Keywords► internship ► ophthalmology residency ► confidence level AbstractPurpose In this study, we set out to better understand the factors that influenced current ophthalmology residents' internship selection. We then tested the hypothesis that certain clinical or research experiences in medical school and internship may influence residents' confidence upon entering ophthalmology residency. Furthermore, we investigated whether completing internship at the same program as one's residency is correlated with confidence at the start of residency. Design Observational, cross-sectional, multicenter survey. Participants U.S. ophthalmology residents (Post Graduate Year 2/3) belonging to the class of 2018. Eighty surveys were submitted of which 63 were analyzed based on established inclusion criteria. Methods Residents responded to a 22-question online survey addressing how residents chose their internship, internship curriculum, exposure to ophthalmology in medical school and during internship, confidence level entering ophthalmology residency, confidence in managing various ocular pathologies, and factors that built confidence prior to ophthalmology residency. A Likert scale format was used for the majority of survey questions. Kruskal-Wallis testing and Fisher's exact testing were used to compare outcome variables among three groups defined by sense of confidence entering ophthalmology training. Main Outcome Measures Level of confidence at the start of ophthalmology residency. Results Quality of life and geographic location were found to be the most important factors in choosing internship programs, while obtaining ophthalmology skills was least. Although 32.3% of residents either agreed or strongly agreed that they felt confident at the start of ophthalmology residency, 42.9% disagreed or strongly disagreed. Residents who felt most confident for ophthalmology training spent more time on ophthalmology rotations in medical school (p ¼ 0.05) or internship (p ¼ 0.02) and worked up patients independently during their internship ophthalmology rotation (s) (0.01). Completing one's internship at the same institution as one's ophthalmology residency did not correlate with confidence entering residency.
Purpose To report a case of severe bilateral descemetoceles in a patient with alpha-1 antitrypsin (A1AT) deficiency during intensive care unit hospitalization. Observations A 42-year-old male presented with sub-acute bilateral vision loss during an intensive care unit hospitalization following liver and kidney transplantations. On exam, this patient's best-corrected visual acuity was 20/80 in both eyes. There were bilateral descemetoceles inferotemporally in both eyes with overlying epithelial defects and dense surrounding punctate epithelial staining. The patient was initially treated with gatifloxacin drops and frequent lubricating ointment. Given the concern for impending perforation, cyanoacrylate glue with bandage contact lens was applied to both eyes. His best corrected visual acuity remained unchanged in the right eye and improved to 20/30 in the left eye. Upon medical stabilization, anterior lamellar graft was performed in the right eye, with plans for the same treatment in the left eye in the future. Conclusions As A1AT is found in the tear film and is believed to play a role in regulating protease activity in the cornea, we hypothesize that this patient's A1AT deficiency exacerbated the progression of corneal ulceration leading to severe descemetocele formation.
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