Purpose: To determine the operative time and complication rates of resident phacoemulsification surgeries at different time points in training. Methods: Retrospective cross-sectional study at the Department of Ophthalmology of the Philippine General Hospital. All resident-performed elective adult phacoemulsification surgeries from January 1, 2014, to December 31, 2018, were included, while operations with planned anterior or posterior procedures were excluded. Cases were arranged chronologically and divided into time points with 25 cases each. Operative time and complication rates were computed for each time point. As defined by the ICO Ophthalmology Surgical Competency Assessment Rubric (OSCAR), 30 minutes was used to gauge competency based on operative time, while complications were compared to published rates for residents. Results for the first 50 cases, the minimum number required by graduation, were also compared with succeeding cases. Results: A total of 4635 cases were included. Residents performed an average of 115.9 ± 30.4 cases, with no significant difference among residents (F(4,35)=2.64, p=0.12). Overall complication rate was 6% (n=276), similar to those reported internationally. Both median operative time and complication rates decreased significantly for every time point in training (p<0.001). After 50 cases, only 40% (n=16) of residents reached the operative time of 30 minutes. Median operative time is significantly lower when comparing the first 50 surgeries with the succeeding cases (37 minutes vs 29 minutes, p<0.001). Likewise, complication rate is also significantly lower (9.3% vs 3.5%, Χ 2 (1, N=4635) = 68.481, p<0.001), with an odds ratio of 2.85 (p<0.001, 95% CI [2.2, 3.7]). Conclusion: There are significant improvements in both operative time and complication rates as more surgeries are performed. However, the minimum required 50 cases is not enough for resident competency based on operative time and complication rates.
Purpose Operating room processes must be efficient to boost profitability and minimize cost while retaining surgical care quality. This study aims to assess operating room efficiency for resident-performed elective phacoemulsification surgeries done under local anesthesia by measuring different key performance indicators and comparing this with international benchmark data. Patients and Methods This is a prospective cross-sectional study done in the Department of Ophthalmology of the Philippine General Hospital, the National University Hospital. The operating room milestones were noted and recorded by a single third-party observer in randomly selected operating rooms from April to June 2019. Results Fifty-six phacoemulsification cases in randomly selected rooms fulfilling both inclusion and exclusion criteria were observed. None of the cases started on or before the scheduled 6:30 a.m. cutting time, with an average of 34 (SD 8.53) minutes late. Entry lag was above the median, while exit lag and turnover time were above the 95th percentile compared to benchmarking data. Segment analysis also showed an increased entry lag (35.11% vs 21.5%), significantly higher than benchmarks (t: 10.99, df: 55, p<0.01). Comparison with proposed targets in other studies also showed an increased time for entry lag. Conclusion This study determined that entry lag is the performance indicator that should be addressed to improve efficiency. A multidisciplinary approach and group goal-setting are needed to implement changes in the operating room.
Objective. This study was designed to assess the impact of the COVID-19 pandemic on ophthalmology training from the perspective of ophthalmology residents and fellows in the Philippines.Methods. A 55-item online survey on the COVID-19 pandemic’s impact on ophthalmology training was sent to 168 ophthalmologists-in-training from March 15, 2021 to April 19, 2021. Participants from all ophthalmology training programs in the Philippines were selected via random sampling and proportional allocation.Results. A total of 158 ophthalmologists-in-training (138 residents and 20 fellows) completed the survey. The areas of ophthalmology training that were found to be most disrupted during the COVID-19 pandemic were surgical training (95%), clinical activity (94%), and in-person interaction with consultants in the out-patient department (94%) and operating room (85%). In contrast, trainees found an increase in didactic teaching activities (75%) and research activities (39%).Overall, 78% of the trainees felt that the pandemic had a negative impact on their ophthalmology training. The aspects which were most frequently found to be negatively impacted by the pandemic were mental health (70%), followed by technical skills (69%), and clinical skills (61%). No major differences were found on the impact of COVID-19 on training when compared across year levels and across institutions compared by location (National Capital Region vs. non-National Capital Region) and funding type (government vs. private funding).Ninety-nine percent (99%) of institutions shifted most of their didactic teaching activities to online platforms. Surgical video conferences and simulator training or skills labs were thought to be helpful to surgical training by 89% and 81% of the trainees, respectively. Majority of trainees attended to patients via telemedicine averaging 40% of their clinic consults. However, only 16% reported confidence in handling their patients through telemedicine.Conclusions. The COVID-19 pandemic has had an overall negative impact on ophthalmology training in the Philippines. It caused significant disruption in trainees' clinical and surgical activities, and affected their mental health. Despite this, the situation provided an opportunity to boost trainees' theoretical knowledge. Majority are receptive to new technology-based learning tools to preserve the effectiveness of their training. Efforts to re-evaluate current training programs are needed to ensure sustainability and quality of ophthalmology training in the Philippines.
BackgroundSevere vision-impairing ocular inflammation is rarely reported following extensive laser. Previous cases have involved retinal photocoagulation for diabetic retinopathy resolving over days. This report documents a rare instance of this where encircling retinopexy/cerclage was done as fellow eye retinal detachment prophylaxis in a patient with no overt comorbidities.ResultsA panuveitis-like reaction with severe, near-total visual impairment was documented 1 day following single-sitting encircling laser retinopexy/cerclage done as fellow eye prophylaxis for a 21-year-old male presenting with total retinal detachment in the other eye. Pre-laser findings were unremarkable, other than an equatorial ring of fine vitreous condensations. Pre-laser vision of 20/20 uncorrected decreased to hand motion, light perception on all quadrants, accompanied by severe anterior segment inflammation with hypopyon, retrolental membranes, vitreous cells, and choroidal effusion/suspicious exudative retinal detachment on B-scan ultrasound and ultrasound biomicroscopy. Combination of oral, topical, and depot steroids resulted in restoration of vision by 1 month post-laser, but with persistent anterior segment inflammation and retrolental membranes at month 2 post-laser.ConclusionsThe atypically inordinate degree of post-laser inflammation and multiple sequelae following encircling retinopexy/cerclage as retinal detachment prophylaxis, in this case, demonstrate the potency and risks of retinal photocoagulation. The value of pre-laser assessment for potential risk factors, caution and mindfulness in conducting the intervention, and, the value of prudent and thorough follow-up are exhibited in this case.
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