Nasolacrimal duct screening to minimize post-cataract surgery endophthalmitis.

BACKGROUND: To examine unrecognized nasolacrimal duct obstruction as a risk factor for developing endophthalmitis post-cataract surgery in order to assess the value of preoperative lacrimal system screening. DESIGN: Prospective case-control study. PARTICIPANTS: A random sample of patients undergoing phacoemulsification cataract surgery (control group) and a consecutive series of patients admitted to our hospital with post-cataract surgery endophthalmitis. METHODS: We compared the rate of nasolacrimal duct obstruction in the control group versus the endophthalmitis series. Both groups underwent nasolacrimal duct syringing with normal saline on the ipsilateral side to the surgery. A standard macro-dacryocystogram was performed to confirm for obstruction detected on syringing. MAIN OUTCOME MEASURES: Nasolacrimal duct obstruction rate. RESULTS: Forty-four eyes from 39 patients were included in this study: 34 eyes from 29 patients formed the control group and 10 eyes from 10 patients formed the endophthalmitis group. A higher rate of nasolacrimal duct obstruction was found among patients who developed endophthalmitis post-cataract in comparison with the control group, on both nasolacrimal duct syringing (50.0% vs. 11.8%; P = 0.018) and macro-dacryocystogram (20.0% vs. 2.9%, P = 0.125). Two out of the three patients with radiologically confirmed nasolacrimal duct obstruction reported a long history of epiphora. CONCLUSION: The higher rates of obstruction on nasolacrimal duct syringing and macro-dacryocystogram among patients who developed endophthalmitis suggest that nasolacrimal duct obstruction is a significant risk factor for postoperative endophthalmitis. We recommend routine screening for symptoms and examination of the lacrimal system prior to cataract surgery.

iPhone applications for eye care professionals: a review of current capabilities and concerns.

PURPOSE: To quantitatively review and categorize the eye care-related iPhone(®) (Apple(®), Cupertino, CA) applications ("apps") currently available, evaluate qualified professional involvement in app development, and suggest future needs in this emerging area of mobile health. MATERIALS AND METHODS: The Apple iTunes(®) store was searched for iPhone eye care-themed apps using the general terms "ophthalmology," "ophthalmologist," "optometry," "optometrist," "eye care," and "ocular," in addition to terms based on the Centers for Disease Control and Prevention's common eye conditions. Data collected from each app included publication date, target audience, category of app, estimated number of downloads, average user rating, and documented involvement of qualified professionals. RESULTS: In total, 182 apps were identified. The majority of apps lacked community user ratings and had 3,000 or fewer downloads (84% and 69%, respectively). Consistent with other medical specialties, only 37% of apps had documented qualified professional involvement in their development. When stratified by intended audience, 52% and 44% of apps designed for ophthalmologists and optometrists, respectively, had professional input, compared with 31% for non-eye care clinicians and 21% for the general public. CONCLUSIONS: Smartphone apps are likely to become of increasingly greater relevance to the modern eye care professional with tremendous versatility in daily practice. However, despite the rapid emergence of eye care apps, a low level of qualified professional involvement in app development and a lack of peer review after publishing remain. There is a clear need for evidence-based principles and standards of app development to be adopted in this emerging area.

A vertical study programme for medical students: peer-assisted learning in practice.

BACKGROUND: Monash University employs a vertically-integrated curriculum with cumulative knowledge testing throughout the course. To facilitate cross-year level revision, a vertical study programme (VESPA) was established using the principles of peer-assisted learning (PAL). AIM: To implement and evaluate VESPA in relation to defined objectives. METHODS: Following from a successful pilot, a working group organised five 2 h VESPA sessions over the course of 2009. Each was case-based and study materials were provided. Participants were allocated to a group of 10-15 students of all year levels, and pre-interns acted as facilitators. Sessions were evaluated using a 10-question survey. RESULTS: A total of 647 evaluation surveys were completed overall and participant numbers ranged from 79 to 182 per session. Of these, 624 (96%) agreed the case materials were easy to follow and 562 (87%) believed they allowed students from all year levels to contribute; 552 (85%) felt VESPA helped them understand curriculum content. There were no significant differences between sessions. CONCLUSIONS: VESPA represents an innovative application of PAL that has been well received by students. Potential benefits to participants include academic revision, the development of mentoring relationships and enhanced teaching and facilitation skills. This model of a structured revision programme would suit other settings with vertically-integrated curricula and assessment.

A cost-analysis study of robotic versus conventional mitral valve repair.

BACKGROUND: Robotic mitral valve repair has been performed in Australia since 2004. The aim of this study was to perform a cost-analysis of robotic mitral valve repair (MVR) with direct comparison to conventional MVR surgery. METHODS: All isolated MVRs performed within one metropolitan hospital network, between June 2005 and June 2008, were retrospectively compared. Ad hoc cost analysis was conducted. RESULTS: There were 107 robotic and 40 conventional MVRs performed. The post-operative degrees of mitral regurgitation were comparable. Total operating time was 18% longer in robotic compared to conventional (239 min vs. 202 min, p<0.001, 95% CI: 11-27%). In robotic, Intensive Care Unit stay was reduced by 19% (p=0.002, 37 h vs. 45 h), and length of hospital stay was reduced by 26% (p<0.001, 6.47 days vs. 8.76 days). Mean hospital cost, without including capital costs, was not significantly increased (AUD$18,503 vs. AUD$17,880 p=0.176, 95% CI: -282 to 1,530). CONCLUSIONS: Robotic mitral repair can be performed with similar immediate repair success rates as conventional surgery with a shorter recovery time, but a slightly longer operative time. There is no significant increase in cost over conventional surgery.

Ocular injuries resulting from commercial cosmetic procedures.

The prevalence of potentially precarious cosmetic facial procedures appears to be on the rise. A significant amount of these cosmetic procedures are offered and performed by operators without formal medical training and anatomical knowledge, and with variable degrees of skill. Some of these procedures can result in devastating sight-threatening complications, and many of the individuals undergoing such treatments are relatively young and healthy. Patients need to be aware of the potential risks, including permanent visual loss, before embarking on any cosmetic facial procedure. Optometrists may be the first point of contact for patients with ocular complaints following these treatments. Hence, the authors present here a review on the various ocular injuries that may result from commercial cosmetic procedures.