Background This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. Methods Three five-week distance wet lab courses were administered through Cybersight, Orbis International’s telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution’s wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0–32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4–6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees’. Results In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees’ average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization’s criterion for good quality. Conclusions Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
Características epidemiológicas de los traumatismos oculares en un instituto oftalmológico de referencia regional, Trujillo Perú, 2016 -2017 Epidemiological characteristics of eye injuries at one ophthalmological institute of regional reference, Trujillo Perú, 2016 -2017 RESUMEN Objetivo: Describir las características epidemiológicas de los traumatismos oculares atendidos en el Instituto Regional de Oftalmología (IRO). Materiales y métodos: Estudio descriptivo y prospectivo, en el cual se aplicó un protocolo estandarizado de registro de datos demográficos y clínicos de pacientes con traumatismos oculares que acudieron al servicio de emergencia del IRO, entre enero 2016 y abril 2017. Resultados: Un total de 1 288 pacientes cumplieron los criterios de selección, la edad promedio fue de 37 años, en su mayoría los afectados fueron varones (84,7 %) y el grupo etario más afectado fue el de 21 a 40 años (46,7 %). Los accidentes laborales fueron la causa más frecuente (63,7 %), ocurriendo principalmente en trabajadores de metalmecánica, construcción y albañilería; seguido de los accidentes domésticos (19,2 %). El 95,4 % fueron traumatismos cerrados, predominantemente con compromiso unilateral, ocupando el primer lugar los cuerpos extraños corneales (73,4 %), seguido de las contusiones (16,2 %). El 56,2 % de traumatismos abiertos fueron penetrantes restringiéndose el daño principalmente a la córnea (64,9 %). El 52,6 % de pacientes con traumatismo abierto terminaron con agudeza visual entre 4/200 y no percepción de luz. Conclusiones: Los traumatismos oculares cerrados fueron los más frecuentes y afectaron a pacientes jóvenes, de sexo masculino que laboraban en industria metalmecánica y construcción; siendo los cuerpos extraños corneales metálicos el principal tipo. La mayoría de los traumatismos abiertos tuvieron un pobre pronóstico visual luego de su reparación quirúrgica. ABSTRACTObjective: To describe the epidemiological characteristics of eye injuries treated at Regional Ophthalmology Institute (IRO). Material and Methods: A descriptive and prospective study, in which a standardized protocol was developed to obtain and record demographic and clinical data of patients with ocular trauma who attended the emergency department of IRO between January 2016 and April 2017. Results: 1 307 patients with eye injuries were evaluated, 19 were excluded due to incomplete information, resulting in a sample of 1 288 patients, aged between 5 and 70 years, mostly of male gender (84.7 %), being more frequent patients from 21 to 40 years (46.7 %). Occupational accidents were the most frequent cause (63.7 %), occurring mainly in metal-mechanic workers, welders and workers, followed by domestic accidents (19.2 %). A total of 95.4 % were closed injuries, mostly unilateral. Corneal foreign bodies accounted of 73.4 % of cases, followed by contusions (16.2 %). 56.2 % of open-globe injuries were penetrating, restricting damage mainly to the cornea (64.9 %). 52.6 % of patients with openglobe injury ended up with visual acuity between 4/200 and no...
Efecto de la cirugía de catarata en la sensibilidad al contraste y la calidad de vida de pacientes con diferentes tipos de catarata Effect of cataract surgery on contrast sensitivity and quality of life in patients with different types of cataract
To determine efficacy of mydriatic-digital images (MDI) when screening retinal complications in people living with HIV, in this study, a consecutive series of 79 people living with HIV (PLHIV) were evaluated. Two series of MDI were taken: - macula and optic nerve - nine gaze fields, which findings were compared with those obtained by a retina specialist. Both examiners were unaware of each other’s results. Average age was 32.2 years old, predominantly male (75.9%). Most frequent complications were HIV retina microangiopathies (6.3%) and toxoplasmosis (5.1%), followed by Cytomegalovirus and neuro-retinitis, optic neuritis and vitreitis, each one with 1.3%. Sensitivity with two MDI was 92.8% (CI 95% 66.0–100.0) and with nine 100% (CI 95% 77.0–100.0) and specificity of 95.4% (CI 95% 87.0–99.0) for both series. The positive predictive value was 81.3 and 82.4%, and negative predictive value was 98.4 and 100% respectively. The strength of agreement was substantial for the two series with the retina specialist examination (Kappa index of 0.836 and 0.888 respectively). Mydriatic-digital-images appear to be an effective method to screen for HIV-related retinal-complications in a regional hospital in Perú.
Objective: To determine the effect of cataract surgery on contrast sensitivity and quality of life of patients with different types of cataract. Methods: Prospective study with a preand post-test design in patients with indication for cataract surgery by phacoemulsification. Best-corrected visual acuity (BCVA) at different contrast levels and vision-related quality of life (V-RQOL) were evaluated before and 30 days after surgery. The study population was divided into 3 comparative groups according to the type of predominant cataract following the Lens Opacities Classification System III: nuclear, cortical and posterior subcapsular (PSC). Results: Seventy-eight eyes of 78 patients with a mean age of 69.3 ± 9.6 (51-86) years were included. In the preoperative period, low contrast sensitivity was slightly affected in the nuclear group and severely affected in the PSC group. V-RQOL limitations scale was significantly lower for the PSC group compared to the nuclear group (0 [0-15.6 vs. 6.2 [0-12.5; p = 0.040). After surgery, BCVA and contrast sensitivity improved in the three study groups. The most significant changes were observed in the PSC group. V-RQOL improvement was positively related to visual acuity gain in high and low contrast in the three study groups. Conclusion: Cataract surgery significantly improved contrast sensitivity and quality of life of all patients, especially in those with PSC opacity.
Background: This study aimed to assess the acceptability and effectiveness of training second and final-year residents, at the Regional Institute of Ophthalmology, a tertiary-level ophthalmic training center in Trujillo, Peru, in phacoemulsification cataract surgery through structured distance surgical mentorship wet lab courses. Methods: Delivered three five-week distance surgical mentorship wet lab courses, administered through Cybersight, Orbis International’s telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution’s wet lab and uploaded to Cybersight for grading. Competency was assessed through the anonymous grading of pre- and post-training surgical simulation videos, masked as to which videos were recorded before and after training, using a standardized competency rubric adapted from the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents. An anonymous satisfaction survey was administered to trainees’ post-course. Results: In total, 21 second and final-year residents participated in the courses, submitting a total of 210 surgical videos. Trainees’ average competency score (scale of 0-32) increased 6.95 (95%CI [4.28, 9.62], SD=5.01, p<0.0001, two sample t-test) from 19.3 (pre-training, 95%CI [17.2, 21.5], SD=4.04) to 26.3 (post-training, 95%CI [24.2, 28.3], SD=3.93). Among 100 post-training resident surgeries, visual acuity for 92 (92%) was ≥20/60, meeting the World Health Organization’s criterion for good cataract surgical quality. Conclusions: Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person wet lab training and can also be effectively deployed to respond to a disruptive event in medical education, such as the current COVID-19 pandemic.
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