Department of Ophthalmology, Duke University.
Durham Veterans Affairs Medical Center, Durham, NC.
J Glaucoma. 2019 Nov;28(11):958-964. doi: 10.1097/IJG.0000000000001354.
When compared with outcomes by glaucoma specialists in several prospective studies, residents at the Durham Veterans Affairs Medical Center achieved comparable reductions in intraocular pressure (IOP) and failure rates during the year following Baerveldt drainage device implantation.
To review the outcomes of resident performed Baerveldt implantation through 1 year of postoperative management in a resident-run clinic.
The medical records of all veterans at the Durham Veterans Affairs Medical Center were searched to identify those with Baerveldt implantation by resident physicians from July 1, 2007 to June 30, 2017. Exclusion criteria include previous glaucoma tube or concurrent surgical intervention, including cataract extraction. All postoperative visits were reviewed and clinical data were collected. Failure was defined as 2 consecutive visits, starting at postoperative month (POM) 3, with IOP ≤5 mm Hg, or with IOP >21 mm Hg or <20% IOP reduction from baseline, reoperation for glaucoma, or loss of light perception.
A total of 48 eyes were included with mean (SD) IOP and number of medications: baseline, 23.1 (6.7) mm Hg on 3.7 (1.0) medications; postoperative day 1, 20.5 (11.7) mm Hg on no medications; postoperative week 1, 14.3 (6.9) mm Hg and 1.9 (1.7) medications; POM1, 16.7 (6.4) mm Hg and 2.2 (1.5) medications; POM3, 15.1 (5.2) mm Hg and 2.1 (1.6) medications; POM6 12.8 (4.9) mm Hg and 2.8 (1.3) medications; POM12, 13.0 (4.0) mm Hg and 2.8 (1.4) medications. IOP decreased at all time intervals (P<0.01) but postoperative day 1 (P=0.15) while medication burden was reduced at every visit (P<0.01). Through 12 months, 8 patients (17%) failed with a time to failure of 9.2 (0.3) months. No patients underwent additional glaucoma surgical interventions or lost light perception.
Residents can safely and efficaciously perform Baerveldt implantation, providing reassurance regarding the autonomy afforded residents in the operating room and clinic.
在几项前瞻性研究中，与青光眼专家的结果相比，达勒姆退伍军人事务医疗中心的住院医师在贝伐单抗引流装置植入后的一年中，眼压（IOP）和失败率降低幅度相当。
通过对住院医师管理下的贝伐单抗植入术后 1 年的结果进行回顾，评估住院医师在该诊所的表现。
检索达勒姆退伍军人事务医疗中心所有退伍军人的医疗记录，以确定 2007 年 7 月 1 日至 2017 年 6 月 30 日期间由住院医师实施的贝伐单抗植入术患者。排除标准包括以前的青光眼管或同时进行的手术干预，包括白内障摘除术。所有术后就诊均进行了回顾，并收集了临床数据。失败定义为术后第 3 个月开始的 2 次连续就诊，眼压（IOP）≤5mmHg，或眼压（IOP）>21mmHg 或较基线下降<20%，需要再次手术治疗青光眼或视力丧失。
共纳入 48 只眼，平均（标准差）眼压和药物数量为：基线时，23.1（6.7）mmHg，使用 3.7（1.0）种药物；术后第 1 天，20.5（11.7）mmHg，不使用药物；术后第 1 周，14.3（6.9）mmHg，使用 1.9（1.7）种药物；术后第 1 个月，16.7（6.4）mmHg，使用 2.2（1.5）种药物；术后第 3 个月，15.1（5.2）mmHg，使用 2.1（1.6）种药物；术后第 6 个月，12.8（4.9）mmHg，使用 2.8（1.3）种药物；术后第 12 个月，13.0（4.0）mmHg，使用 2.8（1.4）种药物。眼压在所有时间间隔均下降（P<0.01），但术后第 1 天（P=0.15）除外，而药物负担在每次就诊时均降低（P<0.01）。在 12 个月时，有 8 名患者（17%）失败，失败时间为 9.2（0.3）个月。没有患者需要额外的青光眼手术干预或失去光感。
住院医师可以安全有效地进行贝伐单抗植入术，这为住院医师在手术室和诊所的自主权提供了保证。
