Síndrome de desgaste profesional o «burnout» en la oftalmología andaluza / Syndrome of professional wear and tear or «burnout» in Andalusian ophthalmology

INTRODUCCIÓN: El síndrome de desgaste profesional, más conocido por su traducción inglesa de síndrome de burnout, hace referencia al cansancio físico y psicológico que sufre un trabajador como consecuencia de su actividad laboral. Se caracteriza por cansancio emocional, despersonalización y falta de realización personal. OBJETIVO: Determinar la prevalencia del síndrome de burnout entre los oftalmólogos andaluces, tanto adjuntos como residentes, analizando su relación con diversas variables sociodemográficas. MATERIAL Y MÉTODOS: Estudio descriptivo con carácter transversal. Se incluyeron dentro de un formulario de Google(R) todas las variables sociodemográficas a estudiar junto al cuestionario estandarizado Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Este formulario se remitió a la comunidad oftalmológica andaluza por diferentes medios electrónicos (Sociedad Andaluza de Oftalmología, aplicaciones móviles de mensajería instantánea, etc.). RESULTADOS: Ciento cuarenta y dos oftalmólogos contestaron el cuestionario, con una distribución similar por sexos, y una edad media de 43,77 años, cumpliendo criterios de burnout ocupacional el 67,61% de ellos. Su prevalencia fue mayor entre los oftalmólogos jóvenes con menos años de práctica clínica, divorciados/separados, aquellos con menor número de hijos, pertenecientes a centros de la provincia de Huelva, trabajadores de ámbitos rurales/comarcales, aquellos con actividad pública exclusiva, adjuntos con contratos eventuales y residentes de 4.° año. En cuanto a subespecialidades, la prevalencia resultó mayor entre los que se dedican a córnea-superficie ocular-cirugía refractiva. CONCLUSIONES: Este trabajo objetiva por primera vez en Andalucía el desgaste profesional de los oftalmólogos. El hecho de que dos terceras partes de la muestra estudiada cumplan criterios de síndrome de burnout evidencia la necesidad de implementar mejoras en las condiciones asistenciales y profesionales de nuestro colectivo

INTRODUCTION: Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. PURPOSE: To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. MATERIAL AND METHODS: Descriptive cross-sectional study. All the sociodemographic variables were included in a Google(R) form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). RESULTS: One hundred fourty two ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43.77 years, with 67.1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced/separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural/regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. CONCLUSIONS: This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group

Syndrome of professional wear and tear or «burnout¼ in Andalusian ophthalmology. / Síndrome de desgaste profesional o «burnout¼ en la oftalmología andaluza.

INTRODUCTION: Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. PURPOSE: To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. MATERIAL AND METHODS: Descriptive cross-sectional study. All the sociodemographic variables were included in a Google® form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). RESULTS: One hundred fourty two ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43.77 years, with 67.1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced/separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural/regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. CONCLUSIONS: This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group.

Atrofia geográfica en seudoxantoma elástico / Geographical atrophy in pseudoxanthoma elasticum

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Coroideremia: a propósito de un caso / Choroideraemia: A case report

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Oftalmología de urgencias. Un estudio epidemiológico: ¿se utilizan correctamente los recursos? / Ophthalmological emergencies. An epidemiological study: Are resources been used properly?

Objetivo: Determinar la epidemiología de todas las visitas a urgencias oftalmológicas incluyendo todos los grupos de edad durante los años 2014 y 2015 en dos hospitales de tercer nivel. Métodos: Fueron incluidos todos los pacientes que acudieron a urgencias oftalmológicas desde el 1 de enero de 2014 al 31 de diciembre de 2015. Las variables estudiadas fueron el sexo, la edad, el lugar de procedencia, la hora de llegada, el día de la semana, el mes y el año de la visita, el diagnóstico, el lugar de derivación al alta, el nivel de prioridad y el tiempo total de asistencia. Las patologías fueron clasificadas según los códigos CIE-9, MC. Resultados: Se produjeron un total de 39.869 visitas a urgencias entre los años 2014 y 2015. Estas fueron más frecuentes en el sexo femenino, los lunes y en los meses de abril, mayo y junio. La edad media fue de 46,24 años. El 73,42% de las visitas se clasificaron como no urgentes. La patología más frecuente atendida fue la conjuntivitis (17,28%), seguida de queratitis (15,31%) y desprendimiento de vítreo posterior (5,37%). La celulitis orbitaria fue la patología que cursó con un mayor porcentaje de ingresos (23%). La mayoría de los pacientes fueron derivados al alta a su domicilio (94,85%). Conclusiones: Dado que la gran mayoría de patologías atendidas en urgencias son no urgentes, es conveniente el establecimiento de medidas para conseguir una asistencia más eficiente, orientada a la patología urgente y que no consuma recursos innecesarios

Objectives: To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015. Methods: All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorised using codes from ICD-9, CM. Results: A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24 years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit. Conclusions: Given that the great majority of Ophthalmological Emergency visits are categorised as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources

Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas / Importance of ocular electrophysiology in the diagnosis of retinal dystrophies

Antecedentes y objetivo: El diagnóstico de las distrofias retinianas es complejo y se basa en estudio oftalmológico completo, estudio genético y los estudios electrofisiológicos (EEF). En este estudio pretendemos evaluar el papel de las pruebas electrofisiológicas y del médico solicitante en el diagnóstico de las distrofias de retina. Materiales y métodos: Estudio observacional retrospectivo. Se seleccionaron 50 pacientes atendidos en el Servicio de Neurofisiología del Hospital Universitario Virgen Macarena. Se valoró el sexo, la edad, el hospital de origen, motivo por el que se solicitó los EEF, diagnóstico de presunción tras examen oftalmológico, EEF realizados, estudio genético y el diagnóstico definitivo tras realización de EEF. Se elaboró un sistema de clasificación que otorga a cada caso un valor comprendido entre 0 y 2, en función de la contribución de las pruebas electrofisiológicas al diagnóstico final. Resultados: La edad media fue 44,34 ± 18,03 años (60% mujeres). Retinosis pigmentaria, neuropatía óptica y enfermedad de Stargardt fueron los diagnósticos más frecuentes. Los EEF modificaron el diagnóstico de presunción en el 48% de los casos, confirmaron el diagnóstico en el 44% y no aportaron información en el 8%. La contribución de los EEF fue mayor en pacientes atendidos en el Hospital Universitario Virgen Macarena y cuando se solicitaban por hallazgos en la exploración (p = 0,001). Los falsos positivos para distrofia retiniana fueron del 60% en pacientes no valorados en dicho hospital. Conclusiones: Las pruebas electrofisiológicas y el manejo especializado de los pacientes con distrofias retinianas desempeñan un papel importante en el diagnóstico de estas patologías

Background and objective; The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. Material and methods: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. Results: The mean age was 44.34 ± 18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P = .001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. Conclusions: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions

Ophthalmological emergencies. An epidemiological study: Are resources been used properly? / Oftalmología de urgencias. Un estudio epidemiológico: ¿se utilizan correctamente los recursos?

OBJECTIVES: To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015. METHODS: All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorised using codes from ICD-9, CM. RESULTS: A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit. CONCLUSIONS: Given that the great majority of Ophthalmological Emergency visits are categorised as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources.

Importance of ocular electrophysiology in the diagnosis of retinal dystrophies. / Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas.

BACKGROUND AND OBJECTIVE: The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. MATERIAL AND METHODS: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. RESULTS: The mean age was 44.34 ±18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P=.001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. CONCLUSIONS: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions.

[Experimental study on usefulness of silicone-fluorsilicone copolymer oil (SiFO) in vitreoretinal surgery]. / Estudio experimental sobre la utilidad del aceite de copolímero de silicona-fluorsilicona (SiFO) en la cirugía vitreorretiniana.

PURPOSE: To evaluate the usefulness of silicone-fluorsilicone copolymer oil (SiFO) as an intraoperative tool and a vitreous substitute in vitreoretinal surgery. METHODS: Handling properties of SiFO were tested and compared with those of perfluorooctane (PFO). The transparency of both substances was measured by spectrophotometry and subjectively assessed. Their tendency to dispersion was observed during injection in balanced saline solution (BSS) and after mechanized and manual shaking. Ease of injection and aspiration through small-gauge instruments was evaluated. Ocular tolerance to SiFO and PFO was studied after intravitreal injection in rabbit eyes: intraocular pressure, anterior segment inflammatory response and dispersion were evaluated, and a histopathological study was performed. RESULTS: Injection and aspiration of SiFO were more difficult than those of PFO because of its higher viscosity. PFO dispersed progressively into small droplets as early as two days after intravitreal injection, whereas SiFO remained as a single bubble for 14 days. Histopathologically both substances induced an inflammatory response over the inferior retina, with microvacuolated macrophages and foreign body giant cells, which were larger in eyes wearing SiFO. CONCLUSIONS: SiFO may be useful as an intraoperative tool, although its main drawback is a more difficult injection and aspiration compared to PFO. It has been well tolerated as a short-term vitreous substitute, but further clinical studies are needed.

[Corneal epithelial complications after vitrectomy: a retrospective study]. / Complicaciones corneales epiteliales de las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence, evolution and final visual outcome of corneal epithelial complications after vitrectomy in a consecutive series performed throughout a period of one year. METHODS: 195 consecutive medical records of patients vitrectomized in 2001 have been retrospectively reviewed. Patients were clinically evaluated the day after vitrectomy, during the first week, and then weekly for 3 months (minimum follow-up). Functional results have been established at the end of this period. RESULTS: 12 out of 195 eyes developed corneal epithelial complications after surgery (6.1%). Eight cases were diagnosed of persistent epithelial defect (4.1%), and four cases (2%) of necrotizing herpetic keratitis. Six out of 12 were diabetic. Corneal epithelial complications affected 10.5% of diabetic and 4.3% of non-diabetic patients (p=0.10). The majority of persistent epithelial defects healed without sequelae in less than two months. Herpetic keratitis required between 3 to 4 months to heal and caused corneal scarring in all cases. CONCLUSIONS: Persistent corneal epithelial defects after vitrectomy are a relatively frequent complication, mainly in diabetic patients. Recurrence of herpetic keratitis must also be kept in mind. This finding has not been previously reported and needs further studies.

[Iatrogenic retinal breaks during vitrectomy: retrospective study]. / Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. METHODS: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. RESULTS: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. CONCLUSIONS: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy.

Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo / Iatrogenic retinal breaks during vitrectomy: retrospective study

Objetivo: Establecer la incidencia y las características de las roturas retinianas iatrogénicas que se han producido en vitrectomías y proponer un protocolo de actuación. Métodos: Se han revisado de forma retrospectiva 195 vitrectomías consecutivas realizadas en 2001. El seguimiento mínimo de todos los casos ha sido de 3 meses. Resultados: Se han detectado roturas retinianas en 13 pacientes (6,6 por ciento). El tipo más frecuente han sido las roturas periféricas con 8 casos. Hubo 4 casos de roturas posteriores y una diálisis retiniana. En 4 casos se produjo más de una rotura. En 9 casos (70 por ciento) la vitrectomía se indicó por lesiones derivadas de la diabetes mellitus. La mayoría (12) fueron detectadas durante la intervención y todas tratadas con endoláser y/o frío (3 casos de localización inferior). En el postoperatorio, 7 casos (54 por ciento) desarrollaron un desprendimiento de retina de los que 2 pudieron ser reaplicados. Conclusiones: De las roturas retinianas iatrogénicas producidas por la vitrectomía, los desgarros periféricos son un poco más frecuentes que los producidos en polo posterior. Son más frecuentes en diabéticos y tienen mal pronóstico ya que evolucionan con frecuencia a un desprendimiento de retina a pesar del tratamiento con endoláser o frío (AU)

Purpose: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. Methods: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. Results: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. Conclusions: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy (AU)

[Can the use of intraocular silicone oil increase the risk of sympathetic ophthalmia?]. / ¿Puede aumentar el riesgo de oftalmía simpática el uso intraocular de aceite de silicona?

CLINICAL CASES: We report two cases of SO (sympathetic ophthalmia) among 1,456 vitrectomies and 255 silicone oil injections performed since 1990. In both patients intraocular silicone oil was used. Both cases were clinically documented and one pathologically demonstrated. DISCUSSION: No cases were reported among vitrectomies without silicone oil. We found a longer delay between injury and the onset of the disease in comparison to the literature. Pathological findings confirmed a foreign body granulomatous reaction. Chronic inflammation caused by silicone oil might be involved in the development of SO. Larger series are necessary to establish a possible relationship between silicone oil and SO.

¿Puede aumentar el riesgo de oftalmía simpática el uso intraocular de aceite de silicona? / Can the use of intraocular silicone oil increase the risk of sympathetic ophthalmia?

Se describen dos casos de oftalmía simpática (OS) presentados entre 1.456 pacientes vitrectomizados en 10 años, ambos portadores de aceite de silicona intraocular.Discusión: La presentación de OS únicamente en pacientes con silicona, el mayor tiempo de latencia con respecto a la media publicada y el hallazgo anatomopatológico de una reacción granulomatosa a cuerpo extraño en el contexto clínico de una OS inducen a pensar que la inflamación intraocular crónica causada por la silicona podría estar implicada en el desarrollo de la OS. No obstante, se necesitan series más largas para confirmar esta posible relación entre aceite de silicona y OS (AU)

Posibilidad de predecir el riesgo de una vitreorretinopatía proliferante mediante el análisis de factores clínicos de los desprendimientos de retina regmatógenos / Risk of developing proliferative vitreoretinopathy (PVR) in patients with regmatogenous retinal detachments: clinical assessment

Objetivo: Investigar la posibilidad de clasificar, en diferentes grupos de riesgo, a los pacientes con DR según su probabilidad de desarrollar VRP. Métodos: Se revisaron retrospectivamente las historias de 298 pacientes intervenidos de DR, sin VRP o con VRP de grado B o menor. Se evaluaron factores de riesgo pre, intra y postquirúrgicos mediante un análisis multivariante de regresión logística para obtener los factores de riesgo de VRP. Según estos resultados del análisis de regresión se asignó una puntuación a cada factor de riesgo. La suma de cada una de estas puntuaciones proporcionó una puntuación final para cada paciente, la cual fue utilizada para dividir a los pacientes en tres grupos de riesgo de VRP. Resultados: Se identificaron los siguientes factores de riesgo de VRP: VRP preoperatoria grado A o B, DR afectando a 4 cuadrantes, cirugía intraocular previa, aplicación de endoláser e inyección intraocular de gas. Se obtuvieron tres factores protectores: DR en el ojo contralateral, hipertensión ocular postquirúrgica y replicación a las 24 horas de la cirugía. Los pacientes fueron divididos en tres grupos según su probabilidad de desarrollar VRP: riesgo bajo (192 pacientes) el 11,5 por ciento desarrolló una VRP, riesgo moderado (70 pacientes) 50 por ciento de VRP, riesgo alto (36 pacientes) 80 por ciento de VRP. Conclusiones: Es posible clasificar a los pacientes en grupos de riesgo de desarrollar VRP, sin embargo es necesario un estudio prospectivo para confirmar estos resultados y obtener nuevos indicadores de riesgo (AU)