Cataract surgical training in Europe: European Board of Ophthalmology survey.

PURPOSE: To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING: Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN: Cross-sectional study of anonymous survey results. METHODS: A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS: 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS: CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

Ciliary body medulloepithelioma treated with intra-operative brachytherapy after fine needle aspiration biopsy.

Medulloepithelioma is the second most common type of pediatric intra-ocular tumors. It commonly arises from ciliary body, and it is generally diagnosed in the first decade of life. Management options for medulloepithelioma include enucleation, resection, or radiotherapy, but further investigation is still needed. Herein, we report a case of a 1-year-old girl with a ciliary body mass highly suggestive of medulloepithelioma, which caused recurrent acute episodes of intense pain. Fine needle aspiration biopsy (FNAB) of ciliary body mass was performed with trans-scleral approach, and treatment with a iodine-125 brachytherapy COMS10 plaque was undertaken during the same interventional procedure. Lesion was treated using a plaque brachytherapy, with total radioactivity of 13.5 mCi distributed in 5 seeds with immediate disappearance of pain episodes and decrease of tumor size. This is the first case of medulloepithelioma treated with brachytherapy plaque after an extemporaneous anatomo-pathological examination in children with favorable response. We consider that intra-operative brachytherapy therapy after FNAB in selected ocular tumors may be safe and effective therapeutic option, but longer follow-up is needed to confirm safety and applicability of this approach in a larger group of patients.

Fundus changes after cardiac surgery.

A Caucasian male with known severe aortic stenosis was referred to our Ophthalmology Department after undergoing cardiac surgery using extracorporeal circulation. Signs of retinal ischaemia were found during fundus examination and neuroimaging showed posterior cerebral artery occlusion.

Procedural aspects of the organization of the comprehensive European Board of Ophthalmology Diploma examination.

The comprehensive European Board of Ophthalmology Diploma (EBOD) examination is one of 38 European medical specialty examinations. This review aims at disclosing the specific procedures and content of the EBOD examination. It is a descriptive study summarizing the present organization of the EBOD examination. It is the 3rd largest European postgraduate medical assessment after anaesthesiology and cardiology. The master language is English for the Part 1 written test (knowledge test with 52 modified type X multiple-choice questions) (in the past the written test was also available in French and German). Ophthalmology training of minimum 4 years in a full or associated European Union of Medical Specialists (UEMS) member state is a prerequisite. Problem-solving skills are tested in the Part 2 oral assessment, which is a viva of 4 subjects conducted in English with support for native language whenever feasible. The comprehensive EBOD examination is one of the leading examinations organized by UEMS European Boards or Specialist Sections from the point of number of examinees, item banking, and item contents.

Rate of cataract formation in 343 highly myopic eyes after implantation of three types of phakic intraocular lenses.

PURPOSE: To assess the feasibility of using phakic intraocular lenses (PIOL) to treat high myopia, and evaluate the incidence of cataract, comparing three different lens types. METHODS: From 1989 to 2002, we implanted three different phakic intraocular lenses (PIOL) in 343 eyes of 232 patients; 231 eyes recieved an Ophtec (Worst-Fechner model, iris-claw), 89 an Adatomed (silicone posterior chamber), and 23 a Staar (posterior chamber, models V2, V3, V4). Average follow-up was 96.2 months for the Ophtec group, 31.5 months for the Adatomed group, and 19.3 months for Staar group. Eyes that subsequently developed cataract were studied for clinical evolution and had PIOL explantation and cataract extraction. RESULTS: Nuclear cataract developed in 7 of 231 eyes (3.04 %) with an Ophtec lens. Anterior subcapsular cataract developed with the two types of posterior PIOLs (Adatomed group: 38/89 eyes, 42.69%; Staar group: 3/23 eyes, 13.04%). Anterior subcapsular cataract in the Adatomed group developed more rapidly compared to the Staar group. We explanted 7 lenses in the Ophtec group, 16 lenses in the Adatomed group, and 2 lenses in the Staar group (models V2 and V3 only). Patient age older than 40 years at implantation of PIOLs and axial length greater than 30 mm were factors significantly related to nuclear cataract formation and the Ophtec lens. However, these two factors had a weaker correlation with the posterior phakic lenses (Adatomed, Staar) for high myopia than with the Ophtec lens. Postoperative best spectacle-corrected visual acuity remained stable after explantation, phacoemulsification, and posterior chamber lens implantation. CONCLUSIONS: Delayed cataract development and cataract type (nuclear) in patients with an Ophtec lens and the variables of patient age (>40 yr) and axial length (>30 mm) may considered prognostic factors. Other factors such as lens design, material, and placement probably influenced cataract formation in patients with the Adatomed and Staar PIOLs. The lens styles used in this study are no longer manufactured.

Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan.

PURPOSE: To evaluate the feasibility and safety of using phakic intraocular lenses (IOLs) to correct high myopia by comparing 3 IOL models: Adatomed, Staar, and Artisan. SETTING: La Fe University Hospital, Department of Ophthalmology, and the Fundación Oftalmológica del Mediterráneo, Valencia, Spain. METHODS: In this prospective comparative study, a phakic IOL was implanted in 217 highly myopic eyes (118 patients). Fifty-nine eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. The mean preoperative spherical equivalent was -15.39 diopters (D) +/- 2.83 (SD), -16.00 +/- 5.05 D, and -16.17 +/- 2.75 D in the Adatomed, Staar, and Artisan groups, respectively. The mean follow-up was 32.4 months (range 19 to 46 months) in the Adatomed group, 18.3 months (range 11 to 21 months) in the Staar group, and 121.4 months (range 38.4 to 154.3 months) in the Artisan group. At the follow-up examinations, intraocular pressure (IOP), IOL pigment deposits, cataract formation, and visual acuity were evaluated. RESULTS: The best corrected and uncorrected visual acuities improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. The difference in mean IOP between preoperatively and the last follow-up examination was 1.5 mm Hg in the Staar group, 1.3 mm Hg in the Adatomed group, and 1.7 mm Hg in the Artisan group (P =.36, P =.26, and P =.32, respectively). The incidence of pigment deposits was similar in the Adatomed and Staar groups, with deposits in 32 eyes (54.23%) and 8 eyes (38.1%), respectively. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. CONCLUSIONS: There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.