Background The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as "severe" by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed "moderate" (37.3%), "mild" (14.1%) or "slight" (4.2%) long-term impact. The vast majority of trainees reported a decrease ≥50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular webbased teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions This survey, focusing on trainees' perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health system.
BackgroundBlood–retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood–retinal barrier breakdown postoperatively.MethodsProspective, placebo-controlled, double blind clinical trial. In 34 patients with rhegmatogenous retinal detachment scheduled for conventional scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5 ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5–6 hours before surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and 6 weeks after randomisation between dexamethasone and placebo were analysed using mixed model ANOVA, while correcting for the preoperative flare measurement.ResultsSix patients did not complete the study, one because of recurrent detachment within 1 week, and five because they missed their postoperative laser flare visits. The use of dexamethasone resulted in a statistically significant decrease in laser flare measurements at the 1-week postoperative visit.ConclusionThe use of a preoperative subconjunctival injection of dexamethasone decreased 1-week postoperative blood–retina barrier breakdown in patients undergoing conventional scleral buckling retinal detachment surgery. This steroid priming could be useful as a part of a peri-operative regime that would aim at decreasing the incidence of PVR.
<b><i>Purpose:</i></b> The aim of this study is to establish if air can be considered as a safe substitute for long-lasting tamponade agents for primary rhegmatogenous retinal detachment (RRD) treatment, regardless of the position or the number of retinal breaks. <b><i>Methods:</i></b> In this study, 230 consecutive patients (236 eyes) who underwent a pars plana vitrectomy (PPV) for primary RRD with air or SF<sub>6</sub> tamponade from January 2014 till March 2020 were analyzed. The main outcome measure was the rate of an anatomically attached retina without the presence of any tamponade agent for at least 3 months postoperatively. <b><i>Results:</i></b> Our overall success rate in treating RRD with PPV in cases involving superior, inferior, and also multiple breaks is 88.5% (146/165 eyes) with air tamponade and 80.3% (57/71 eyes) with SF<sub>6</sub> 20% tamponade. Preoperative characteristics were almost similar between the two groups. <b><i>Conclusion:</i></b> Our study shows encouraging results for RRD treated with air tamponade, not only for superior breaks but also for inferior and multiple breaks. Thorough removal of vitreous traction, aspiration of subretinal fluid, and sealing of all the retinal breaks are mandatory elements to treat RRD. After this is accomplished, air tamponade seems to be a safe and effective agent for primary RRD. In order to clarify the use of intravitreal gases or air in the treatment of primary RRD with PPV, a randomized controlled prospective study should be realized in the future.
Prof. dr. M.J. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794; PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany.
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