Aims To investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes. Methods A prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial corneal dystrophy or pseudophakic bullous keratopathy undergoing a first EK procedure in that eye between 2005 and 2020. EK procedures were either Descemet Stripping Endothelial Keratoplasty (DSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK). Primary outcome was transplant survival at 2 years. Secondary outcomes at 1-year post-transplant were (1) best-corrected visual acuity, (2) requirement for repeat air injection procedures to treat graft detachment and (3) iatrogenic primary graft failure. Results Following analysis of 11 516 EK transplants, significant impact of surgeon learning was indicated by (1) the influence of surgeon prior experience in that EK technique, (2) the influence of surgeon prior experience in postoperative management and (3) the time interval from introduction of that EK technique in the United Kingdom to time of surgery. EK grafts reported to have failed within the first 6 months were a significant proportion of all transplant failures. Conclusions Influence of surgeon learning and inexperience in EK of clinical and statistical significance can be quantified and diminishes over time. Equivalent analyses may be feasible for novel procedures in other ophthalmology specialties and surgical training. Training programmes and nationwide advisory networks may be helpful in reducing the duration and impact of surgeon learning curves. Data are available upon reasonable request.

中文翻译：

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外科医生学习对新眼科手术结果的影响：全国范围内角膜内皮移植的量化证据


目的 探讨外科医生学习对内皮角膜移植术 （EK） 手术结果的影响。方法 2005 年至 2020 年间，对年龄至少 21 岁的 Fuchs 角膜内皮营养不良或假晶状体大疱性角膜病变患者进行 EK 移植物的前瞻性全国登记研究。EK 手术是后弹力层剥离内皮角膜移植术 （DSEK） 或后弹力层内皮角膜移植术 （DMEK）。主要结局是 2 年移植存活率。移植后 1 年的次要结局是 （1） 最佳矫正视力，（2） 需要重复空气注射手术以治疗移植物脱离和 （3） 医源性原发性移植物失败。结果 在对 11 516 例 EK 移植物进行分析后，外科医生学习的显着影响表现为 （1） 外科医生先前对该 EK 技术经验的影响，（2） 外科医生先前经验对术后管理的影响，以及 （3） 从在英国引入该 EK 技术到手术时间的时间间隔。据报道，在前 6 个月内失败的 EK 移植物在所有移植失败中占很大比例。结论 外科医生学习和缺乏 EK 对临床和统计学意义的影响可以量化并随着时间的推移而减弱。等效分析对于其他眼科专业和外科培训的新程序可能是可行的。培训计划和全国性咨询网络可能有助于减少外科医生学习曲线的持续时间和影响。数据可根据合理要求提供。