Kam Jason P, Zepeda Emily M, Ding Leona, Wen Joanne C
Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Clin Ophthalmol. 2017 Oct 16;11:1871-1876. doi: 10.2147/OPTH.S148467. eCollection 2017.
To investigate the power use and complication frequency of resident-performed laser peripheral iridotomy (LPI).
A retrospective analysis of 196 eyes from 103 patients who underwent neodymium: yttrium-aluminum-garnet laser iridotomy performed by resident physicians from January 1, 2010 through April 30, 2015 at a university-based county hospital was done. All patients were treated for primary angle closure, primary angle closure suspects, and primary angle closure glaucoma. Data were collected on pre- and post-laser intraocular pressure (IOP), ethnicity, laser parameters and complications. Mean power use and frequency of complications were evaluated. Complications included elevated post-laser IOP at 30-45 minutes (≥8 mmHg), hyphema, aborted procedures, and lasering non-iris structures. The number of repeated LPI procedures, was also recorded.
Mean total power used for all residents was 78.2±68.7 mJ per eye. Power use by first-year trainees was significantly higher than second- and third-year trainees (103.5±75.5 mJ versus 73.7±73.8 mJ and 67.2±56.4 mJ, respectively, =0.011). Complications included hyphema or microhyphema in 17.9% (35/196), IOP spikes in 5.1% (10/196), aborted procedures in 1.1% (3/196) and lasering non-iris structures in 0.5% (1/196). LPI was repeated in 22.4% of cases (44/196) with higher incidence of repeat LPI among non-Caucasian compared to the Caucasian subjects (=0.02). Complication rates did not differ with increased training (=0.16).
Total power used for LPI decreased with increased resident training, while the complication rate did not differ significantly among resident classes. Complication rates were comparable to rates reported in the literature for attending-performed LPIs.
研究住院医师实施激光周边虹膜切开术（LPI）的能量使用情况及并发症发生率。
对2010年1月1日至2015年4月30日在一所大学附属医院由住院医师实施钕:钇铝石榴石激光虹膜切开术的103例患者的196只眼睛进行回顾性分析。所有患者均接受原发性闭角型青光眼、原发性闭角型青光眼可疑病例和原发性闭角型青光眼的治疗。收集激光术前和术后眼压（IOP）、种族、激光参数及并发症等数据。评估平均能量使用情况及并发症发生率。并发症包括激光术后30 - 45分钟眼压升高（≥8 mmHg）、前房积血、手术中止及激光照射非虹膜结构。还记录重复LPI手术的次数。
所有住院医师每只眼睛使用的平均总能量为78.2±68.7 mJ。第一年住院医师培训学员的能量使用显著高于第二年和第三年培训学员（分别为103.5±75.5 mJ、73.7±73.8 mJ和67.2±56.4 mJ，P = 0.011）。并发症包括17.9%（35/196）的前房积血或微小前房积血、眼压峰值5.1%（10/196）、手术中止1.1%（3/196）以及激光照射非虹膜结构0.5%（1/196）。22.4%的病例（44/196）需要重复LPI手术，非白种人患者重复LPI手术的发生率高于白种人患者（P = 0.02）。并发症发生率并未随培训增加而有差异（P = 0.16）。
随着住院医师培训的增加，LPI使用的总能量减少，而不同级别住院医师的并发症发生率无显著差异。并发症发生率与文献报道的主治医师实施LPI的发生率相当。
