Comparison of trabeculotomy ab externo outcomes between resident physicians and supervising ophthalmologists using propensity score matching

This study compared the surgical performance of resident doctors and their supervising ophthalmic surgeons in trabeculotomy (LOT) ab externo using propensity score matching. We retrospectively analyzed surgical data on 248 eyes that underwent LOT ab externo at our hospital between April 2016 and December 2022. The procedures were performed by three full-time supervising ophthalmologists (≥ 5 years of experience) and 12 resident physicians (< 5 years of experience). Propensity score matching was used to adjust for significant variables identified through univariate analysis of five covariates: preoperative visual acuity, preoperative intraocular pressure [IOP], preoperative ophthalmoscopy score, presence of preoperative pseudophakia, and concomitant cataract surgery. Postoperative outcomes including IOP, eye drop scores, and complications, were evaluated at 3-month intervals up to 24 months. Survival curves showed no significant difference between the eyes operated by resident physicians and those by supervising ophthalmologists (P = 0.183). The median change in IOP (first quartile-third quartile) was also comparable between the two groups (P = 0.234). Furthermore, both groups had similar rates of anterior chamber hemorrhage and transient IOP elevation (P = 0.577 and 0.85, respectively). These findings suggest that resident physicians can achieve surgical outcomes and complication rates comparable to those of their supervising ophthalmic surgeons when performing LOT ab externo.