Background. Primary pars plana vitrectomy (PPV) is often performed by vitreoretinal fellows. We aimed to evaluate the incidence of retinal breaks and detachments (RD) after fellow-performed PPV. Methods. We reviewed 119 consecutive cases of standard 3-port primary PPVs on 115 patients at a teaching institution from 2003 to 2006. In all cases, the primary surgeon was a vitreoretinal fellow. Patients with previous RD were excluded. Cases were reviewed for postoperative retinal detachments, and all patients were followed for up to 1 year. Results. Intraoperative retinal breaks occurred in 5 of 119 eyes (4.2%). One break was associated with sclerotomy and 4 were not. Postoperative RD occurred in 8 of 119 eyes (6.7%). Two RDs were sclerotomy related, 5 were not, and 1 was of indeterminate origin. Conclusions. Incidence of retinal breaks and RD following primary PPV by vitreoretinal fellows is low and comparable to that of fellowship-trained surgeons. 1. Introduction Pars plana vitrectomy (PPV) is the most common surgery performed by vitreoretinal surgeons. This procedure is used to treat for an increasing number of indications and is done on eyes with relatively good vision. During their fellowships, vitreoretinal (VR) surgery fellows are required to perform a considerable number of these procedures and to become highly proficient. As they train vitreoretinal fellows, attending vitreoretinal surgeons are naturally concerned about safety and outcomes for their patients. Ramkissoon et al. described over 600？PPVs and found an incidence of 15% iatrogenic intraoperative breaks and a 1.7% rate of postoperative retinal detachments [1]. It is important to know how vitreoretinal fellows in training perform by comparison with these published percentages. Knowing whether PPV is as effective and safe when performed by vitreoretinal fellows as by attending surgeons is important for reasons besides reduced morbidity. The current United States health care climate includes growing emphasis on outcomes, and retina fellowship programs emphasize competency in surgical training. Given the frequency of retinal surgeries, it is important to determine the comparative effectiveness and safety of trainee-performed surgeries by current standards. The purpose of this review is to evaluate the incidence of retinal breaks and retinal detachment (RD) following primary PPV performed by vitreoretinal fellows at one teaching institution and to compare those results with those in the general literature. To our knowledge, no previous studies evaluate the outcomes of primary PPV done by
References
[1]
Y. D. Ramkissoon, S. A. Aslam, S. P. Shah, S. C. Wong, and P. M. Sullivan, “Risk of iatrogenic peripheral retinal breaks in 20-G pars plana vitrectomy,” Ophthalmology, vol. 117, no. 9, pp. 1825–1830, 2010.
[2]
S. S. Park, D. M. Marcus, J. S. Duker et al., “Posterior segment complications after vitrectomy for macular hole,” Ophthalmology, vol. 102, no. 5, pp. 775–781, 1995.
[3]
A. S. Banker, W. R. Freeman, J. W. Kim et al., “Vision-threatening complications of surgery for full-thickness macular holes,” Ophthalmology, vol. 104, no. 9, pp. 1442–1453, 1997.
[4]
R. G. Michels, “Vitrectomy for macular pucker,” Ophthalmology, vol. 91, no. 11, pp. 1384–1388, 1984.
[5]
S. de Bustros, J. T. Thompson, R. G. Michels, C. Enger, T. A. Rice, and B. M. I. Glaser, “Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes,” American Journal of Ophthalmology, vol. 105, no. 2, pp. 160–164, 1988.
[6]
J. K. Moore, J. W. Kitchens, W. E. Smiddy, E. C. Mavrofrides, and G. Gregorio, “Retinal breaks observed during pars plana vitrectomy,” American Journal of Ophthalmology, vol. 144, no. 1, pp. 32.e1–36.e1, 2007.
[7]
J. B. Carter, R. G. Michels, B. M. Glaser, and S. de Bustros, “Iatrogenic retinal breaks complicating pars plana vitrectomy,” Ophthalmology, vol. 97, no. 7, pp. 848–854, 1990.
[8]
R. N. Sjaarda, B. M. Glaser, J. T. Thompson, R. P. Murphy, and A. Hanham, “Distribution of iatrogenic retinal breaks in macular hole surgery,” Ophthalmology, vol. 102, no. 9, pp. 1387–1392, 1995.
[9]
C. Territo, J. P. Gieser, C. A. Wilson, and R. Anand, “Influence of the cannulated vitrectomy system on the occurrence of iatrogenic sclerotomy retinal tears,” Retina, vol. 17, no. 5, pp. 430–433, 1997.
[10]
R. G. Michels and S. J. Ryan Jr., “Results and complications of 100 consecutive cases of pars plana vitrectomy,” American Journal of Ophthalmology, vol. 80, no. 1, pp. 24–29, 1975.
[11]
Y. M. Tardif, C. L. Schepens, and F. I. Tolentino, “Vitreous surgery. XIV. Complications from sclerotomy in 89 consecutive cases,” Archives of Ophthalmology, vol. 95, no. 2, pp. 229–234, 1977.
[12]
A. E. Kreiger, “The management of wound related complications in pars plana vitrectomy,” Transactions of the American Ophthalmological Society, vol. 92, pp. 307–324, 1994.
[13]
Z. Gregor and S. J. Ryan, “Pars plana vitrectomy entry sites,” Transactions of the Ophthalmological Societies of the United Kingdom, vol. 102, part 4, pp. 461–467, 1982.
[14]
Market Scope Web site, 2013, http://www.market-scope.com/.
[15]
B. Wimpissinger and S. Binder, “Entry-site-related retinal detachment after pars plana vitrectomy,” Acta Ophthalmologica Scandinavica, vol. 85, no. 7, pp. 782–785, 2007.
[16]
C. K. Chan, S. Lee, P. Sangani, L. W. Lin, M. S. Lin, and S. C. Lin, “Primary trabeculectomy surgery performed by residents at a county hospital,” Journal of Glaucoma, vol. 16, no. 1, pp. 52–56, 2007.
[17]
A. Rowden and R. Krishna, “Resident cataract surgical training in United States residency programs,” Journal of Cataract and Refractive Surgery, vol. 28, no. 12, pp. 2202–2205, 2002.
[18]
R. P. Corey and R. J. Olson, “Surgical outcomes of cataract extractions performed by residents using phacoemulsification,” Journal of Cataract and Refractive Surgery, vol. 24, no. 1, pp. 66–72, 1998.
[19]
K. J. Tarbet, N. Mamalis, J. Theurer, B. D. Jones, and R. J. Olson, “Complications and results of phacoemulsification performed by residents,” Journal of Cataract and Refractive Surgery, vol. 21, no. 6, pp. 661–665, 1995.
[20]
E. S. Chen, M. A. Terry, N. Shamie, K. L. Hoar, P. M. Phillips, and D. J. Friend, “Endothelial keratoplasty: vision, endothelial survival, and complications in a comparative case series of fellows vs. attending surgeons,” American Journal of Ophthalmology, vol. 148, no. 1, pp. 26.e2–31.e2, 2009.
