Role of Physician Experience in Pterygium Surgical Outcomes
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.