Cataract surgery training: Report of a trainee's experience.

BACKGROUND: To report a trainee's experience gained in the cataract extraction training program after the COVID-19 pandemic. METHODS: An ophthalmologist was trained in phacoemulsification and intraocular lens (IOL) implantation in the ETAPE foundation, Eye Center, Cairo for a period of 4 weeks by three expert cataract surgeons. The training was tailored to the previous trainee's experience according to his residency logbook and supervised by one expert cataract surgeon. The training included didactic lectures, clinical observations, and hands-on practical experience. In addition, the trainee was provided with a logbook to record details of patients operated on and procedures observed. RESULTS: The trainee performed 58 phacoemulsification surgery with IOL implantation and two extracapsular cataract extraction over the 4 weeks. Seven patients underwent intraoperative complications. Surgical time (ST) improved from 48.77 ± 9.65 min in the 1stweek to 19.34 ± 1.31 min during the last week of training (P = 0.046). Poisson regression showed that patients affected by less severe cataracts were more likely to exhibit a lower incidence of complications than patients affected by more severe cataracts. In addition, patients operated on during the 1stweek were more likely to show a higher incidence of complications than those operated on during the last week. CONCLUSIONS: The 4-week surgical training effectively improved surgical confidence and micro incisional skills according to ST reduction and complication rate occurrence. Ophthalmologists benefit from enhancing their cataract skills in a short time following a well-structured cataract extraction course. This could undoubtedly lead to improved surgical outcomes for patients undergoing cataract extraction.

Application of Three-Dimensional Printers for Production of Personal Orbital Implants during Pandemics

Objective: The production of personalized prosthesis depends on human resources and involves a manufacturing process in which patients are involved individually in. As the world is experiencing the COVID-19 pandemic, less contact with the manufacturer is needed to stay safe. 3D printed prosthesis has reduced the need for human resource in the process, while allowing the patient to be completely removed from the design and manufacturing process. In this study an approach in which the patient is kept out of the manufacturing process was investigated. Material(s) and Method(s): The prosthesis model was created by using the image data obtained from the medical imaging devices. The outer part of the prosthesis was shaped with a developed image sampling system. The model was produced using three-dimensional printer. A cytotoxic analysis of the raw material used in the manufacturing process was performed. Result(s): The total production cost of the orbital implants was approximately about 8$. The cytotoxic analysis showed that layered manufacturing strategies could be used to develop implants and prostheses applicable to patients. Conclusion(s): COVID-19 underlined the importance of social distancing which is hard to apply during manufacturing of an eye prosthesis. The manual method results in an eye prosthesis which suits well after numerous trials. On the contrary, Digital Imaging and Communications in Medicine (DICOM) based eye prosthesis designation and manufacturing is not only rapid but also flawlessly fitting due to precise measurement during the manufacturing. Copyright © 2022, Nobelmedicus. All rights reserved.

AI/ML enabled decision making in facilitating Robotic surgery

Technological advancements have the potential to help every surgeon to enhance the quality of world-wide surgical care. Robotic surgery is currently at its inception stage but is expected to bloom with parallel advancements in computer science and artificial intelligence. The objective of this paper would be to understand the present and future scope of robotic surgery utilizing AI/ML techniques. The study will revolve around how next-generation surgical robots will be inherent in optimizing a surgeon's skills productively, to achieve the pinnacle of precision during complicated surgical procedures. It will focus on how AI/ML helps in Robotic Spine Surgery, Minimally Invasive Surgery techniques, and ophthalmic surgeries. It will talk about the current limitations of robotic surgery and how with latest technological advancements it will be possible to overcome the shortcomings. © 2022 IEEE.

Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India.

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription-polymerase chain reaction (RT-PCR) to screen COVID-19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital-based study. Point-of-care (PoC) RAT was performed using nasopharyngeal swab, while RT-PCR for SARS-CoV-2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS-CoV-2 by using both RAT and RT-PCR. Only one patient had tested positive for SARS-CoV-2 with both RAT and RT-PCR, while two patients had tested positive with RT-PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT-PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen's kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT-PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen's kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT-PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID-19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Global Ophthalmology Practice Patterns during COVID-19 Pandemic and Lockdown.

AIM: To assess the impact of practice patterns amongst global ophthalmologists during severe acute respiratory syndrome Coronavirus 2 (SARS Cov2) causing Corona virus disease (COVID-19) and understand the various modifications made to address emergency surgeries and practice needs. METHODS: An online survey was sent to practicing ophthalmologists around the world through email, Whatsapp™ ListServ17.0™ (for pediatric ophthalmologists), WeChat™ (China) and ophthalmology associations (Indonesia, Philippines, Ireland). All queries were collected and categorized. Responses to the queries were given according to the recommendations by the Ophthalmology association. Practices ability to deal with the COVID were also classified according to country and type of access to PPE. Statistical analyses of the association between these data and queries, where appropriate were carried out. RESULTS: One thousand nine hundred sixteen ophthalmologists were invited to participate in a survey between April 10th and April 30th, 2020 of which 1207 responded, which is a response rate of approximately 63%. The majority of respondents were from India, Indonesia, China, Singapore and the USA. Our study indicates a precipitous drop in surgical procedures with 46% (n = 538) ophthalmologists ceased to operate on their patients and almost 40% (n = 486) were doing less than 25% of their original number of surgeries. The intent to resume elective surgeries was a consideration in 41% (n = 495) after an evaluation of the situation and in consultation with professional bodies. More than 2/3 of the respondents (n = 703) made it a priority to use and mandate their patients to practice physical distancing, wearing masks, and hand dis-infection for protection to limit the spread of infection. CONCLUSION: This global survey provides a real-world assessment of diverse practices that were in various forms of "shut down mode" and circumstances with varying capabilities to deal with COVID. It is unprecedented that the collective wisdom for a curtailment of practice has had an enormous immediate and far reaching implications on the livelihoods of ophthalmologists, their staff, and their families. Nevertheless, ophthalmologists and their staff remain resilient and have adapted to these changes pragmatically.