Role of Physician Experience in Pterygium Surgical Outcomes

Friday, April 25, 2014
KIOSKS (Boston Convention and Exhibition Center)
Ben Janson, BS, The Johns Hopkins School of Medicine, Baltimore, MD, USA
Shameema Sikder, MD, Johns Hopkins University, Baltimore, MD, USA

Narrative Responses:

Purpose
To compare the pterygium surgical outcomes of complication rate and recurrence rate between surgical trainees and surgical attendings.

Methods
This was a retrospective review over a 9-year period of 139 eyes with primary pterygium that received pterygium excision at Wilmer Eye Institute (Baltimore, MD).  Each type of procedure (bare sclera, conjunctival autograft, limbal-conjunctival autograft, amniotic membrane grafting, and primary conjunctival closure) was analyzed separately.  The surgical outcomes of two groups were analyzed: those of attending surgeons and of trainees.  The trainee group included both residents and fellows.  Post-operative data collection included reported complications and the time until recurrence.

Results
139 primary pterygium eyes were recorded.  Mean follow up time was 467±637 days.  Between the two groups there were no statistical differences in patient demographics (p-values >0.59). The recurrence rates were: amniotic membrane grafts (24.4%, n=45), bare sclera (20%, n=5), conjunctival autograft (8.8%, n=68), conjunctival-limbal autograft (54.5%, n=11), and primary closure (30%, n=10). When evaluating procedure types, there were no statistically significant differences between attending and trainee groups in complications (p-values >0.28) or recurrence rates (p-values >0.074).  No differences in recurrence times were significant between the two groups (p=0.64) and overall recurrence time averaged 9.16±10.93 months (0.5-40.5 months).

Conclusion
There were no statistical differences between experience groups in recurrence or complication rates, but small sample sizes limit this conclusion.  There was a statistical difference between surgical technique and recurrence rate.  Additionally, the recurrence time often was longer than one year, which may prompt further investigation into adequate follow up-times.