 months. Simple and multiple regression analyses indicated no difference between the 2 groups in all outcome measures.
Properly supervised cornea fellows in training achieved favorable penetrating keratoplasty results that were comparable to those of an experienced staff surgeon.
比较在监督下由角膜专科住院医师和经验丰富的 staff 外科医生进行穿透性角膜移植术的结果。
回顾性分析4年间进行穿透性角膜移植术的病例，并对透明植片进行角膜地形图检查。总共纳入了184例患者的202例病例：108例由经验丰富的 staff 外科医生进行，94例由9名角膜专科住院医师进行。查阅病历以获取地形图散光、其他地形图指数、屈光性散光和最佳矫正视力（BCVA），所有数据均在拆除10-0缝线而11-0缝线仍在位时记录。在最终随访时评估植片清晰度。
专科住院医师组术后平均地形图散光为4.60±2.7屈光度，staff 外科医生组为4.08±2.41屈光度。专科住院医师组获取角膜地形图的术后平均时间为9.53±4.4个月，staff 外科医生组为9.22±4.6个月。平均屈光性散光专科住院医师组为3.77±1.97屈光度，staff 外科医生组为3.49±1.93屈光度。平均表面不对称指数（SAI）专科住院医师组为1.89±1.42，staff 外科医生组为1.61±1.08。平均表面规则性指数（SRI）专科住院医师组为1.43±0.72，staff 外科医生组为1.45±0.61。平均BCVA专科住院医师组为0.49 logMAR（20/61）±4.3行，staff 外科医生组为0.47 logMAR（20/59）±3.9行。在专科住院医师组，平均随访32个月期间85例（90%）植片保持透明，在 staff 外科医生组，平均随访38个月期间100例（93%）植片保持透明。简单和多元回归分析表明两组在所有结果指标上无差异。
接受适当监督培训的角膜专科住院医师取得了与经验丰富的 staff 外科医生相当的良好穿透性角膜移植术结果。
