Vitreous loss during phacoemulsification learning curve performed by third-year residents.

OBJECTIVES: To assess the resident's phacoemulsification learning curve as a risk factor for vitreous loss and to determine the incidence of vitreous loss among the residents performing phacoemulsification. DESIGN: Retrospective matched case-control study MATERIAL AND METHOD: A case-control study comparing all consecutive cases of attempted phacoemulsification with intraocular lens (IOL) implantation from January 1st, 1998 to December 31st, 1999. The surgeon variable will be categorized into two groups, the third year ophthalmology residents, representing resident's phacoemulsification learning curve, and faculty staffs. The study group consisted of eyes that had had intraoperative complication of vitreous loss. The control group consisted of eyes that had not had vitreous loss. Continuous variables were compared with the 2-sided unpaired t-test. Categorical variables were compared between groups using analytical matched case-control study with relative risk or odd ratio, Mc Nemar's (Marginal) o 2 test and 95% confident interval of relative risk. RESULTS: The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 4 times the odds that the eyes in the faculty staff group would have such complication (P = 0.0052, 95% confidential interval (CI) of relative risk (RR) = 1.516-10.556). The incidence of vitreous loss among residents was 6.93% (28/404) and 2.06% (28/1358) among the faculty staffs. The overall incidence of vitreous loss was 3.18% (56/1762). CONCLUSION: The incidence of intraoperative complication of vitreous loss, the relative risk of such complication performed by the learning curve surgeon in the present study serve as benchmarks for residents-in-training, beginning and surgeon-in-practice converting to phacoemulsification.

Self-medicated over the counter ophthalmic solutions in central Bangkok.

BACKGROUND: There is a paucity of research about patients' attitudes, motivations and expectations towards self-medicated over the counter (OTC) ophthalmic solutions. OBJECTIVES: To identify the attitudes, motivations and expectations of general population towards self-medicated OTC ophthalmic solutions. MATERIAL AND METHOD: 200 consecutive participants who were studying or lived in Patumwan District of Bangkok filled in a questionnaire in a 3-months period. RESULTS: 67.5% (135/200) of the participants had an age range of 15-24 years old and 32.5% (65/200) were between 25-35 years old. Participants who were university graduates and currently university students were 53% and 35.5% respectively. Most history of illness was allergy (10/200). Half of the participants had normal vision and 40% (80/200) were near-sighted. The factor that most influenced the use of solution was dust in the eye (55%-111/200). Ocular allergic symptoms, such as eye itching, irritation and tearing, was the second. The most frequent symptom that induced the use of solutions was eye itching and irritation (48.5%-97/200). The symptom of red or pink eye was the second (33%-66/200). 48.5% (97/200) and 53.50% (107/200) of participants started using the solution at the time the influencing symptoms occurred and used for one day respectively. 46.5% (93/200) of the participants realized that the solution could be use only within 1 month after opening. CONCLUSION: From the data of this survey, more information and knowledge about the use of OTC products needs to be campaigned, even among highly educated citizens in the center of Bangkok. Better information for patients could improve the safety of OTC medicines. The ways of advising patients need to be found. The uncertainty is, therefore, how far this trend will go and how health care professionals and consumers will resspond.

Treatment of subfoveal choroidal neovascularization secondary to age related macular degeneration with single treatment of verteporfin photodynamic therapy: a safety and short-term outcome.

OBJECTIVE: To evaluate the short-term efficacy on visual outcome and safety of a single treatment of photodynamic therapy with verteporfin using the standard dosage regimen in patients with predominantly classic subfoveal choroidal neovascularization (CNV) from age related macular degeneration. DESIGN: Prospective, noncomparative, consecutive, interventional case series. SETTING: Department of Ophthalmology, Chulalongkorn University and Hospital, Bangkok, Thailand. PARTICIPANTS: Patients with subfoveal CNV caused by age related macular degeneration. METHOD: Standardized protocol refraction, visual acuity testing, complete ophthalmic examination, color photography, and fluorescein angiography were used to evaluate the effects of a single treatment of photodynamic therapy with verteporfin. Follow-up was planned through 3 months in all patients. RESULTS: A total of 39 eyes from 35 patients enrolled into the present study and have completed 3 months follow-up. The mean +/- SD logMAR BCVA at baseline was 0.76 +/- 0.48, equivalent to the Snellen BCVA of 20/114 (range, 20/40 to 20/1000). The mean +/- SD logMAR BCVA at the final 3-month visit was 0.55 +/- 0.37, which was a Snellen equivalent of 20/70 (range, 20/30 to 20/1000). The mean line of BCVA improvement was 2.1 lines. The improvement in BCVA at the 3-month follow-up was statistically significant (Wilcoxon signed-rank test, P = .043). No patient suffered moderate loss of vision or a loss of vision in 2 or more lines. None of the patients suffered severe visual threatening adverse events at the time of treatment and during the study period. CONCLUSIONS: The results of short-term visual outcome is encouraging; PDT is the least invasive treatment method currently available to achieve a stable or improved vision in AMD patients. PDT with verteporfin can lead to cessation of fluorescein leakage from CNV for up to 3 months, with stabilization or improvement of vision for 12 weeks. A randomized, controlled study in the near future would be beneficial to demonstrate the long-term results and efficacy in the treatment of CNV associated with AMD.