Sakamoto Tomoaki, Nisiwaki Hirokazu
Department of Ophthalmology, Tenri Hospital, 200 Mishimacho, Tenri city, 632-8552, Nara prefecture, Japan.
Sci Rep. 2025 May 14;15(1):16669. doi: 10.1038/s41598-025-01151-7.
This study compared the surgical performance of resident doctors and their supervising ophthalmic surgeons in trabeculotomy (LOT) ab externo using propensity score matching. We retrospectively analyzed surgical data on 248 eyes that underwent LOT ab externo at our hospital between April 2016 and December 2022. The procedures were performed by three full-time supervising ophthalmologists (≥ 5 years of experience) and 12 resident physicians (< 5 years of experience). Propensity score matching was used to adjust for significant variables identified through univariate analysis of five covariates: preoperative visual acuity, preoperative intraocular pressure [IOP], preoperative ophthalmoscopy score, presence of preoperative pseudophakia, and concomitant cataract surgery. Postoperative outcomes including IOP, eye drop scores, and complications, were evaluated at 3-month intervals up to 24 months. Survival curves showed no significant difference between the eyes operated by resident physicians and those by supervising ophthalmologists (P = 0.183). The median change in IOP (first quartile-third quartile) was also comparable between the two groups (P = 0.234). Furthermore, both groups had similar rates of anterior chamber hemorrhage and transient IOP elevation (P = 0.577 and 0.85, respectively). These findings suggest that resident physicians can achieve surgical outcomes and complication rates comparable to those of their supervising ophthalmic surgeons when performing LOT ab externo.
本研究采用倾向评分匹配法，比较了住院医生及其指导眼科医生在小梁切开术（外路小梁切开术，LOT）中的手术表现。我们回顾性分析了2016年4月至2022年12月期间在我院接受外路小梁切开术的248只眼的手术数据。手术由三名全职指导眼科医生（经验≥5年）和12名住院医生（经验<5年）进行。倾向评分匹配法用于对通过对五个协变量进行单因素分析确定的显著变量进行调整：术前视力、术前眼压[IOP]、术前眼底镜检查评分、术前人工晶状体植入情况以及是否同时进行白内障手术。术后结果包括眼压、滴眼液评分和并发症，在长达24个月的时间里每3个月评估一次。生存曲线显示，住院医生手术的眼睛与指导眼科医生手术的眼睛之间无显著差异（P = 0.183）。两组眼压的中位数变化（第一四分位数 - 第三四分位数）也相当（P = 0.234）。此外，两组前房出血和短暂眼压升高的发生率相似（分别为P = 0.577和0.85）。这些发现表明，住院医生在进行外路小梁切开术时，能够取得与指导眼科医生相当的手术效果和并发症发生率。
