A Modular Cataract Surgery Training Model Incorporating Human Factors and a Pedagogical Theory.

Synopsis: High volume cataract lists are cost-effective, reduce waiting times, and facilitate surgical teaching. We propose a stepwise training model that incorporates human factor principles and a reflective pedagogical approach, which has not been documented previously. Background/Aims: Surgical training in ophthalmology is effective when a modular approach is utilised. High volume lists further enhance training by increasing exposure to a newer way of learning and working. We evaluated the efficiency and safety of trainee-assisted cataract surgery across a single NHS eye unit and an independent sector (IS) provider. Methods: We examined results from audits of surgical efficiency and safety in trainee-assisted high-volume lists, including a single-centre comparative evaluation of consultant-only and trainee lists. The quantitative and qualitative information gained from these projects helped us to implement a modular, structured training programme that utilises a reflective cycle of pedagogy, suitable for any grade of trainee. Results: Our projects included an audit following cataract surgery performed by a surgical trainee over a 5-month period, which showed excellent post-op refractive results and no cases of intra-operative and post-operative complications. A single-centre observational study demonstrated comparable surgical throughput and safety results for trainee and solo consultant high volume lists. Systemic and ocular complication rates were reported to be similar for low and medium risk cataract surgery among trainee supervised IS and NHS lists. Conclusion: Cataract surgery outcomes and patient feedback support the effectiveness of the surgical training model. Combining Gibbs' reflective cycle of critical reflection with the International Council of Ophthalmology's principles helped us to develop the QM Model of modular teaching for cataract surgery, which we believe is suitable for utilisation in all surgical centres in the NHS and IS settings, for both low volume and high-volume surgical lists regardless of trainee experience.

What Is Already Known on This Topic High volume lists are increasingly popular for cataract surgery; however, trainee exposure to high flow cataract surgery lists is limited. What This Study Adds A modular approach to training via high volume training lists is possible.Origination and implementation of a stepwise cataract surgery training model that incorporates human factors and a pedagogical learning approach within high volume lists in the independent sector and NHS setting. How This Study Might Affect Research, Practice, or Policy Promote the widespread adoption of the QM model which integrates modular-based experiential learning approaches for surgical training in both NHS and independent sector settings, applicable to low and high volume surgical lists, irrespective of trainee experience.

Ocular toxicity following carboplatin chemotherapy for neuroendocrine tumour of the bladder.

INTRODUCTION: Carboplatin is a commonly used platinum analogue chemotherapeutic agent that is similar to cisplatin but is known to be better tolerated. This case report outlines a case of ocular toxicity following carboplatin chemotherapy used for the management of a neuroendocrine tumour of the bladder. CASE REPORT: A 70-year-old man with a history of neuroendocrine bladder cancer underwent chemotherapy with carboplatin and etoposide. He presented 4 weeks following his fourth chemotherapy cycle with a 1-week history of right eye blurriness. The patient had suffered a similar episode 2 weeks following his third chemotherapy cycle in his left eye. Carboplatin-induced ocular toxicity was suspected and his vision remained stable following cessation of carboplatin chemotherapy. DISCUSSION: Current literature on carboplatin-induced ocular toxicity remains scanty, however, previous cases have reported symptoms beginning 5 days to 2 weeks following carboplatin use. Visual disturbance in the form of altered colour vision, blind spot, blurred vision and metamorphopsia have been reported by previous literature. This case report emphasised a case of bilateral sequential blurring of vision following carboplatin chemotherapy. CONCLUSION: It remains critical for ophthalmologists and oncologists to look out for ocular side effects of chemotherapy due to its devastating effects.

Change in Incidence and Severity of Abusive Head Trauma in the Paediatric Age Group Pre- and During COVID-19 Lockdown in the North East of England.

Background: Abusive head trauma (AHT) is currently the accepted terminology that encompasses previously used terms such as non-accidental injury (NAI) or non-accidental head injury (NAHI) and shaken baby syndrome (SBS). It is AHT and its ocular manifestations that ophthalmologists are vital in identifying and reporting. Objectives: To investigate whether there is a change in the incidence or severity of AHT pre- and during COVID-19 lockdown. Participants and Settings: AHT cases reported between March-June 2019 and March-June 2020. Data will be collected from ***** **** ********* NHS Foundation Trust. Methods: A retrospective comparative study. Main Outcome Measures: Comparison of total number of children reported to child protection services pre- and during lockdown.Severity of reported cases.Ophthalmic involvement. Results: Of the pre-lockdown safeguarding referrals, 5/61 (8.19%) had confirmed AHT, and 4/40 (10%) of the during lockdown group were confirmed AHT. The absence of teachers was evident, as in the pre-lockdown group 40% (2) of referrals originated from schools compared to none during the lockdown period. Ophthalmic involvement was not present in any of the pre-lockdown cases and only 50% (2) of the during lockdown cases, with the appropriate proforma only used in one of these cases. Unfortunately, no further statistical testing was meaningful in light of the small sample size. Conclusions: The loss of the early warning detection mechanism provided by schools and health visitors may have contributed to both the change in presentation and severity of cases during the lockdown. There is also a need for ophthalmology and paediatrics to collaborate to ensure AHT cases are thoroughly investigated and documented.

Caruncular tumor as the first sign of T-cell lymphoma relapse.

The lacrimal caruncle is a modified cutaneous tissue that contains hair follicles, accessory lacrimal glands, sweat glands, lobules of fat, and sebaceous glands. Due to the nature of tissue, a variety of lesions, both benign and malignant, could arise from this area. Lymphomas of the eye and its adnexa are frequently of B-cell lineage. We would like to report a rare and unique case of a patient presenting with a caruncular tumor of CD30-positive T-cell anaplastic large cell lymphoma (T-ALCL) origin, serving as the first, initial, sole sign of recurrence of previously treated cutaneous T-ALCL. We believe this to be the first such report in the literature. We aim to emphasize the importance of considering such a condition while formulating the differential diagnosis of caruncular tumour in patients with history of T-cell lymphoma and to characterize the clinical course of such a presentation.

A rare ophthalmic presentation of pituitary metastases.

Metastasis to the pituitary gland is very uncommon and a first presentation of any systemic tumour through pituitary metastasis is rare. The authors report an 82-year-old Caucasian woman, well-controlled hypertensive and moderate smoker who presented with worsening diplopia. On ocular motility examination she had partial right third nerve paralysis along with reduced vision in the right eye and headache. MRI brain showed a large growth in the pituitary gland consisting with radiological features of pituitary macroadenoma. The initial chest x-ray showed a non-specific shadow that raised some suspicions and a CT scan of her thorax confirmed a right central bronchial carcinoma. The authors suggest that pituitary gland metastases be considered as part of the differential diagnosis for any patient presenting with a pituitary lesion, as pituitary disease could be the first manifestation of an underlying malignancy.

Proliferative retinopathy in Cowden syndrome.

Cowden syndrome is a multiple hamartoma syndrome with a high risk of breast and thyroid tumours, both benign and malignant. The authors report a 24-year-old female patient who presented with reduced vision in both eyes. Ocular examination showed vitreous haemorrhage secondary to retinal new vessels in both eyes. There was no evidence of diabetes mellitus, and she had a wide range of normal investigations. She was labelled as idiopathic retinal neovascularisation. Fifteen years later, she presented with a lump in her left breast and a previous history of excision of a benign lump from her right breast. She also reported multiple tumours in her family. Clinical diagnosis of Cowden syndrome was made and genetic testing confirmed mutation of the PTEN gene.