Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment.

PURPOSE: To characterize the incidence, duration, and risk factors for and outcome of cystoid macular edema (CME) after cataract surgery and investigate the effects of treatment regimens on visual outcome and duration. SETTING: University-based comprehensive ophthalmology practice. METHODS: This study included 1659 consecutive cataract surgeries performed by residents between 2001 and 2006. Cases were classified according to the presence of CME. Subset analysis excluded patients with diabetes mellitus (DM). The CME groups were analyzed according to type of treatment to compare duration of CME and final best corrected visual acuity. RESULTS: The incidence of postoperative CME was 2.35% (39/1659), and history of retinal vein occlusion (RVO) was predictive of postoperative CME (odds ratio [OR], 47.12; P<.001). When patients with DM were excluded, the incidence of CME was 2.14% (29/1357) and history of RVO (OR, 31.75; P<.001), epiretinal membrane (ERM) (OR, 4.93; P<.03), and preoperative prostaglandin use (OR, 12.45; P<.04) were predictive of postoperative CME. Patients with DM and/or intraoperative complications did not have an increased risk for CME when treated with prophylactic postoperative nonsteroidal antiinflammatory drugs (NSAIDs) for 3 months. Groups treated with NSAIDs plus a steroid had significantly shorter resolution times than the untreated group (P = .004). CONCLUSIONS: A history of RVO, ERM, and preoperative prostaglandin use were associated with an increased risk for pseudophakic CME. Treatment with NSAIDs plus steroids was associated with faster resolution of CME than no treatment. Treating high-risk patients with NSAIDs after cataract surgery decreases the incidence of postoperative CME to that of patients who are not at high risk.

Radiotherapy and cataract formation.

In the past five decades, the treatment options for intraocular tumors have expanded from one surgical option of enucleation to numerous regimens including radiotherapy. Radiotherapy has proven to be as efficacious in controlling the malignant lesion; however, normal ocular structures can also be affected. The lens is radio-sensitive and therefore the development of post radiation cataract commonly impairs vision and the ability to monitor tumor recurrence. Prevalence, severity, onset, and prognosis of radiation-induced cataract depend highly on the dose and rate of radiation. Recently, additional studies have given insight into this important relationship and the efficacy of treatment options.

Incidence and causes of ocular surgery cancellations in an ambulatory surgical center.

PURPOSE: To report the incidence and analyze potentially preventable causes of ocular surgery cancellations. SETTING: Ambulatory Care Surgical Center of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. METHODS: A retrospective review of the ambulatory surgical center cancellation records and patient medical records from December 2001 to December 2003 was conducted. The primary statistical analysis was conditional logistic regression. RESULTS: Three hundred seventy-nine of 7153 (5.3%) ambulatory ophthalmic surgeries were cancelled within 24 hours of the scheduled start time. Cancellation rates varied by patient age, with the rate among children being highest (8.7%) and that among older patients (age 60+) lowest (4.9%; P = .08). Surgeons who performed at least 4 surgeries per month on average had the lowest cancellation rate (P = .08). Cancellations occurred less frequently in warmer months (June, 3.3%; August, 4.2%) than during the rest of the seasons (P<.001). The highest incidence of cancellations occurred in February (7.8%) and the lowest in June (3.3%). Of the total causes, 41% were considered "preventable," 45% "unpreventable," and 14% "no reason given." Cancellations deemed preventable were lower in general anesthesia cases (1.0%) than in local anesthesia cases (2.0%; P = .02). Preventable cancellation rates also varied by procedure and were statistically significant. CONCLUSIONS: Among ambulatory ophthalmic surgeries, there was a higher incidence of late cancellations in pediatric cases. Late cancellation rates were highest in cases scheduled in the winter, especially in February. Of the reasons documented for cancellations, 41% were considered "preventable" with proper preoperative counseling and instructions. The costs of late cancellations to the particular institution are estimated to be at least $100 000 per year, or nearly 1 month of scheduled surgeries in a 2-year period.

Global Rating Assessment of Skills in Intraocular Surgery (GRASIS).

OBJECTIVE: The American Board of Ophthalmology in conjunction with the Accreditation Council for Graduate Medical Education has mandated the systematic assessment of surgical competence of ophthalmology residents at all residency programs. We present a tool complementary to the Objective Assessment of Skills in Intraocular Surgery (OASIS) to assess residents' surgical competence. PARTICIPANTS: Twenty experts in resident education, including the chiefs of all ophthalmology services and the chief resident at the Harvard Medical School Department of Ophthalmology. METHODS: A 1-page subjective evaluation form was developed in conjunction with the Objective Assessment of Skills in Intraocular Surgery evaluation form to assess the surgical skills of residents. A panel of surgeons at the Harvard Medical School Department of Ophthalmology at the Massachusetts Eye and Ear Infirmary reviewed the form and provided constructive feedback. RESULTS: Experts' comments were incorporated, establishing face and content validity. CONCLUSIONS: The Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) has face and content validity. It can be used to assess a resident's surgical care of patients as well as a resident's surgical knowledge, preparedness, and interpersonal skills. Reliability and predictive validity will be determined at our institution. We believe the GRASIS evaluation form will be a valuable tool in conjunction with the OASIS evaluation form for assessing ophthalmology residents' surgical skills at other residency programs as well.

Objective Assessment of Skills in Intraocular Surgery (OASIS).

OBJECTIVE: To establish an objective ophthalmic surgical evaluation protocol to assess residents' surgical competency and improve residents' surgical outcomes. PARTICIPANTS: Eight experts in resident education from comprehensive ophthalmology, cornea, glaucoma, and retina services; 2 chief residents (postgraduate year 5 [PGY5]); and resident representatives from PGYs 2, 3, and 4 participated in the development of an objective assessment tool of skills in resident cataract surgery. METHODS: Analysis of all resident cataract surgeries performed at our service from July 2001 to July 2003 led to the development of a 1-page objective evaluation form to assess residents' skills in cataract surgery. A panel of surgeons at the Massachusetts Eye and Ear Infirmary reviewed the database and the evaluation form and provided constructive feedback. RESULTS: Development of a unique database of all resident cataract cases and constructive feedback by experts in resident teaching assisted in creating a 1-page evaluation form entitled Objective Assessment of Skills in Intraocular Surgery (OASIS). CONCLUSIONS: OASIS has face and content validity and can be used to assess, objectively, surgical events and surgical skill. We believe the OASIS evaluation form and database will be a valuable tool for assessing ophthalmology residents' surgical skills at other residency programs as well.