Implementation and methodology of a pilot, localized video library of cataract surgeries for residency training in a tertiary Philippine Eye Institute

Objectives@#Video-based learning of surgical skills is a useful complement in training programs. This is more evident where direct patient exposure is limited due to multiple factors. In ophthalmic surgery, access to high quality ocular surgery videos such as for cataract operations, can provide significant learning points for trainees in an institutional program. Creation therefore of a local, curated, and indexed library of cataract surgery would support alternative means to maximize training of new ophthalmic surgeons. The objective of the project was to develop a local library of cataract surgery videos as an adjunct teaching tool for resident trainees in a Philippine tertiary eye care center. @*Methods@#A collection of cataract surgery videos from 2013-2020 were compiled into a single workstation. Videos were reviewed and catalogued using set keywords for easy searchability and labelling. @*Results@#256 videos of cataract surgeries were compiled into the library. 6 main headings for the keywords, with 159 total subheadings were established to provide robust tagging and search options to index the video.@*Conclusion@#Particularly in Ophthalmic surgery, refinement of surgical technique is essential in ensuring better postoperative visual outcomes. This is achieved through repetition and careful dissection of operative technique. The use of a library with multiple videos of a similar procedure allows trainees more exposure to certain cases. This ultimately affords trainees, better experience and confidence in their own surgeries.

Breast cancer in the young: A 10-year review of the diagnosis, treatment and outcomes at the Philippine General Hospital

RATIONALE@#Breast cancer is the most prevalent cancer in the world. It is usually diagnosed in women 50 years old and older, but is also found in younger women. Its occurrence in young women led to questions with regards issues on its tumor biology, survival and fertility. There is insufficient local data to formulate treatment options relevant to this age group. This study reviews the data on breast cancer in young female patients seen in a tertiary institution.@*METHODS@#This is a descriptive study involving a review of medical records of young female breast cancer patients (<35 years of age), seen at the Philippine General Hospital - Breast Care Center from January 2008 to December 2017. @*RESULTS@#A total of 119 patients were included in the study. Of these young female patients, 29.4% presented with locally advanced disease (Stage IIIB) correlating with a high number of patients who underwent neoadjuvant chemotherapy (38.7%) and modified radical mastectomies with primary closure (62.18%). @*CONCLUSION@#Breast cancer in young females should be aggressively investigated as it commonly presents in an advanced stage.

Male breast cancer: The Philippine General Hospital experience

RATIONALE/OBJECTIVE@#Breast cancer among males is often diagnosed at a later age and at an advanced stage. The study aimed to present the epidemiology, associated risk factors, clinical and pathological characteristics, treatment patterns and outcomes of male breast cancer patients treated at the Philippine General Hospital from January 2008- December 2017. Information from this study can provide for better understanding of the disease and basis for creating guidelines toward better outcomes. @*METHODS@#Retrospective study of medical records involving male breast cancer patients who underwent surgery and treatment at the Philippine General Hospital from January 2008- December 2017.@*RESULTS@#Male breast cancer accounted for 15 (0.26%) of 5,777 resected breast specimens for breast cancer patients with a 1:384 male to female ratio. The mean age of presentation was 60 years. The most common presentation was a retro-areolar mass, with 33% of patients presenting post-excision. Sixty-seven percent were at Stage II and 20% at Stage III. About 94% of patients have invasive ductal carcinoma, while the only other histology is papillary carcinoma at 13%. Majority of those tested were both estrogen receptor and progesterone receptor (ER/PR) positive (33% versus 1 %), and Her2neu negative. All patients underwent modified radical mastectomy. Only two patients were documented to have received adjuvant chemotherapy while one patient received neoadjuvant chemotherapy.@*CONCLUSION@#Breast cancer remains to be a rare disease among males, is often diagnosed at a later age and at an advanced stage. Because of its rarity, awareness is necessary not only in the community but also among healthcare providers to identify and treat the problem earlier. Further investigation and prospective studies are recommended.

Visual outcomes and intraoperative complication rates of Phacoemulsification Cataract Surgery by third year ophthalmology residents in the UP-Philippine General Hospital

Background@#Phacoemulsification is the most important cataract surgical procedure performed by ophthalmology residents. There is an increasing and consistent trend in international studies on decreased complication rates and more efficient surgical techniques with more surgeries performed. The data collected from this study can be used to quantitatively assess the cataract surgery training of Ophthalmology residents in the country and can help to improve the quality of cataract surgeries taught and performed in the training programs.@*Objectives@#To analyze outcomes of phacoemulsification cataract surgeries and to determine the intraoperative complication rates of third-year residents of the University of the Philippines - Philippine General Hospital (UP-PGH).@*Methods@#Retrospective chart review of phacoemulsification cases done by eight third-year ophthalmology residents at the UP-PGH from January 1 to December 31, 2017. Outcomes measured included postoperative best corrected visual acuity (BCVA), intraoperative complications (posterior capsular rent and vitreous loss), and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used).@*Results@#Four hundred ninety-two (492) cases were analyzed. Postoperative mean BCVA was 20/25. There were no significant differences in visual acuity outcomes over the course of training. Intraoperative complications occurred in 33 cases, with fewer cases with posterior capsule rent and vitreous loss later in training after the first 50 cases. There was a downward trend of adjusted phacoemulsification time throughout training, with a significant difference between the first 50 and 100 cases.@*Conclusion@#Good visual outcomes are achievable throughout the resident’s phacoemulsification learning curve. Surgical competency in phacoemulsification, as measured by complication rates and phacoemulsification efficiency, still improves significantly with an increasing number of cases and experience beyond the first 100 cases.

Is femtosecond technology the future of our cataract surgery?

@#Techniques and technology for modern-day cataract surgery have taken quantum leaps over the past several decades. We appreciate today’s technology and innovations since we know how it all started. If we look back at how our profession dealt with cataract removal a century ago, fifty years ago, or even ten years ago, we will realize that the refinement of technology and surgical techniques in cataract surgery is one of the greatest success stories in the annals of medicine.1 Cataract surgery today remains one of the most successful and commonly performed procedures worldwide.

The scourge of ethambutol-related toxic optic neuropathy in the Philippines

@#It has been more than five years since the Philippine Journal of Ophthalmology devoted an entire issue on neuro-ophthalmology, a subspecialty that is still considered minor in terms of research and clinical practice, with less than 10 active practitioners locally.1 That issue highlighted several neuro-ophthalmology papers submitted by local and international authors, as well as an editorial on optic neuritis and ethambutolrelated toxic optic neuropathy (ETON). The following years saw members of the Neuro-ophthalmology Club of the Philippines (NOCP) focus on ETON in particular, a local “scourge” that is fraught with unique issues and controversies: