ABSTRACT
PURPOSE: To assess the microarchitectural changes occurring during surgery for vitreomacular traction using intraoperative optical coherence tomography (iOCT). METHODS: A retrospective, consecutive case series of eyes undergoing pars plana vitrectomy for vitreomacular traction with performance of concurrent iOCT. A custom, microscope-mounted portable spectral domain optical coherence tomography system was used. Clinical characteristics and iOCT images were analyzed. RESULTS: Twelve eyes of 12 patients were included with a mean preoperative visual acuity of 20/78 improving to 20/51 (P = 0.02), postoperatively. Intraoperative optical coherence tomography was successfully performed in 100% of cases. Microarchitectural changes were noted on iOCT after surgical release of the vitreomacular traction particularly in the outer retina with increased subretinal hyporeflectivity (e.g., expansion of the distance between the retinal pigment epithelium and photoreceptor layers). In 5 of 12 eyes (42%), iOCT findings altered the surgical procedure (e.g., internal limiting membrane peeling, gas tamponade) to address the subclinical findings (e.g., full-thickness macular hole formation, residual membrane). CONCLUSION: Intrasurgical imaging using iOCT during vitreomacular traction surgery may identify subclinical changes (e.g., occult full-thickness macular hole formation) that may impact surgical decision making. Architectural changes may occur after surgical maneuvers that are particularly noted in the outer retina. The functional significance of these changes requires further investigation.
Subject(s)
Retinal Diseases/diagnosis , Tissue Adhesions/diagnosis , Tomography, Optical Coherence/methods , Vitrectomy , Vitreous Body/pathology , Aged , Aged, 80 and over , Female , Humans , Intraoperative Period , Male , Middle Aged , Retinal Diseases/surgery , Retrospective Studies , Tissue Adhesions/surgery , Visual Acuity/physiologyABSTRACT
An interdisciplinary, proactive perspective allows providers to engage in productive, long-term collaborative relationships with corporations, while 1) maintaining patient care improvements; 2) maintaining legality; 3) enhancing technical and clinical innovation; and 4) providing fair compensation for work done. The case study approach is used to demonstrate an effective approach to compliant behavior.
Subject(s)
Cooperative Behavior , Delivery of Health Care/organization & administration , Organizational Case Studies/methods , Professional Corporations/standards , Continuity of Patient Care/standards , Delivery of Health Care/legislation & jurisprudence , Fraud/legislation & jurisprudence , Humans , Interdisciplinary Communication , Liability, Legal , Organizational Innovation , Patient Care/standards , Practice Guidelines as Topic , Quality Assurance, Health Care/organization & administrationABSTRACT
Knowledge is lacking among Otolaryngologist-Head and Neck Surgeons (ORL-HNS) regarding basic ethical situations in corporate-provider relationships. A pilot educational program demonstrates the need and potential for improvement by structured intervention. "At risk" areas specifically identified regard acceptable gifts, and payments for meetings and travel. Recommendations are made to educate otolaryngologists in standards for compliant behavior in corporate-physician relationships. Further work to formalize and tailor education to the needs of ORL-HNS is warranted, including continued education through the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). A checklist is provided here as a first step in enabling more compliant behavior as surgeons engage in corporate relationships.
Subject(s)
Ethics, Business , Ethics, Medical , Interprofessional Relations , Otolaryngology/ethics , Humans , Interprofessional Relations/ethics , Organizational CultureABSTRACT
I am writing on behalf of the [illegible word] Area Group of Practice [illegible word] in reply to the article by Karen Moss, Chairman of the RCN District Nurses Forum, called 'White Paper a threat to district nurses' (Primary Health CareMay 1988).
