ABSTRACT
Objetivo: Describir la evolución de las complicaciones intraoperatorias y postoperatorias, así como la evolución en la técnica quirúrgica, en los 4 primeros años de un cirujano de retina y poder evaluar el tiempo de aprendizaje necesario para reducir el número de complicaciones, objetivando aquellas patologías que debieran seguir derivándose a otros centros hasta conseguir una mayor experiencia quirúrgica. Métodos: Se revisaron los pacientes intervenidos de cirugía retiniana por un cirujano novel en Tarragona, entre el 23 de octubre de 2007 y el 31 de diciembre de 2011. Se evaluaron el diagnóstico principal, el tiempo de aprendizaje del cirujano, la técnica quirúrgica, las complicaciones intraoperatorias y las postoperatorias. Resultados: Se revisaron 247 cirugías. El porcentaje de uso de los calibres 20G y 23G durante el tiempo denota un cambio hacia la cirugía transconjuntival a partir del noveno trimestre (98 cirugías realizadas). Las complicaciones descienden a partir del trimestre 12 (130 cirugías), con un incremento en los meses anteriores. Conclusiones: El cambio de tendencia hacia la técnica 23G alrededor de las 100 cirugías se interpreta como una mayor comodidad y seguridad en la cirugía. El aumento de complicaciones quirúrgicas durante los meses siguientes hasta el descenso a partir de las 130 cirugías se puede interpretar como un «exceso de confianza». Puede afirmarse que la curva de aprendizaje es más lenta de lo que el cirujano cree, siendo recomendable el análisis individual de las propias complicaciones y de la evolución quirúrgica para poder determinar en qué situación de la curva de aprendizaje se encuentra (AU)
Objective: To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. Methods: A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. Results: A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. Conclusions: The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an overconfidence. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve (AU)
Subject(s)
Humans , Vitreoretinal Surgery/education , Vitrectomy/methods , Retinal Detachment/surgery , Vitreous Hemorrhage/surgery , Vitreoretinal Surgery/methods , Postoperative Complications/epidemiology , Intraoperative Complications/epidemiology , Learning Curve , Professional Competence/statistics & numerical dataABSTRACT
OBJECTIVE: To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. METHODS: A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. RESULTS: A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. CONCLUSIONS: The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve.
Subject(s)
Learning Curve , Vitreoretinal Surgery , Attitude of Health Personnel , Fellowships and Scholarships , Humans , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retinal Detachment/surgery , Retrospective Studies , Spain , Surgeons/psychology , Sutures , Vitrectomy/methods , Vitrectomy/statistics & numerical data , Vitreoretinal Surgery/methods , Vitreoretinal Surgery/statistics & numerical data , Vitreous Hemorrhage/surgeryABSTRACT
CASE REPORT: We present two case reports of patients suffering from severe corneal damage resulting in pain and visual impairment, after undergoing Scopinaro's operation. Both patients improved after treatment with topical autologous serum although their nutritional state became worse. DISCUSSION: Topical autologous serum provides growth factors and nutrients needed for corneal cell repair, and is appropriate treatment for carential ocular pathology which may accompany malnutrition.
Subject(s)
Corneal Diseases/etiology , Corneal Diseases/therapy , Serum , Vitamin A Deficiency/complications , Administration, Topical , Adult , Female , Humans , MaleABSTRACT
Caso clínico: Se presentan dos casos de pacientes con el antecedente de haber sido sometidos a la intervención de Scopinaro, que presentan afectación corneal severa con dolor y deterioro de la agudeza visual en grado variable. Ambos se beneficiaron de un tratamiento a base de suero autólogo tópico con una mejoría que contrastaba con el deterioro de su estado nutricional. Discusión: El suero autólogo tópico aporta a la superficie ocular factores de crecimiento y nutrientes necesarios para el trofismo celular de la cornea, siendo un tratamiento apropiado para la patología ocular carencial que puede ocurrir en pacientes desnutridos
Case report: We present two case reports of patients suffering from severe corneal damage resulting in pain and visual impairment, after undergoing Scopinaros operation. Both patients improved after treatment with topical autologous serum although their nutritional state became worse. Discussion: Topical autologous serum provides growth factors and nutrients needed for corneal cell repair, and is appropriate treatment for carential ocular pathology which may accompany malnutrition
Subject(s)
Male , Female , Adult , Humans , Avitaminosis/complications , Ophthalmic Solutions/administration & dosage , Dry Eye Syndromes/therapy , Gastric Bypass/adverse effects , Avitaminosis/therapy , Malnutrition/complicationsABSTRACT
CASE REPORT: We present a report of a patient suffering from serpiginous choroiditis complicated by choroidal neovascularization (CNV). Sub-tenon steroid treatment, added to the usual immunosuppressive therapy, resolved the CNV, improving visual acuity in one eye. DISCUSSION: Choroidal neovascularization is a sight-threatening complication of posterior uveitis. Our case suggests that sub-tenon steroid treatment, added to systemic immunosuppressive therapy, may accelerate the CNV resolution in posterior uveitis.
Subject(s)
Azathioprine/therapeutic use , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Choroiditis/complications , Glucocorticoids/administration & dosage , Immunosuppressive Agents/therapeutic use , Prednisone/administration & dosage , Drug Therapy, Combination , Female , Humans , Injections , Middle AgedABSTRACT
Caso clínico: Se presenta el caso clínico de una paciente con coroiditis serpiginosa y neovascularización coroidea (NVC) activa en ambos ojos. Tras tratamiento con terapia inmunosupresiva sistémica junto con inyección sub-Tenon posterior de esteroides, conseguimos la resolución de la NVC en ambos ojos, mejorando la capacidad visual en uno de los ojos. Discusión: La NVC es una complicación de las uveítis posteriores, cuya presencia amenaza de forma importante la visión. El presente caso sugiere que los esteroides subtenonianos añadidos a terapia inmunosupresiva sistémica, pueden acelerar la resolución de NVC tras uveítis posteriore (AU)
Case report: We present a report of a patient suffering from serpiginous choroiditis complicated by choroidal neovascularization (CNV). Sub-tenon steroid treatment, added to the usual immunosuppressive therapy, resolved the CNV, improving visual acuity in one eye. Discussion: Choroidal neovascularization is a sight-threatening complication of posterior uveitis. Our case suggests that sub-tenon steroid treatment, added to systemic immunosuppressive therapy, may accelerate the CNV resolution in posterior uveitis (AU)
