RESUMEN
PURPOSE: To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS: This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS: Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION: Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.
Asunto(s)
Competencia Clínica , Destreza Motora , Oftalmólogos , Cirugía Vitreorretiniana , Estudios Prospectivos , Estudios de Cohortes , Simulación por Computador , Cafeína/efectos adversos , Privación de Sueño , Consumo de Bebidas Alcohólicas/efectos adversos , Oftalmólogos/estadística & datos numéricos , Cirugía Vitreorretiniana/estadística & datos numéricos , Destreza Motora/efectos de los fármacos , Destreza Motora/fisiología , Exposición a Riesgos Ambientales/efectos adversos , Propranolol/efectos adversos , Ejercicio Físico , Humanos , Masculino , Femenino , Adulto , Persona de Mediana EdadRESUMEN
Heads-up three-dimensional (3D) surgical visualization systems allow ophthalmic surgeons to replace surgical microscope eyepieces with high-resolution stereoscopic cameras transmitting an image to a screen. We investigated the effectiveness and safety of the heads-up NGENUITY 3D Visualization System in a retrospective evaluation of 241 consecutive vitreoretinal surgeries performed by the same surgeon using conventional microscopy (CM group) over a 1-year period versus the NGENUITY System (3D group) over a consecutive 1-year period. We included for study vitreoretinal surgeries for treatment of retinal detachment (RD) (98 surgeries), macular hole (MH) (48 surgeries), or epiretinal membrane (ERM) (95 surgeries). A total of 138 and 103 eyes were divided into 3D and CM groups, respectively. We found no differences in 3-month postoperative rates of recurrence of RD (10% versus 18%, p = 0.42), MH closure (82% versus 88%, p = 0.69), or decrease in central macular thickness of ERMs (134 ± 188 µm versus 115 ± 105 µm, p = 0.57) between the 3D and CM groups, respectively. Surgery durations and visual prognosis were also similar between both groups. We consolidate that the NGENUITY System is comparable in terms of visual and anatomical outcomes, giving it perspectives for integration into future robotized intervention.
Asunto(s)
Cirugía Vitreorretiniana/instrumentación , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Cirugía Vitreorretiniana/estadística & datos numéricosRESUMEN
Importance: The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective: To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants: Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures: Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results: A total of 526â¯536 CPT codes were ascertained: 483â¯313 injections, 19â¯257 lasers or cryotherapy, 14â¯949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance: Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.
Asunto(s)
COVID-19/epidemiología , SARS-CoV-2 , Cirugía Vitreorretiniana/estadística & datos numéricos , Estudios Transversales , Servicios Médicos de Urgencia , Humanos , Vitrectomía/estadística & datos numéricosRESUMEN
PURPOSE: A prior study revealed discrepancies in self-reported surgical numbers between male and female ophthalmology residents. This study further investigates the gender differences in self-reported procedural volume among vitreoretinal surgery fellows and examines the differences for surgical, medical, and total self-reported procedural volume between male and female vitreoretinal fellows. METHODS: A retrospective review of case logs submitted to the American Society of Retina Specialists by first-year and second-year vitreoretinal fellows from July 1, 2018, to June 30, 2019, was performed. Fellows who reported fewer than 100 pars plana vitrectomies were excluded. A total of 133 fellows were included. RESULTS: Overall, 37 of 57 (65%) first-year fellows and 59 of 76 (78%) second-year fellows were male. An average of 1,120 procedures were self-reported among all vitreoretinal fellows. In the group of second-year fellows at the completion of fellowship, men reported more total procedures (1,171 [864-1,600] vs. 1,005 [719-1,257]; P = 0.072). Women reported statistically significant fewer endolaser (P = 0.018), internal limiting membrane peel (P = 0.042), and cryoretinopexy (P = 0.002) procedures compared with men. When splitting the data by total surgical versus medical procedures, men reported more procedures than women both surgically (1,077 [799-1,490] vs. 925 [622-1,208]; P = 0.085) and medically (72 [41-116] vs. 56 [20-94]; P = 0.141), although these differences were not statistically significant. CONCLUSION: There is a trend for female vitreoretinal fellows to report fewer surgical procedures than their male counterparts, raising concerns for gender gaps in vitreoretinal surgical training. Further research is needed to verify this discrepancy and identify potential barriers that female vitreoretinal surgeons are facing in training.
Asunto(s)
Educación de Postgrado en Medicina/estadística & datos numéricos , Becas/estadística & datos numéricos , Oftalmología/educación , Cirugía Vitreorretiniana/estadística & datos numéricos , Femenino , Humanos , Curva de Aprendizaje , Masculino , Estudios Retrospectivos , Autoinforme , Factores Sexuales , Factores de Tiempo , Estados Unidos , Carga de TrabajoRESUMEN
AIM: To compare the surgical experience and preferred imaging platform, between digitally assisted vitreoretinal surgery systems (DAVS) and analogue microscope (AM), for performing various surgical manoeuvres. MATERIAL AND METHODS: A questionnaire was used to evaluate the experience of surgeons who used DAVS for at least 6 months in the last 1 year. RESULTS: Twenty-three surgeons, including 12 fellows, answered the questionnaire. Eighty-two per cent of surgeons got accustomed to DAVS in <10 surgeries. The higher magnification provided by DAVS was perceived as helpful by 87.0% surgeons. Seventy-eight per cent surgeons felt that DAVS provided a bigger field of view. Colours displayed on DAVS appeared unnatural to 39.1%. Difficulty using three-dimensional glasses over spectacles, asthenopia and dry eye symptoms while using DAVS were faced by 17.4%, 17.4% and 21.7% surgeons, respectively. Difficulty in frequent switching between DAVS and AM was faced by 30.4% surgeons. Difficulty in depth perception, hand-eye coordination and performance anxiety while using DAVS was faced by 43.5%, 21.7 % and 30.4 % surgeons, respectively. Majority consultants did not have any imaging platform preference for most posterior segment procedures, while majority fellows preferred DAVS. Majority surgeons preferred AM for anterior segment procedures and complicated situations like small pupil, corneal oedema and surgical surprise(s). Once the surgeons became accustomed to DAVS, none of them had to shift back to AM during any case. CONCLUSION: It was easy to adapt to DAVS. DAVS was preferred for performing most posterior segment surgeries. Drawbacks like unnatural colours of the projected image and difficulty in performing anterior segment manoeuvres need to be addressed.
Asunto(s)
Hospitales de Alto Volumen/estadística & datos numéricos , Imagenología Tridimensional/métodos , Enfermedades de la Retina/cirugía , Cirugía Asistida por Computador/métodos , Cirugía Vitreorretiniana/estadística & datos numéricos , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios Retrospectivos , Cirugía Vitreorretiniana/instrumentaciónRESUMEN
PURPOSE: To assess the feasibility and acceptability of outpatient care without next-day examination for patients undergoing retinal surgery. METHODS: Patients undergoing ambulatory vitreoretinal surgery between November 2013 and February 2016 at the Vienna medical center were included in this retrospective study. The age, comorbidities, indication, surgical technique and type of anesthesia used, symptoms, intraocular pressure and biomicroscopic examination data at the D0, D7 and M1 visits were recorded. Patient satisfaction with the outpatient treatment was collected by phone call in April 2016. RESULTS: Fifty-three surgeries on 49 patients (24 women, 25 men) with a mean age of 70 years (range, 39-91 years) were analyzed. The surgery was pars plana vitrectomy in all cases, with 26 cases of epiretinal membrane surgery, 7 vitreomacular traction syndrome, 4 vitreous hemorrhage, 6 macular hole, 4 dislocation of lens material, 5 retinal detachment and 1 macular retinoschisis in high myopia. The type of anesthesia was general in 64.1 % of cases (34) and local in 36.9 % of cases (19). Of the D0 examination data, 100 % were compatible with the patient being discharged to home. One patient consulted before the D7 exam for the occurrence of a subconjunctival hemorrhage. There were seven cases (13.2 %) of intraocular pressure elevation and two cases of vitreous hemorrhage (3.8 %) on the D7 examination data. Twenty-seven patients (55.1 %) were reached by phone and all of them were satisfied with their outpatient management. CONCLUSION: Outpatient treatment of patients without next-day examination for vitreoretinal surgery is possible and well accepted.
Asunto(s)
Atención Ambulatoria/métodos , Aceptación de la Atención de Salud , Cirugía Vitreorretiniana/métodos , Adulto , Cuidados Posteriores/métodos , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Aceptación de la Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Vitrectomía/métodos , Vitrectomía/psicología , Vitrectomía/estadística & datos numéricos , Cirugía Vitreorretiniana/psicología , Cirugía Vitreorretiniana/estadística & datos numéricosRESUMEN
AIMS: To determine the background incidence rate of retinal detachment (RD) in Western Australia (WA) between 2000 and 2013, identify sociodemographic features associated with increased risk of incident RD and examine trends in surgical repair technique. METHODS: A whole-population retrospective observational study of all people in WA was carried out using linked hospital inpatient records. Cases of RD were identified using a combination of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-AM (Australian modification) diagnosis and procedure codes from routinely collected hospital inpatient data provided by the WA Data Linkage Branch. A Poisson regression model was used to examine the influence of age group, gender, season and year of surgery on RD incidence rates. MAIN OUTCOME MEASURES: Age-standardised and sex-standardised incidence of first-eye RD and incidence rate ratio (IRR) of first-eye RD associated with age, sex and season. Counts of RD repair according to surgical technique. RESULTS: There were 4376 first-eye RD between 2000 and 2013. Age-standardised incidence ranged between 12.78 and 16.20 cases per 1 00 000 person-years. After adjusting for age, year and season, males had a higher risk than females for incident detachment (IRR 1.82, 95% CI (CI) 1.71 to 1.93), as did those aged 60-79 years (IRR 33.26, 95% CI 27.60 to 40.08) compared with those aged less than 20 years. RD repair with vitrectomy alone increased by 59% over the study period. CONCLUSION: The incidence of first-eye RD remained stable between 2000 and 2013. The risk was higher in males and with older age.
Asunto(s)
Predicción , Vigilancia de la Población , Desprendimiento de Retina/cirugía , Cirugía Vitreorretiniana/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Desprendimiento de Retina/epidemiología , Estudios Retrospectivos , Australia Occidental/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. METHODS: A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. RESULTS: A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. CONCLUSIONS: The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve.
Asunto(s)
Curva de Aprendizaje , Cirugía Vitreorretiniana , Actitud del Personal de Salud , Becas , Humanos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , España , Cirujanos/psicología , Suturas , Vitrectomía/métodos , Vitrectomía/estadística & datos numéricos , Cirugía Vitreorretiniana/métodos , Cirugía Vitreorretiniana/estadística & datos numéricos , Hemorragia Vítrea/cirugíaRESUMEN
OBJETIVO: Revisar las pruebas sobre el coste-efectividad de la ocriplasmina para la tracción vitreomacular (TVM) y estimar el impacto presupuestario que supondría su uso en el Sistema Nacional de Salud (SNS). MATERIAL Y MÉTODOS: 1) Revisión sistemática. Se realizaron búsquedas en enero del 2015 en MEDLINE, PREMEDLINE, EMBASE, CRD y The Cochrane Library, y páginas web clave. Se incluyeron evaluaciones económicas completas que comparaban ocriplasmina con tratamiento habitual (espera vigilante y/o vitrectomía) en pacientes con TVM. Las medidas de resultado de interés fueron los costes de las alternativas y la ratio coste-efectividad incremental. También se incluyeron estudios de análisis de impacto presupuestario. Se valoró la calidad metodológica y se realizó una síntesis narrativa de los estudios incluidos. 2) Estimación del impacto presupuestario. Se estimó el impacto presupuestario que supondría incorporar ocriplasmina en el SNS tomando datos de varias fuentes. RESULTADOS: Se identificaron 6 estudios, ninguno realizado en España. Los 2 estudios de mejor calidad concluyen que ocriplasmina es coste-efectiva en sus respectivos ámbitos (Canadá y Reino Unido) pero solo en pacientes con determinadas condiciones (sin membrana epirretiniana, por ejemplo). Los resultados del análisis de impacto presupuestario son contradictorios entre países. El análisis para España encontró que la introducción de ocriplasmina supondría un ahorro para el SNS superior a un millón de euros en 5 años. CONCLUSIONES: El coste-efectividad de ocriplasmina no ha sido demostrado en España aunque buenos estudios realizados en otros países encontraron que ocriplasmina es coste-efectiva en pacientes seleccionados. Dados los precios vigentes en España, ocriplasmina podría suponer un ahorro para el SNS
OBJECTIVE: To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS: 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS: Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS: The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS
Asunto(s)
Humanos , Masculino , Femenino , Cirugía Vitreorretiniana/economía , Cirugía Vitreorretiniana/estadística & datos numéricos , Cirugía Vitreorretiniana/normas , Mácula Lútea/cirugía , Cirugía Vitreorretiniana/tendencias , Mácula Lútea , Costos de los Medicamentos/estadística & datos numéricos , Costos de los Medicamentos/tendenciasRESUMEN
BACKGROUND: Acid violet 17 (AV17) has recently received CE certification as a dye for intraocular use during vitreoretinal interventions. This publication reviews the available preclinical and clinical data on the use of this new dye. MATERIAL AND METHODS: A systematic MEDLINE literature search was conducted on preclinical testing, clinical testing, and application of AV17 in ocular cell cultures, organ cultures, or ex vivo and in vivo ocular surgical procedures. RESULTS: Of the 59 primary hits, 5 publications (4 preclinical, 1 clinical) were identified as reporting relevant data. All available results on preclinical testing referred to concentrations of AV17 much lower (0.005 to 1.0 mg/ml) than the presently marketed dye (1.5 mg/ml, ala purple, ala®medics, Dornstadt/Germany). Toxic or undesired effects of AV17 on different ocular structures or cells were observed under the following conditions: retinal pigment epithelium: 0.25 mg/ml, 180 seconds, 0.05 mg/ml, 1800 seconds; ganglion cell viability: 0.25 mg/ml, 30 seconds; Müller cell activation: 0.25 mg/ml, 30 seconds; astrocyte activation 0.5 mg/ml, 30 seconds; microglia activation: 0.5 mg/ml, 300 seconds. No adverse effects were observed in a clinical case series of macular hole surgery (Peel et al. 2015). In this series, the dye was not applied as described in the label. In our own clinical experience, two different undesired effects were observed: transient discolouration of hydrophilic intraocular lenses and degeneration of the RPE in cases of macular hole surgery. CONCLUSIONS: Preclinical tests indicate that AV17 has toxic and undesired effects at concentrations much lower than claimed by suppliers. Against the background of these data and the first observations of adverse clinical effects, it seems advisable to be cautious when using AV17.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Monitoreo Intraoperatorio/estadística & datos numéricos , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/cirugía , Colorantes de Rosanilina/administración & dosificación , Cirugía Vitreorretiniana/estadística & datos numéricos , Animales , Colorantes/administración & dosificación , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Prevalencia , Conejos , Enfermedades de la Retina/patología , Factores de RiesgoAsunto(s)
Retinopatía Diabética/cirugía , Oftalmología/educación , Cirugía Vitreorretiniana/educación , Diabetes Mellitus/epidemiología , Retinopatía Diabética/epidemiología , Humanos , India/epidemiología , Internado y Residencia , Oftalmología/normas , Oftalmología/estadística & datos numéricos , Prevalencia , Cirugía Vitreorretiniana/normas , Cirugía Vitreorretiniana/estadística & datos numéricosRESUMEN
PURPOSE: To report pragmatic outcomes from a database study of epiretinal membrane surgery. METHODS: Prospective anonymized clinical audit data from electronic medical records were pooled over 10 years into a national database, from 1,131 primary epiretinal membrane operations, by 69 surgeons, in 16 U.K. vitreoretinal units. RESULTS: The median age of 1,131 patients was 71.6 years. A pars plana vitrectomy and epiretinal membrane peel were combined with internal limiting membrane peel in 17.0% of operations, and cataract surgery in 49.9%. Use of general anesthesia declined from 94.1% in 2001 to 28.9% in 2010. One or more intraoperative complication occurred in 9.8% (8.1% excluding cataract surgery complications). The median preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity improved from 0.60 to 0.30 (Snellen 20/80-20/40) after a median follow-up of 7.0 months; 41.7% of eyes improved ≥0.30 logMAR units (approximately 2 Snellen's lines). The percentages of eyes undergoing subsequent surgery were 3.3%, 1.0%, 0.4%, and 0.8% for epiretinal membrane, retinal detachment, macular hole, and other vitreoretinal indications, respectively. Excluding pseudophakic eyes, 51.7%, 73.2%, and 76.2% of eyes underwent cataract surgery within 1 year, 2 year, and 3 years respectively. CONCLUSION: These results may help vitreoretinal surgeons to benchmark their surgical outcomes, and patients to assess the risks and benefits of surgery.
Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Membrana Epirretinal/cirugía , Auditoría Médica , Oftalmología/organización & administración , Cirugía Vitreorretiniana/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia General/estadística & datos numéricos , Membrana Epirretinal/fisiopatología , Femenino , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/epidemiología , Perforaciones de la Retina/cirugía , Sociedades Médicas/organización & administración , Reino Unido/epidemiología , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: The past decade has seen significant paradigm shifts in the management of many retinal diseases. The goal of this study is to assess the effect these advances have had on the number of retinal specialists, and the differences in output between medical and surgical specialists at the population level. DESIGN: Population-based analysis of surgical and medical retina therapeutic and diagnostic procedures among all ophthalmologists in Ontario, Canada, from April 1999 to March 2012. PARTICIPANTS: This study included all ophthalmologists with an Ontario license and receiving remuneration from the Ontario Health Insurance Plan (OHIP). Ophthalmologists were categorized as a surgical or medical retina specialist based on the type and volume of retina-specific procedures performed each year. METHODS: The IntelliHealth database operated by the Ministry of Health and Long Term Care was used to obtain anonymized physician services, which has excellent accuracy for procedure performance. RESULTS: The number of retina specialists grew from 9.7% to 14.4% of the ophthalmology workforce. The proportion of late-career retina specialists (>25 years since graduation) doubled but had no influence on procedure output. Almost all retina specialists (90%) practice in the region they graduated medical school, and most (65%) practice in counties with a population greater than 400,000 people. Over the study period, the mean number of photocoagulation and fluorescein angiography performed was significantly higher among surgical retina specialists. Scleral buckling declined by 55% over the study period, whereas the number of pars plana vitrectomies grew by 49%. CONCLUSIONS: The retina subspecialty is a growing area of ophthalmology and is mainly located in urban centres. There has been a dramatic shift in the types of procedures performed to treat medical and surgical diseases over the past decade. To our knowledge, this is the first study to quantify differences in diagnostic and procedure performance between the medical and surgical retina subspecialties.
Asunto(s)
Fuerza Laboral en Salud/estadística & datos numéricos , Medicina/estadística & datos numéricos , Oftalmología , Cirugía Vitreorretiniana/estadística & datos numéricos , Bases de Datos Factuales , Atención a la Salud/estadística & datos numéricos , Femenino , Investigación sobre Servicios de Salud , Humanos , Inyecciones Intravítreas/estadística & datos numéricos , Masculino , Ontario/epidemiología , Oftalmología/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
Objetivo. Describir las causas principales de Cirugía Vitreorretiniana en el servicio de Oftalmología del Complejo Hospitalario Universitario de Vigo ( Xeral-Cies ) entre los años 2012 y 2013. Materiales y métodos. Se evaluaron retrospectivamente 285 Cirugías Vitreorretinianas realizadas en el periodo comprendido entre los años 2012 y 2013 en el Complejo Hospitalario Universitario de Vigo. Se estudiaron las causas más frecuentes de estas cirugías, además de otras dos variables: edad y sexo más prevalente de Cirugía Vitreorretiniana por subgrupos. Resultados. La principal causa de Cirugía Vitreorretiniana en el Complejo Hospitalario Universitario de Vigo entre los años 2012 y 2013 fue el Desprendimiento de Retina seguido por las Membranas Epirretinianas. El grupo etario que presento mayor número de cirugías fue el comprendido entre 70 a 79 años, con un predominio de pacientes de género masculino (AU)
Objective. Describe the main causes of Vitreoretinal Surgery in the Hospital Universitary of Vigo(Xeral-Cies) between 2012 and 2013. Material and methods: 285 vitreoretinal surgeries performed in the period between 2012 and 2013 at the Hospital Universitary of Vigo were retrospectively evaluated. The most frequent causes of these surgeries were studied, and two other variables: age and sex of Vitreoretinal Surgery prevalent subgroup. Results. The main cause of Vitreoretinal Surgery at the University Hospital of Vigo between 2012 and 2013 was the Retinal Detachment and after epiretinal membrane. The age group had higher number of surgeries was between 70 to 79 years, with a predominance of male patients (AU)
Asunto(s)
Humanos , Cirugía Vitreorretiniana/estadística & datos numéricos , Enfermedades de la Retina/cirugía , Vitrectomía/estadística & datos numéricos , Cuerpo Vítreo/cirugía , Vitreorretinopatía Proliferativa/cirugía , Desprendimiento de Retina/cirugía , Distribución por Edad y Sexo , Estudios RetrospectivosRESUMEN
PURPOSE: To describe rhegmatogenous retinal detachment (RD) surgery. DESIGN: National Ophthalmology Database study. PARTICIPANTS: A total of 3403 eyes from 3321 patients undergoing primary RD surgery. METHODS: Participating centers prospectively collected clinical data using a single electronic medical record system, with automatic extraction of anonymized data to a national database, from 2002 to 2010. MAIN OUTCOME MEASURES: Description of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing subsequent RD or cataract surgery. We undertook an exploratory analysis of change in visual acuity (VA) using the data available. RESULTS: Of 3403 operations, 2693 (79.1%) were pars plana vitrectomy (PPV), 413 (12.1%) were retinopexy with a scleral buckle (SB), and 297 (8.7%) were PPV with an SB (PPV-SB). For PPV and PPV-SB, 18.8% were with hexafluoroethane, 12.1% were with perfluoropropane, 43.1% were with sulfahexafluoride, 1.8% were with air, 17.9% were with silicone oil, and 10.7% were with cataract surgery. Within 1 year of vitrectomy, 52.1% of phakic eyes had undergone cataract surgery. For all RD operations combined (and excluding cataract surgery complications), 5.1% had 1 or more intraoperative complication, 13.0% underwent further RD surgery, and 8.3% had silicone oil in situ at last review. The RD reoperation rate was 13.3%, 12.3%, and 14.5% for PPV, SB, and PPV-SB, respectively. For 961 eyes with a baseline and final VA measurement, the median presenting logarithm of the minimum angle of resolution VA improved from 1.0 to 0.5 (20/200-20/63) after a median follow-up of 0.6 years. CONCLUSIONS: These results may help vitreoretinal surgeons to benchmark their intraoperative complication rate and reoperation rate and to compare their surgical techniques with their peers'. They suggest that the benefits of RD surgery greatly outweigh the risks.
Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Desprendimiento de Retina/cirugía , Cirugía Vitreorretiniana , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aire , Extracción de Catarata , Niño , Preescolar , Registros Electrónicos de Salud , Endotaponamiento , Femenino , Fluorocarburos/administración & dosificación , Humanos , Lactante , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reoperación , Desprendimiento de Retina/fisiopatología , Aceites de Silicona/administración & dosificación , Reino Unido , Agudeza Visual/fisiología , Cirugía Vitreorretiniana/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department. METHODS: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded. RESULTS: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges (42.9%) formed the largest part, followed by pars plana vitrectomies (35.0%) and encircling bands (22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds (65%) of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%. CONCLUSION: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.
Asunto(s)
Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica/estadística & datos numéricos , Vitrectomía/estadística & datos numéricos , Cirugía Vitreorretiniana/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología , Retina , Esclerótica , Tapones Quirúrgicos de Gaza , Agudeza Visual , Vitreorretinopatía ProliferativaRESUMEN
OBJECTIVE: We aim to demonstrate that vitreoretinal surgery can be established in Nairobi, Kenya, by intermittent short visits of experienced surgeons combined with clinical/surgical observerships over a longer period of cooperation. This strategy might be a model for other developing countries. DESIGN: Time series over 11 years. PARTICIPANTS: 685 operations were performed over 11 years. METHODS: After the 1998 al-Qaeda bomb assault on the U.S. embassy in Nairobi, Kenya, the Ludwig-Maximilians-University München (Germany) provided materials for surgery of 42 victims with eye injuries. From the year 2000 onward, this equipment has been used to establish a training unit at the Kenyatta Hospital in Nairobi. In 1 annual "project week," 1 author (C-L.S.) performed vitreoretinal surgery at the University of Nairobi in cooperation with the Kenyatta National Hospital and supervised resident eye surgeons. After 7 years of training in Nairobi, clinical/surgical observerships of vitreoretinal surgeons and operating theatre staff were commenced in Munich by 4- to 12-week visits. The project week in Nairobi was carried on. Number, indications, operating surgeons, kind, difficulty, duration of operations, and preparation were recorded and evaluated. RESULTS: The percentage of operations by resident surgeons increased from 29% (in 2000) via 80% (in 2009) to 73% (in 2010) with a partial failure of the laser device. The learning curve of local surgeons is also reflected by an increase of the operations' difficulty with only a moderate increase in operation time and marked decrease of preparation time. CONCLUSIONS: A vitreoretinal unit has been established in Nairobi using our training model. This unit has the potential to train colleagues from other sub-Saharan countries. This strategy has advantages over long-term aid deployment of foreign physicians such as avoiding financial burden for the surgeons to be trained and improving the home facility, but it requires commitment for long-term cooperation.
Asunto(s)
Educación Médica Continua , Educación de Postgrado en Medicina , Internado y Residencia , Oftalmología/educación , Cirugía Vitreorretiniana/educación , Centros Médicos Académicos/organización & administración , Personal Profesional Extranjero/educación , Alemania , Humanos , Cooperación Internacional , Kenia , Oftalmología/organización & administración , Especialidades Quirúrgicas/educación , Cirugía Vitreorretiniana/estadística & datos numéricosRESUMEN
PURPOSE: To determine the incidence of unplanned return to the operating room within 30 or 90 d following vitreoretinal surgery. METHODS: Hospital records of 431 patients undergoing vitreoretinal surgery at San Francisco General Hospital between 1 January 1998 and 31 December 2009 were reviewed to determine the incidence of unplanned reoperations. RESULTS: Unplanned reoperation occurred within 30 d in 22 cases (3.77%) and within 90 d in 56 cases (9.61%). CONCLUSIONS: This study establishes benchmarks for the rate of unplanned return to the operating room following vitreoretinal surgery at an urban teaching hospital. Measuring reoperation within 90 d may provide a useful quality improvement metric of short- and middle-term complications.
Asunto(s)
Oftalmopatías/epidemiología , Oftalmopatías/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Reoperación/estadística & datos numéricos , Cirugía Vitreorretiniana/estadística & datos numéricos , Femenino , Hospitales Públicos/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Incidencia , Masculino , Auditoría Médica , Persona de Mediana Edad , Mejoramiento de la Calidad , Reoperación/normas , Retina/cirugía , Cirugía Vitreorretiniana/normas , Cuerpo Vítreo/cirugíaRESUMEN
PURPOSE: The purpose of this study was to evaluate the surgical volume, training, and experiences of 2-year vitreoretinal surgery fellows in the United States. METHODS: An anonymous survey was sent to 82 US graduating vitreoretinal surgery fellows and contained items relating to their training, self-perceived competency, and future plans. RESULTS: A total of 54 fellows (66%) responded. Fellows most commonly performed <20 scleral buckles (38.9%) and 301 to 400 vitrectomies (27.8%) as primary surgeon. Fifty-two fellows performed epiretinal membrane peeling (96.3%), and 51 performed internal limiting membrane peeling (94.4%). Self-reported competency for treating rarer diseases was 90.7% for posterior uveitis and 22.6% for ocular oncology. Most (54.7%) planned to be employed in private practice. CONCLUSION: The experiences of vitreoretinal surgery fellows in the United States varied considerably.
Asunto(s)
Competencia Clínica/normas , Educación de Postgrado en Medicina/normas , Evaluación Educacional , Oftalmología/educación , Cirugía Vitreorretiniana/educación , Actitud del Personal de Salud , Becas , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Encuestas y Cuestionarios , Estados Unidos , Cirugía Vitreorretiniana/estadística & datos numéricosRESUMEN
PURPOSE: To study macular hole (MH) surgery in terms of baseline demographics, intraoperative complications, post-vitrectomy cataract, reoperation, and visual outcome. DESIGN: National Ophthalmology Database study. PARTICIPANTS: A total of 1078 eyes from 1045 patients undergoing primary MH surgery. METHODS: Participating centers prospectively collected clinical data using a single electronic medical record (EMR) system, with automatic extraction of anonymized data to a national database, over 8 years. The following data were extracted for eyes undergoing MH surgery: demographics, procedure elements, intraoperative complications, visual acuity (VA), and further surgery. MAIN OUTCOME MEASURES: Description of the primary procedures performed, intraoperative complication rate, change in VA, proportion of eyes undergoing subsequent surgery for persisting MH, cataract, or retinal detachment. RESULTS: The median age was 70.3 years, with a 2.2:1 female preponderance. All operations included a pars plana vitrectomy (PPV)-41.1% with hexafluoroethane (C2F6), 25.6% with perfluoropropane (C3F8), 24.5% with sulfahexafluoride (SF6), 2.2% with air, and 0.4% with silicone oil. A PPV was combined with internal limiting membrane (ILM) peel in 94.1% and cataract surgery in 40.5%. One or more intraoperative complications occurred in 12.4%. The median presenting logarithm of the minimum angle of resolution (logMAR) VA improved from 0.80 to 0.50 after a median follow-up of 0.6 years; 57.8% of eyes improved ≥0.30 logMAR units (â¼2 Snellen lines). The choice of gas tamponade did not significantly influence the visual outcome, but eyes undergoing ILM peel were significantly more likely to gain ≥0.30 logMAR units, as were eyes with poor presenting VA. Subsequently, 4.2% of eyes underwent repeat surgery for MH and 2.4% for retinal detachment, and, excluding pseudophakic eyes, 64.6% underwent cataract surgery within 1 year. CONCLUSIONS: This study provides pooled, anonymized data on the demographics, complications, and visual outcome of MH surgery. This may enable vitreoretinal surgeons to benchmark their case-mix and outcomes, and facilitate risk-benefit and cost-benefit analyses.