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Micro-invasive glaucoma surgery (MIGS) is a developing field in the management of glaucoma. Outcomes of resident-performed iStent procedures have yet to be reported. The purpose of this study is to report the outcomes of resident-performed iStent procedures and to compare completed and aborted iStent procedures.
Retrospective chart review was performed at the Iowa City Veterans Affairs Medical Center (VAMC). Subjects who underwent a combined cataract surgery and attempted iStent procedure as well as patients who underwent cataract surgery alone were included in the analysis. Demographic data, intraocular pressure (IOP), and ocular antihypertensive drops were collected from pre-operative visits and the last follow up visit. Operative time as well as intraoperative and post-operative complications were recorded.
Fifty-five iStent procedures were attempted by 10 PGY-4 residents over a 2-year period at the Iowa City VAMC. Six of the 55 iStent attempts were aborted due to an inadequate intraoperative view (hyphema:4, corneal edema:1, patient tolerance:1). Two aborted attempts occurred on a resident’s first iStent attempt. Average follow up was 187 days. Reductions in IOP and ocular antihypertensive drops were similar between completed and aborted groups (% IOP reduction: 17.0% vs 15.9%, p value=0.97; Drop reduction: 0.5 vs 0.8, p value=0.5). Average operative time for cases including iStent was 5.0 minutes longer than cases without iStent completed by PGY-4 residents during the same time period (n=1067) (28.0 vs 23.0 min; p value=0.0001). No visually-significant adverse events or complications were noted.
Resident-performed iStent procedures are safe. No visually-significant complications or adverse events were noted. The increased operative time of cases including the iStent procedure was 5.0 minutes. Completed and aborted resident-performed iStent procedures resulted in a similar reduction in IOP and ocular antihypertensive drops.