Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.
Ophthalmologica. 2010;224(1):22-9. doi: 10.1159/000233232. Epub 2009 Aug 13.
BACKGROUND/AIMS: To provide an insight into the learning curve associated with scleral buckling surgery for an ophthalmologist on a fellowship course and to evaluate risk factors affecting outcomes during this period.
Retrospective data were collected on 97 consecutive scleral buckling procedures (divided into 3 consecutive groups) performed by one surgeon (W.C.) beginning his first fellowship year. We evaluated the anatomic results, operative times and complications, and sought to identify risk factors of anatomic failure.
The single-operation success rate was 71.9% (23 of 32 eyes) in the first group, which was lower than 87.5% (28 of 32 eyes) in the second and 84.8% (28 of 33 eyes) in the third. The operative time was 106.3 min in the first, which is longer than 86.5 min in the second and 73.8 min in the third group. Factors predictive of unfavorable anatomic outcome were multiple breaks and multiple buckling procedures in the first 32 cases, and multiple breaks and breaks located posterior to the equator in the latter 65.
Surgical experience of approximately 30 cases was required to achieve stable clinical results. Thus, a retinal surgeon at the beginning of his career may increase his success rate by careful case selection avoiding high-risk groups until he reaches the level of experience indicated by the learning curve.
背景/目的：为 fellowship课程中的眼科医生提供巩膜扣带手术相关学习曲线的深入了解，并评估在此期间影响手术结果的风险因素。
回顾性收集了一位外科医生（W.C.）在其首个 fellowship 年进行的 97 例连续巩膜扣带手术（分为 3 个连续组）的临床数据。我们评估了解剖学结果、手术时间和并发症，并试图确定解剖学失败的风险因素。
第一组单手术成功率为 71.9%（32 只眼中的 23 只），低于第二组的 87.5%（32 只眼中的 28 只）和第三组的 84.8%（33 只眼中的 28 只）。第一组的手术时间为 106.3 分钟，长于第二组的 86.5 分钟和第三组的 73.8 分钟。影响解剖学不良结果的因素是前 32 例中的多处裂孔和多处扣带手术，以及后 65 例中的多处裂孔和位于赤道后部的裂孔。
大约需要 30 例手术经验才能获得稳定的临床结果。因此，一位刚开始职业生涯的视网膜外科医生可以通过仔细选择病例，避免高风险群体，直到达到学习曲线所示的经验水平，从而提高他的成功率。
