ABSTRACT
Diabetes mellitus (DM) is of increasing public health importance in India. The magnitude has been increasing over the past three decades. DM is associated with major microvascular complications among which diabetic retinopathy (DR) is emerging as one of the leading causes of visual impairment in low and middle income countries. Two-thirds of the Indian population resides in rural areas where access to modern medicine is limited mostly to the public health system. Operational guidelines are critical in delivering program components effectively. They provide the template to benchmark service delivery and help in improving quality of care. A pilot initiative to reduce visual impairment in people with diabetes was supported by an international nongovernmental funding organization over a 5-year period in India. This initiative facilitated the development of operational guidelines for DR. The guidelines were developed through consensus and primarily addressed the public health system in India.
ABSTRACT
The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.