ESCRS - PP26.07 - A Comparative Retrospective Study Between Corneal Fellows And Consultants To Determine The Role Of Surgeon Experience In Descemet Membrane Endothelial Keratoplasty (Dmek) Outcomes

A Comparative Retrospective Study Between Corneal Fellows And Consultants To Determine The Role Of Surgeon Experience In Descemet Membrane Endothelial Keratoplasty (Dmek) Outcomes

Published 2022 - 40th Congress of the ESCRS

Reference: PP26.07 | Type: ESCRS 2022 - Posters | DOI: 10.82333/4znj-zh90

Authors: Alfredo Borgia* 1 , Giulia Coco 2 , Davide Romano 3 , Luca Pagano 4 , Stephen B Kaye 5 , Vito Romano 6

1Eye Clinic,Humanitas-Gradenigo Hospital,Turin,Italy;Department of Corneal and External Eye Diseases, St Paul's Eye Unit,Royal Liverpool University Hospital,Liverpool,United Kingdom, 2Department of Clinical Science and Translational Medicine,University of Rome Tor Vergat,Rome,Italy, 3Eye Clinic, Department of Neurological and Vision Sciences,University of Brescia,Brescia,Italy, 4Department of Corneal and External Eye Diseases, St Paul's Eye Unit,Royal Liverpool University Hospital,Liverpool,United Kingdom, 5Department of Corneal and External Eye Diseases, St Paul's Eye Unit,Royal Liverpool University Hospital,Liverpool,United Kingdom;Department of Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom, 6Eye Clinic, Department of Neurological and Vision Sciences,University of Brescia,Brescia,Italy;Department of Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom

Purpose

To compare the complication rate of Descemet Membrane Endothelial Keratoplasty (DMEK) conducted by fellows with those performed entirely by staff surgeons

Setting

Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK

Methods

Retrospective comparative case series of 181 eyes undergoing DMEK, with or without fellows’ involvement. Patients included were diagnosed with Fuchs’s Endothelial Dystrophy (FED), Pseudophakic Bullous Keratopathy (PBK) or previous endothelial graft failure with a minimum follow-up of 12 weeks. Data on patients’ demographics, surgical details, surgeon level, intra- and post-operative complications, and rate of DMEK rebubbling were collected

Results

DMEK surgery was conducted by corneal fellows in 92 cases,and by corneal consultants in 89 cases.There was no overall significant difference in the success rates of surgeries and complications rate between fellows and consultants after a minimum follow-up of 12 weeks.The rebubbling rate was similar in the two groups. 97,24% of 181 eyes achieved a best corrected visual acuity of ≥0.3 LogMAR in 6 months.Intraoperative complications occurred in 9,78% of cases in the fellows group and in 8,98% in the consultants group(P=0,864); postoperative complications occurred in 10,86% of cases in the fellows group and in 5,61% of cases in the consultants group(P=0.281). A total of 5 cases(2,76%),all from the fellow group,required a secondary keratoplasty.

Conclusions

The participation of fellows appears to have occurred without an overall increase in the risk of complications. On the other hand, fellows’ patients had a larger rate of poor outcomes that necessitated a keratoplasty repeat. These findings support the quality of surgical care delivered by trainees, especially in view of the trend toward expertise instruction and increased scrutiny of patient outcomes.