Assessing the value of preoperative medical clearance in patients with primary rhegmatogenous retinal detachment.

PURPOSE: To determine rates of intraoperative and postoperative systemic and ocular adverse events and establish the value of preoperative medical assessment in patients undergoing surgery for primary rhegmatogenous retinal detachment repair at a single academic center. PATIENTS AND METHODS: Retrospective cohort study of 185 patients undergoing surgery for repair of primary rhegmatogenous retinal detachment (RRD) at a single academic center. Medical records were reviewed for medical comorbidities, completion of preoperative medical examination, anesthesia used during surgery, intraoperative adverse medical events, intraoperative ocular complications, and systemic and ocular postoperative complications. The main outcome of interest was the association of comorbidities and preoperative medical evaluation with intraoperative and postoperative complications. RESULTS: Approximately 48% of the patients presented with no medical comorbidities of interest. Formal preoperative evaluation by an independent medical provider was completed in 36% of the patients. Overall, intraoperative and postoperative systemic complications (5.7% and 1%, respectively) and intraoperative and postoperative ocular complications (0.5% for both) were uncommon. Patients with a history of chronic heart failure (OR 24.5, P=0.02) or who received general anesthesia (OR 9.56, P<0.001) had increased risk of having experienced any intraoperative or postoperative complication. No relationship between preoperative medical evaluation and intraoperative and postoperative complications was observed. CONCLUSION: Patients undergoing surgery for RRD repair presented with fewer medical comorbidities than previously reported in patients undergoing all vitreoretinal surgeries. Intraoperative and postoperative complications were uncommon and were increased in patients with chronic heart failure or who received general anesthesia. Complications were not significantly associated with preoperative evaluation by an independent medical provider.

Global health training in ophthalmology residency programs.

PURPOSE: To assess current global health education and international electives in ophthalmology residency programs and barriers to global health implementation in ophthalmology resident education. METHODS: A web-based survey regarding participation in global health and international electives was emailed to residency program directors at 116 accredited ophthalmology residency programs via an Association of University Professors in Ophthalmology (AUPO) residency program director listserv. RESULTS: Fifty-nine (51%) ophthalmology residency program directors responded. Thirty-seven program directors (63%) said global health was important to medical students when evaluating residency programs. Thirty-two program directors (55%) reported developing international electives. Reported barriers to resident participation in international electives were: 1) insufficient financial support, 2) inadequate resident coverage at home, and 3) lack of ACGME approval for international electives. Program directors requested more information about resident international electives, funding, and global ophthalmology educational resources. They requested ACGME recognition of international electives to facilitate resident participation. More than half (54%) of program directors supported international electives for residents. CONCLUSIONS: This survey demonstrates that program directors believe global health is an important consideration when medical students evaluate training programs. Despite perceived barriers to incorporating global health opportunities into residency training, program directors are interested in development of global health resources and plan to further develop global health opportunities.

A review of outcomes of an intracavernosal injection therapy programme.

UNLABELLED: Study Type--Therapy (outcomes research) Level of Evidence 2b. What's known on the subject? and What does the study add? Intracavernosal injection (ICI) therapy is an important treatment option for erectile dysfunction. However, high discontinuation rates have been reported for ICI therapy, and a risk of priapism has long been a concern. There has never been a large sample study performed with multivariate analysis to characterise outcomes of ICI therapy. The present paper reviews ICI therapy outcomes in a very large population of men at a tertiary care Sexual Medicine Clinic over 5 years. Multivariate analysis was used to further characterise these outcomes. The present study shows that for a large percentage of our sample of patients, ICI therapy is a successful treatment strategy. And, while discontinuation rates are still high, many of those not continuing ICI therapy achieved success with phosphodiesterase inhibitors. Also, the incidence of priapism was less in the present study than previously reported. OBJECTIVES: • To review the outcomes, adverse events and discontinuation rates of intracavernosal injection (ICI) therapy in men with erectile dysfunction (ED) in a sexual medicine practice over a 5-year period at a tertiary referral centre. • Since 1983, ICI has become a staple therapeutic option and high success rates have been reported. However, priapism is a significant concern and discontinuation rates are estimated to be >50%. PATIENTS AND METHODS: • Men presenting with ED who were enrolled in our ICI programme between September 2002 and August 2006 were followed at least annually. • Patient demographic information, agents used, erectile function outcomes and adverse events were recorded. • Failure was defined as the inability to have penetrative sex. Discontinuation was defined as patient declaration of such, failure to attend an annual follow-up visit or failure to call for a repeat prescription. • Multivariable analysis was used to define predictors of failure to respond to ICI therapy, as well as predictors of discontinuation within 36 months of starting ICI in those patients responding. RESULTS: • In all, 1412 patients had complete data and constituted the study population. Most patients were using Trimix and 89% of Trimix users were capable of having sexual intercourse. • Response rates were lower in pelvic radiation and diabetic patients. • However, the discontinuation rate was significant; it was lower in men who had not undergone radical prostatectomy (RP). Of note, many RP patients discontinued ICI because of recovery of natural or phosphodiesterase type 5 inhibitor-assisted erections. CONCLUSIONS: • ICI therapy is associated with very high success rates even in men with high comorbidity profiles; however, the discontinuation rates, even in men who had not undergone RP, by the end of the third year are significant. • Of note, the recorded priapism rate was extremely low (0.5%).