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Purpose: To report outcomes and assess the risk factors for failure of trabeculectomy (trab), trabeculectomy with mitomycin?C (trabMMC), and combined trabeculectomy with cataract extraction (CT) in vernal keratoconjunctivitis (VKC) eyes with steroid?induced glaucoma (SIG). Methods: Trab was performed in 45 eyes of 30 subjects, trabMMC in 36 eyes of 25 subjects, and CT in 34 eyes of 27 subjects. Success was complete when intraocular pressure (IOP) was between 6 and 21 mm Hg without anti?glaucoma medications (AGM) and qualified with AGM. Results: Median age (14 vs. 16.3 and 17.4 years) was significantly less in the trab cohort (P = 0.007). Majority (88%–93%) were male (P = 0.78). Preoperatively, median duration of steroid usage was >2 years (P = 0.52), mean IOP (32, 29.4, and 28.4; P = 0.26) and median cup:disc ratio (CDR) (0.9; P = 0.27) were similar in the three groups. Complete success (76%, 71%, and 66% at 5 years; P = 0.91), and qualified success (88%, 97%, and 94% at 5 years; P = 1.0) with trab, trabMMC, and CT, respectively, were similar. Preoperative factors significantly associated with qualified failure (multiple logistic regression) were older children, longer duration of VKC, longer duration and mixed type of steroid use (all P < 0.001) and larger CDR (P < 0.02). At the last follow?up, 38% in trab, 33% in trabMMC, and 50% eyes in CT were blind (visual acuity ?20/400 and/or visual field ?10°) due to glaucoma (P = 0.33). Conclusion: The surgical success for all three types of surgery was similar at 5?years. Chronic VKC and long?term steroid use were associated with surgical failure. The majority had advanced disease and a significant proportion were blind due to glaucoma.
RESUMO
Introduction: Mismatch between patient expectation and the service received is related to decreased satisfaction Aims and Objectives: To measure level of satisfaction and identify the obstacles in availing services among the patient at Tertiary Care Center, South Gujarat. Method: It was a cross sectional study, included 800 respondents, 400 each from indoor and outdoor facilities. Respondents from all the department have been taken by proportion to their OPD and IPD load (PPS) after informing and taking their consent. Data has been collected by using android smart phones Results: General perception of the clients for the OPD services were 60% believed that the time to get services is appropriate, 98% respondents satisfied with staff behavior, 60% satisfied with the cleanliness OPD at the same time few dissatisfied with public utilities (16%), 70% patient satisfied with available water and other amenities in, around the hospital and 77% felt that the space in OPDs was crowded. All the patient whom examination required reported that the privacy has been maintain. As many as 92% wish to return every time for the treatment from our hospital. General perception regarding the IPD services shows that more than 95% patients were satisfied with various services like quality of medical care, nursing care, diagnostic and referral service, admission process, discharge process and physician services. As far as the staying is concerned at people ranked lowest to the availability of drinking water and cleanliness of toilet and bathroom Conclusion: The findings of the present study can be utilized to improve the services