Purpose
To evaluate long-term outcomes of primary trabeculectomy with mitomycin C performed by ophthalmology residents.
Design
Cohort study and case-matched comparison.
Methods
setting : Residency program. population/intervention : A cohort of glaucoma patients at a Veterans Administration hospital (VAH) and private patients of attending physicians (“attendings”) who underwent primary trabeculectomy between 2003 and 2012 with ≥6 months of postoperative follow-up. Qualified surgical success was defined as intraocular pressure (IOP) ≤15 and >5 mm Hg (± glaucoma medications) without complications or additional glaucoma surgery. A subgroup of VAH patients with resident-performed trabeculectomy was case-matched to private patients with attending-performed trabeculectomy. outcome measures : Success rate, IOP, glaucoma medication number, visual acuity, complications, and additional glaucoma surgery.
Results
Eighty-five eyes (85 patients) underwent resident-performed primary trabeculectomy at the VAH with mean follow-up duration of 45.2 ± 28.1 months. Cumulative survival rates were 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up. The complication rate was 9.4%. Patients in the resident group had more severe preoperative visual field defects, poorer long-term postoperative visual acuity, and a lower rate of cataract surgery performed after trabeculectomy than those in the attending group.
Conclusion
Glaucoma patients at a VAH with primary trabeculectomy performed by residents under attending supervision had similar success and complication rates as patients who underwent attending-performed trabeculectomies. However, the visual outcomes of patients with trabeculectomy performed by residents were worse in the long term, which might be attributable to a more advanced glaucoma disease stage or a lower rate of cataract surgery performed in the VAH patients.
Trabeculectomy remains the gold-standard surgical procedure for glaucoma. Ophthalmology residents are required to become proficient in trabeculectomy during their training. The ophthalmology Residency Review Committee (RRC) for the Accreditation Council for Graduate Medical Education (ACGME) requires residents to perform a minimum of 5 glaucoma filtering/shunting surgeries as primary surgeon before graduation. Previous studies suggest that resident-performed trabeculectomies may yield outcomes comparable to those in the overall literature. Direct comparisons of surgery performed by residents and supervising surgeons are rare. In a 1980s retrospective comparison of trabeculectomies performed by senior surgeons and surgeons-in-training in the United Kingdom, outcomes and complication rates were comparable. At that time, antimetabolites were not in common use. The aims of this study were: (1) to evaluate the long-term outcomes of primary trabeculectomy with intraoperative application of mitomycin C (MMC) performed by ophthalmology residents at a United States residency program; and (2) to compare the outcomes between resident-performed vs attending physician (“attending”)-performed trabeculectomy.
Methods
This retrospective study was approved by the Institutional Review Boards of the University of California Los Angeles (UCLA) and the West Los Angeles Veterans Administration Hospital (VAH) and was conducted with adherence to the Declaration of Helsinki and all applicable HIPAA rules. The ophthalmology service at the VAH was staffed by residents and attendings from UCLA.
Medical records were retrospectively reviewed of patients who underwent a primary trabeculectomy with adjunctive intraoperative MMC application performed by trainees of the UCLA ophthalmology residency program between July 1, 2003 and June 30, 2012 at the West Los Angeles VAH. Eyes that underwent a concurrent procedure and those with less than 6 months postoperative follow-up were excluded. All glaucoma surgeries at the VAH were performed by residents in their third or fourth year of postgraduate training (PGY-3 or PGY-4, respectively) under the direct surgical supervision of 1 of 2 experienced attending glaucoma surgeons (S.K.L., J.A.G.). Only 1 eye per patient was included; in cases where both eyes qualified for the study, the first operated eye was enrolled. All forms of glaucoma were eligible for inclusion in the study. Glaucoma was defined as having structural changes in the optic disc consistent with glaucomatous optic neuropathy, visual field abnormalities consistent with glaucoma, and a need for medical therapy to control intraocular pressure (IOP). In order to compare surgeries performed by residents and attendings, cases of primary trabeculectomy with MMC application performed by residents at the VAH were matched to those performed by attendings at the Jules Stein Eye Institute (JSEI) of UCLA. A list of all primary trabeculectomies with MMC application performed at JSEI between July 2003 and June 2012 was generated. Surgeries performed by residents at the VAH and those performed by attendings at JSEI (S.K.L., K.N.M., J.C., J.A.G.) were matched case by case based on age (±5 years), race, glaucoma subtype, and the surgical technique for creating the conjunctival flap during trabeculectomy (ie, fornix- or limbus-based approach of creating the conjunctival flap). If more than 1 match was found, the first patient on the list was selected for inclusion.
Preoperative data collected from the patient charts included the following: age at time of surgery, sex, race, glaucoma subtype, eye laterality, prior surgeries, prior laser treatments, ocular comorbidities, lens status, visual field mean deviation and pattern standard deviation, visual acuity, IOP, number of glaucoma medications, and systemic comorbidities. Operative data included primary surgeon level (attending or resident), postgraduate year of training for resident-performed surgeries, duration of operation, conjunctival flap approach (limbus- or fornix-based), MMC concentration and duration of application, and intraoperative complications. Postoperative data collected included complications, subsequent surgeries and procedures, visual acuity, IOP, and number of glaucoma medications used. Snellen visual acuity was converted to logMAR scale for comparison. LogMAR values of 1.40, 2.70, and 3.70 were assigned to counting fingers, hand motions, and light perception, respectively. Only reliable visual field results (24-2 SITA-Standard algorithm) were included (reliability was defined as fixation loss of <20%, false-positive and false-negative rate of <33%). Data were collected for every postoperative visit up to 5 years.
Surgical Technique
The surgical technique used was previously described and was similar between cases performed by residents and attendings. All cases were performed under local peribulbar anesthesia with monitored anesthesia care (MAC). Percutaneous injection of 4-5 mL of a 1:1 mixture of lidocaine 2% and bupivacaine 0.75% was administered to the spaces between the orbital rim and the globe at the inferior temporal quadrant and the superior quadrant. A 6-0 silk suture was placed in the superior peripheral clear cornea and the eye was infraducted to provide exposure of the superior conjunctival area for conjunctival dissection. For the limbus-based approach, the conjunctiva and Tenon capsule were incised approximately 8-10 mm posterior to the limbus in the superior fornix and extended horizontally for approximately 8-10 mm before undermining anteriorly to the limbus. For the fornix-based approach, a peritomy of 6-8 mm was created at the limbus and the conjunctiva and Tenon capsule were undermined posteriorly. All eyes received MMC application intraoperatively. A thin cellulose sponge (approximately 6 × 12 mm) soaked in MMC with concentrations of 0.25-0.3 mg/mL was placed over the intended site of the scleral flap for 1-3 minutes, followed by thorough irrigation with balanced salt solution. The concentration and duration of MMC were based on the preoperative evaluation of each patient’s risk factors for failure (conjunctival hyperemia, inflammation, and race) according to the surgeon’s discretion. A rectangular half-thickness limbus-based scleral flap of approximately 3 × 4 mm in its vertical and horizontal dimensions, respectively, was created. The scleral flap was dissected anteriorly into clear cornea until approximately 1 mm of the blue-gray zone of the cornea-scleral junction was visualized anterior to the scleral spur. The anterior chamber was entered just posterior to the scleral flap hinge with a 15-degree microblade. A sclerostomy was made using a Kelly punch or a pair of microsurgical scissors and a 15-degree microblade. A peripheral iridectomy was created with 0.12 mm tooth forceps and de Wecker scissors through the sclerostomy site, with its size large enough to prevent incarceration of iris tissue in the sclerostomy. The scleral flap was closed with interrupted 10-0 nylon sutures. The number, location, and tightness of the interrupted nylon scleral flap sutures varied according to individual patient factors and desired flow. In the limbus-based approach, the conjunctiva and Tenon capsule were closed with 8-0 polyglactin suture in a running fashion, incorporating both conjunctiva and Tenon capsule. In the fornix-based approach, the conjunctiva and Tenon capsule were anchored to the limbus with 9-0 or 10-0 polyglactin suture at the 2 limbal wing locations.
The choice of a limbus-based or fornix-based approach rested on many factors, including the accessibility and condition of the superior conjunctiva, resident experience, and attending preference. Previous studies have not shown a significant difference with regard to success rates and IOP control between limbus-based and fornix-based trabeculectomies.
Postoperative medications included an antibiotic drop for 1 week and topical steroid drop (prednisolone acetate 1%) starting at 4 times daily and tapered over a period of 4-8 weeks based on the postoperative inflammatory reaction. Argon suture lysis and 5-fluorouracil (5-FU) bleb needling were performed according to surgeon discretion in response to postoperative IOP and bleb profile. These procedures were performed either by the operating resident with the attending’s direct supervision or by the attending surgeon. Postoperatively, medical glaucoma therapy was initiated according to the individual patient’s requirement for IOP control. At the VAH, postoperative care was provided by residents under the direct supervision of the 2 attending glaucoma surgeons (S.K.L., J.A.G.), who also attended the surgery.
Statistical Analysis
The primary outcome measure was the rate of qualified surgical success (with or without medications), defined by an IOP ≤15 mm Hg and >5 mm Hg (or a 15% reduction of IOP if it is 15 mm Hg or less preoperatively), without complications or additional glaucoma surgery, and no loss of light perception. Complete success was defined similarly, except that no glaucoma medical therapy was required. The IOP criteria were chosen based on our usual clinical practice of setting a target IOP goal at the mid-teens or lower in patients requiring trabeculectomy. Needling of encapsulated blebs with 5-FU injection or laser suture lysis was not considered a failure. Kaplan-Meier survival analyses were used to assess the cumulative success rate. Survival curves of each group were compared with the log-rank test. Secondary outcome measures were IOP, number of glaucoma medications, visual acuity, surgical complications, and additional glaucoma surgical interventions. Surgical complications were defined as serious complications that might result in reduction of vision (such as corneal decompensation, suprachoroidal hemorrhage, retinal detachment, or endophthalmitis) or complications that required surgical intervention.
Outcomes of the resident-performed trabeculectomy cohort were analyzed first. The case-matched comparison between resident-performed vs attending-performed surgery was analyzed separately. Student t tests were used to assess IOP, number of glaucoma medications, and logMAR visual acuity between the resident-performed and attending-performed surgeries. Categorical variables were analyzed with χ 2 tests and Fisher exact tests. In order to avoid false positives from multiple comparisons, we only examined differences between groups at 36 months postoperatively where data from more than 50% of the sample remained available for analysis. P values ≤ .05 were considered significant. Mean values were presented with their standard deviations (± SD).
Results
Cohort of Resident-Performed Trabeculectomies
Eighty-five eyes of 85 patients who underwent a resident-performed primary trabeculectomy with MMC application, without concurrent procedures, were included in the study. Of all cases reviewed (90 cases), only 5 cases (5.3%) were excluded based on the follow-up criterion (follow-up less than 6 months). Demographic and preoperative characteristics of the cohort are summarized in Table 1 . Mean age was 69.2 ± 11.9 years. All patients were male except 1. Approximately half of the study population was black (42 patients or 49.4%). Three-quarters of patients (64 patients or 75.3%) had primary open-angle glaucoma. A quarter of patients (21 patients or 24.7%) were pseudophakic. Mean duration of follow-up was 45.2 ± 28.1 months.
| Total number of patients (eyes) | 85 |
| Mean age in years (range) | 69.2 ± 11.9 (24-92) |
| Sex: male/female | 84 (98.8%)/1 (1.2%) |
| Race: black/white/Asian | 42 (49.4%)/35 (41.2%)/8 (9.4%) |
| Glaucoma subtype, n (%) | |
| Primary open-angle glaucoma | 64 (75.3%) |
| Combined-mechanism glaucoma | 5 (5.9%) |
| Primary angle closure glaucoma | 3 (3.5%) |
| Pseudoexfoliation glaucoma | 3 (3.5%) |
| Angle recession glaucoma | 2 (2.4%) |
| Secondary angle closure glaucoma | 2 (2.4%) |
| Uveitic glaucoma | 2 (2.4%) |
| Juvenile onset glaucoma | 1 (1.2%) |
| Neovascular glaucoma | 1 (1.2%) |
| Normal tension glaucoma | 1 (1.2%) |
| Traumatic glaucoma | 1 (1.2%) |
| Preoperative lenticular status, n (%) | |
| Phakic | 64 (75.3%) |
| Pseudophakic | 21 (24.7%) |
| Prior intraocular surgery, n (%) | |
| Laser trabeculoplasty | 25 (29.4%) |
| Cataract operation with intraocular lens implantation | 21 (24.7%) |
| Laser-assisted in situ keratomileusis (LASIK) | 2 (2.4%) |
| Penetrating keratoplasty | 1 (1.2%) |
| Ruptured globe repair | 1 (1.2%) |
| Pars plana vitrectomy | 1 (1.2%) |
| Preoperative IOP control | |
| Mean IOP in mm Hg (range) | 22.5 ± 7.5 (10 to 41) |
| Mean number of glaucoma medications (median) | 4.0 ± 1.0 (4) |
| Preoperative visual field (59 patients with reliable tests) | |
| Mean deviation (dB) | −16.3 ± 9.6 |
| Pattern standard deviation (dB) | 7.5 ± 3.7 |
| Preoperative mean visual acuity (logMAR scale) | 0.6 ± 0.7 |
| Mean follow-up duration (months) | 45.2 ± 28.1 |
All patients were on maximally tolerated medical therapy preoperatively, with a mean number of glaucoma medications of 4.0 ± 1.0 and IOP of 22.5 ± 7.5 mm Hg. Over a quarter (29.4%) of the sample had received laser trabeculoplasty. Reliable preoperative visual fields were available for 59 patients (69.4%). The preoperative visual field average mean deviation (MD) and pattern standard deviation (PSD) were −16.3 ± 9.6 and 7.5 ± 3.7 dB, respectively. Mean preoperative visual acuity was 0.6 ± 0.7 (logMAR scale), which is equivalent to 20/80 (Snellen visual acuity chart).
All VAH surgeries were performed by residents under the direct supervision of attendings who were experienced glaucoma surgeons. Resident surgeons were either in their PGY-3 (21 cases or 24.7%) or PGY-4 (64 cases or 75.3%) years. A fornix-based approach was used more frequently than a limbus-based one (83.5% vs 16.5%, respectively). The concentration of MMC used in all cases was 0.3 mg/mL, with a mean duration of application of 2.7 ± 1.0 minutes. Mean operation time was 48.0 ± 10.8 minutes. Laser suture lysis was performed in 36 patients (42.4%) at 16.4 ± 16.8 days after surgery. Five patients underwent bleb needling with 5-FU postoperatively at an average time of 36.6 ± 16.0 days postoperatively. There were no significant differences in the operative characteristics between cases performed by PGY-3 residents and those by PGY-4 residents ( Table 2 ).
| Cases Performed by PGY-3 and PGY-4 (% Total Patients) | Cases Performed by PGY-3 (% Total Patients) | Cases Performed by PGY-4 (% Total Patients) | P Value (Comparing PGY-3 and PGY-4 Groups) | |
|---|---|---|---|---|
| Total number of patients | 85 | 21 | 64 | |
| Fornix-based approach, n (%) | 71 (83.5%) | 20 (95.2%) | 51 (79.7%) | .172 a |
| Limbal-based approach, n (%) | 14 (16.5%) | 1 (4.8%) | 13 (20.3%) | .172 a |
| Mean operation time (min) | 48.0 ± 10.8 | 48.4 ± 10.3 | 47.8 ± 11.1 | .845 b |
| Mean number of scleral flap sutures | 2.7 ± 1.0 | 2.8 ± 1.0 | 2.6 ± 1.0 | .501 b |
| Mean mitomycin C concentration (mg/mL) | 0.3 ± 0.0 | 0.3 ± 0.0 | 0.3 ± 0.0 | NS |
| Mean mitomycin C duration of application (min) | 1.3 ± 0.4 | 1.3 ± 0.4 | 1.3 ± 0.5 | .503 b |
| Laser suture lysis | 36 (42.4%) | 10 (47.6%) | 26 (40.6%) | .794 a |
| Postoperative interval of laser suture lysis (d) | 16.4 ± 16.8 | 17.0 ± 26.9 | 16.2 ± 11.5 | .904 b |
| 5-FU needling, n (%) | 5 (5.9%) | 2 (9.5%) | 3 (4.7%) | NS |
| Postoperative interval of 5-FU needling (d) | 36.6 ± 16.0 | 37.5 ± 26.2 | 37.7 ± 14.5 | NS |
Table 3 summarizes the IOP, number of glaucoma medications, and visual acuity of the cohort. Postoperative reductions of IOP and number of glaucoma medications were statistically significant at each time point up to 60 months ( P < .001). Mean IOP decreased from 22.5 ± 7.5 mm Hg preoperatively to 11.1 ± 4.8 mm Hg and mean number of glaucoma medications was reduced from a preoperative mean of 4.0 ± 1.0 to 1.8 ± 1.6 at 36 months. However, the number of glaucoma medications required gradually increased over the 5 years of postoperative follow-up, from 1.0 ± 1.4 at 6 months to 2.3 ± 1.8 at 60 months. In the first 24 months postoperatively, visual acuity was similar to preoperative visual acuity (0.6-0.7, equivalent to 20/80-20/100 range). In subsequent follow-up visits, visual acuity decreased to 0.8-0.9, equivalent to approximately 20/150 ( P < .05). Twenty-one of 64 patients (32.8%) who were phakic before trabeculectomy underwent cataract extraction with intraocular lens implantation at an average of 22.3 ± 20.3 months after trabeculectomy. After cataract extraction, visual acuity improved from 1.0 ± 0.8 to 0.5 ± 0.4 (equivalent to improving from 20/200 to 20/60, P = .004).
| Visits (Number of Patients) | Mean IOP ( P Value) | Mean Number of Glaucoma Medications ( P Value) | Visual Acuity in LogMAR Scale ( P Value) |
|---|---|---|---|
| Preoperative | 22.5 ± 7.5 | 4.0 ± 1.0 | 0.6 ± 0.7 |
| 3 months | 12.0 ± 5.5 ( P < .001) | 0.5 ± 1.0 ( P < .001) | 0.6 ± 0.6 ( P = .775) |
| 6 months | 12.1 ± 4.7 ( P < .001) | 1.0 ± 1.4 ( P < .001) | 0.7 ± 0.7 ( P = .426) |
| 12 months (62) | 11.8 ± 4.2 ( P < .001) | 1.3 ± 1.6 ( P < .001) | 0.7 ± 0.7 ( P = .415) |
| 24 months (48) | 11.7 ± 4.0 ( P < .001) | 1.3 ± 1.6 ( P < .001) | 0.6 ± 0.7 ( P = .591) |
| 36 months (34) | 11.1 ± 4.8 ( P < .001) | 1.8 ± 1.6 ( P < .001) | 0.9 ± 0.9 ( P = .041) |
| 48 months (26) | 12.7 ± 4.9 ( P < .001) | 2.1 ± 1.9 ( P < .001) | 0.9 ± 0.9 ( P = .033) |
| 60 months (18) | 11.8 ± 5.2 ( P < .001) | 2.3 ± 1.8 ( P < .001) | 0.8 ± 0.8 ( P = .158) |
Table 4 summarizes reasons for failure in the 24 patients (28.2%) among the cohort of 85 resident-operated patients. Failure was distributed fairly evenly among 3 categories: uncontrolled IOP, complications, and additional glaucoma surgery. The cohort’s qualified success rate was 71.2% (61 patients) and the complete success rate was 30.6% (26 patients). There was not a significant difference in the success rates between trabeculectomies performed by PGY-3 and PGY-4 residents. Figure 1 represents the Kaplan-Meier survival curve for qualified success. Mean survival time was 46.6 ± 2.8 months (95% confidence interval [CI]: 41.2, 52.0 months). The cumulative proportion of survival was 69.0% ± 5.6% at 3 years and 65.0% ± 6.5% at 5 years of follow-up.
| Reasons for Failure | Number of Patients (% Total Patients) |
|---|---|
| Uncontrolled intraocular pressure (>15 mm Hg) without additional glaucoma surgery | 7 (8.2%) |
| Complications (complications that may affect visual outcomes or complications that required surgical intervention): | 8 (9.4%) |
| (1) Hypotony maculopathy | 2 |
| (2) Persistent limbal conjunctival wound leak | 2 |
| (3) Bleb leak | 2 |
| (4) Flat anterior chamber requiring reformation of anterior chamber | 1 |
| (5) Blebitis/endophthalmitis | 1 |
| Additional glaucoma surgery required: | 9 (10.6%) |
| (1) Second trabeculectomy | 6 |
| (2) Revision of trabeculectomy with 5-FU needling in operating room | 1 |
| (3) Tube shunt procedure | 2 |
| Total number of failures: | 24 (28.2%) |
Intraoperatively, there were no serious complications. Table 5 summarizes the technical difficulties encountered by residents during surgery. Scleral flap dissection (5 cases, 5.9%) was the most frequent intraoperative issue. These technical difficulties were managed successfully under the supervision of the attending surgeon and did not produce a significant impact in surgical recovery.
| Intraoperative Complications | Number of Patients (% Total Patients) | Management |
|---|---|---|
| Full-thickness corneal penetration from traction suture | 2 (2.4%) | Reformation of anterior chamber with balanced-salt solution (1 case) and viscoelastic material (1 case) |
| Radial tear of conjunctiva of the periotomy at limbus | 1 (1.2%) | Closure of tear by additional suturing |
| Scleral flap dissection difficulties: | 5 (5.9%) | |
| a. Inadequate dissection of fibrous and friable sclera flap (1 case) | a. Flap dissection completed by attending | |
| b. Flap dissected was too thin partially (1 case) | b. First flap was abandoned, and new flap was created | |
| c. Bleeding of perforating blood vessel under the flap during dissection (1 case) | c. Hemostasis achieved with wet field cautery and pressure | |
| d. Premature entry of anterior chamber (2 cases) | d. Sclerotomy continued with the premature entry site | |
| Iris prolapse into trabeculectomy site | 1 (1.2%) | Iridectomy was enlarged |
| Vitreous prolapse from trabeculectomy site | 1 (1.2%) | Manual vitrectomy with Weck-cel and Westcott scissors |
| Excessive bleeding from iris after iridectomy | 1 (1.2%) | Anterior chamber washout of blood and bleeding spontaneously stopped |
| Inadequate aqueous outflow | 1 (1.2%) | Sclerostomy was enlarged and flap reclosed |
| Persistent limbal conjunctival wound leak | 1 (1.2%) | Additional sutures used to attach conjunctiva to limbus |
| Total number of complications | 13 (15.3%) | |
| Number of patients with complications | 10 (11.8%) |
The rates of serious postoperative complications and complications requiring surgical intervention were relatively low (9.4%). Persistent limbal conjunctival wound leakage (2 patients) and flat chamber (1 patient) were successfully managed with surgical repair and reformation of the anterior chamber, respectively. Two patients had late bleb leak requiring excision of the avascular bleb tissue and conjunctival advancement. Two patients developed hypotony maculopathy that required trabeculectomy revision. One patient developed blebitis on postoperative day 11, which quickly progressed to endophthalmitis. This patient underwent a tap and injection of intravitreal antibiotics and subsequently required pars plana vitrectomy. Cultures were positive for methicillin-resistant Staphylococcus aureus . The patient recovered from the infection; at the last follow-up visit (42 months), vision and IOP were 20/40 and 10 mm Hg, respectively.
Comparison of Resident-Performed Versus Attending-Performed Trabeculectomy
Twenty-nine patients (eyes) who had primary trabeculectomy with MMC application performed by ophthalmology residents at the West Los Angeles VAH (resident group) were case-matched to 29 patients (eyes) performed by an attending glaucoma specialist at the Jules Stein Eye Institute of UCLA (attending group). Because of the strict criteria for matching, only a limited number of patients could be matched successfully. The demographic and preoperative characteristics of the 2 groups are summarized in Table 6 . All 29 patients in the resident group and 20 patients (69.0%) in the attending group were male ( P = .002). Although the mean preoperative IOP of the resident group and attending group were similar (20.4 ± 6.8 mm Hg and 19.8 ± 7.3 mm Hg, respectively, P = .764), the resident group was taking a higher mean number of glaucoma medications preoperatively than the attending group (4.1 ± 1.1 and 2.9 ± 1.3, respectively, P < .001). The visual fields of the resident group had a worse average MD than those of the attending group (−19.0 ± 7.8 dB and −12.1 ± 7.3 dB, respectively, P = .003) but a similar mean PSD (8.5 ± 3.6 dB and 8.9 ± 3.1 dB, respectively, P = .682).
| Primary Trabeculectomy Performed by Residents | Primary Trabeculectomy Performed by Attendings | P Value | |
|---|---|---|---|
| Total number of patients | 29 | 29 | |
| Mean age, years (range) | 71.1 ± 8.7 (52-85) | 70.9 ± 8.3 (57-84) | .902 a |
| Sex: male/female, n (%) | 29 (100.0%)/0 (0%) | 20 (69.0%)/9 (31.0%) | .002 b |
| Race: black/white/Asian, n (%) | 14 (48.3%)/14 (48.3%)/1 (3.4%) | 14 (48.3%)/14 (48.3%)/1 (3.4%) | NS |
| Glaucoma subtype, n (%) | NS | ||
| Primary open-angle glaucoma | 25 (86.2%) | 25 (86.2%) | |
| Primary angle closure glaucoma | 1 (3.4%) | 1 (3.4%) | |
| Pseudoexfoliation glaucoma | 3 (10.3%) | 3 (10.3%) | |
| Preoperative lenticular status, n (%) | .748 b | ||
| Phakic | 23 (79.3%) | 24 (82.8%) | |
| Pseudophakic | 6 (20.7%) | 5 (17.2%) | |
| Prior intraocular surgery, n (%) | |||
| Laser trabeculoplasty | 15 (51.7%) | 8 (27.6%) | .106 b |
| Cataract operation with intraocular lens implantation | 6 (20.7%) | 5 (17.2%) | .863 b |
| Laser-assisted in situ keratomileusis | 1 | 1 | NS |
| Preoperative IOP control: | |||
| Mean IOP, mm Hg (range) | 20.4 ± 6.8 (11-32) | 19.8 ± 7.3 (10-45) | .764 a |
| Mean number of glaucoma medications (median) | 4.1 ± 1.1 (3) | 2.9 ± 1.3 (4) | <.001 a |
| Preoperative visual field (23 VAH patients and 26 JSEI patients with reliable tests for analysis) | |||
| Mean deviation (dB) | −19.0 ± 7.8 | −12.1 ± 7.3 | .003 a |
| Pattern standard deviation (dB) | 8.5 ± 3.6 | 8.9 ± 3.1 | .682 a |
| Preoperative mean visual acuity (logMAR scale) | 0.5 ± 0.7 | 0.3 ± 0.4 | .236 a |
| Mean follow-up duration (mo) | 46.3 ± 28.1 | 52.7 ± 29.5 | .403 a |
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