Cost-Effective Surgical Management of Pterygium: A Blood-Based Adhesion Technique Substituting Fibrin Glue.

Pterygium is a degenerative eye condition marked by the abnormal growth of conjunctival tissue over the cornea, primarily affecting individuals near the equator. When it reaches the cornea's center, patients may experience obstructed and blurry vision, necessitating pterygium surgery. The standard surgical approach involves excision with a blade, using a conjunctival autograft to address the defect, and securing it with fibrin glue. Recurrence rates exhibit variability, with approximately half occurring within the initial three months. In this case, we present a more cost-effective surgical approach, avoiding the use of a blade to minimize intraoperative complications. Additionally, autologous blood is employed instead of fibrin glue. We evaluate immediate and post-operative complications, as well as the incidence of recurrence rates at the three-month mark.

Preoperative Evaluation of Patients Undergoing Eye Surgery.

Ophthalmic surgery encompasses a wide range of procedures addressing various ocular conditions. Although generally considered low risk, a thorough preoperative evaluation is still crucial in optimizing patient outcomes and ensuring safe surgical interventions. This review provides a comprehensive overview of the preoperative assessment and management of patients presenting for ophthalmic surgery, specifically focusing on cataract surgery. We discuss the role of routine preoperative testing, the assessment of intraocular factors, and the evaluation of systemic comorbidities and medications. The review emphasizes the importance of individualized decision-making based on patient-specific factors and collaborative efforts between ophthalmologists and the health-care team.

[Economics of operating room use at a university eye hospital]. / Wirtschaftlichkeit der Operationssaalnutzung an einer Universitäts-Augenklinik.

BACKGROUND: In ophthalmologic surgery, there are usually short operation times and thus many changes between the individual operations, which are not subject to remuneration. As in maximum care hospitals consecutive different operations with different durations are often performed, emergency operations have to be inserted and further training of colleagues is practiced, it is particularly important to generate the shortest possible transfer times in order to have both sufficient operation time and to be able to treat as many cases as possible. The aim of this work is to evaluate the efficiency of the surgical performance of a university eye hospital. MATERIAL AND METHOD: The surgeries performed in 2021 at the MHH Eye Clinic were evaluated with respect to the spectrum, number, surgery duration, transfer times and process times. In terms of personnel, each operating room was staffed with one assistant anesthesiologist, one nurse anesthetist, two operating room nurses, one surgeon, and 20% senior anesthesiologist supervision. Based on a theoretical concept, which provides an increased staffing ratio while maintaining the same infrastructure, it was calculated how many more surgeries could be performed if the transfer time was halved and whether the additional financial expense could be compensated. RESULTS: With a total of n = 2712 surgeries performed during regular duty hours (244 working days) in 2 operating rooms (average daily n = 11.1; weekly n = 53.6 and monthly n = 237.1), the average surgery duration was 37 min and the transition time 43 min. This means that the operating rooms were used for surgery for 51% of the total operating time. Main procedures were vitrectomy with n = 1350 and cataract surgery with n = 1308. The new personnel concept provided one additional operating room nurse per operating room and one additional anesthesiologist for both operating rooms. The additional costs for this personnel expenditure were calculated at approx. 300,000 € per year. The halving of the transfer time from 43 min to about 21 min through possible overlapping induction and parallel work, which was not possible until now, results in an additional operation time of about 100 min per operating room, so that at least 4 additional operations can be planned and performed. In this way, with stringent implementation and the same spatial structures with stable fixed costs, n = 976 more operations could be performed, which, minus the personnel costs, the additional material costs for surgery and anesthesia of 557,042 € and the inpatient hotel costs of 600,663 €, with an average length of stay of 2.8 days, would result in an additional revenue of about 2.4 times the additional personnel costs at the current flat rate of 3739.40 € and an average case mix index of the MHH Eye Hospital of 0.649 (total revenue: 2,155,449 €; profit margin II: 701,389 €) for the considered surgical patient collective in 2021. CONCLUSION: An increase of the personnel expenditure in the operating room for surgical subjects such as ophthalmology with shorter interventions and many changes is economically worthwhile also for a large hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.

Safety and efficacy of XEN gel drainage tube implantation in the treatment of refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To preliminarily evaluate the efficacy and safety of XEN drainage tube implantation in the treatment of refractory glaucoma.METHODS: The clinical data of 10 patients(11 eyes)with refractory glaucoma who underwent XEN gel drainage tube implantation in Peking University Third Hospital from September 2021 to January 2022 were retrospectively analyzed. All patients were followed-up for 8-12mo after surgery, the intraocular pressure(IOP)and the use of IOP lowering medication were observed, and the effect of the surgery was evaluated.RESULTS: The highest IOP was 21-55(median 35)mmHg before surgery and 10-40(median 15)mmHg at the last follow-up. There were 2-4(median 4)kinds of IOP lowering drugs before operation and 0-4(median 0)kinds of IOP lowering drugs at the last follow-up. Up to the last follow-up, the surgery was successful in 8 eyes and unsuccessful in 3 eyes.CONCLUSION: Implantation of XEN gel drainage tube is a safe and effective method for the treatment of refractory glaucoma.

Effects of a chair for ophthalmic microsurgery on pressure distribution and pelvic tilt in surgeons.

BACKGROUND: Ophthalmic surgeons experience high levels of physical strain in the neck, lower back, and buttocks. While ergonomic interventions may help to solve these problems, only a few studies have reported chair designs for ophthalmic microsurgery. OBJECTIVE: To design a chair that reduces the physical strain on surgeons and examine its effectiveness in improving posture and reducing seat pressure. METHODS: A prototype chair with a three-dimensional seat surface and a sliding adjustment mechanism for the backrest was designed to fit the surgeon's body. A conventional chair (A) and the prototype chair (B) were compared during microsurgeries performed by five surgeons. Seat pressure was measured using a pressure-sensing device, and the pelvic tilt angle was measured using a gyroscope sensor. RESULTS: A paired t-test indicated significant differences between the chairs: average seat pressure was 70.4±12.7 mmHg for A and 40.5±3.8 mmHg for B (p = 0.008); the maximum seat pressure was 242.2±19.7 mmHg for A and 170.5±38.5 mmHg for B (p = 0.024); contact area was 906.1±114.5 cm2 for A and 1,255.9±60.1 cm2 for B (p < 0.001); and relative value of the pelvic tilt angle was -13.7°±3.7° for A and -7.1°±4.9° for B (p = 0.032). CONCLUSIONS: The prototype chair was associated with lower seat pressure and maintenance of a more neutral posture than the conventional chair, indicating that it may help to reduce physical strain in ophthalmic surgeons.

Impact of Preoperative Testing on Patients Undergoing Ophthalmologic Surgery: A Retrospective Cohort Study.

OBJECTIVE: Routine medical testing is not recommended before cataract surgery, but no consensus exists about preoperative testing before general ophthalmologic surgery. We aimed to assess the impact of preoperative testing on patients undergoing ophthalmologic surgery by analyzing their surgical outcomes and complications. METHODS: We retrospectively reviewed electronic health records of patients who had preoperative evaluations before cataract or noncataract ophthalmologic surgery at a tertiary care center from January 1, 2015, through December 31, 2019. RESULTS: The cohort consisted of 2268 patients (1270 [56.0%] women). The most frequent ophthalmologic procedure was cataract extraction (n = 1450 [63.9%]). Laboratory tests results were available for 489 patients (33.7%) in the cataract group; of these, 275 results (56.2%) had abnormal values, and 18 patients (6.5%) required preoperative interventions. Preoperative test results were available for 772 out of 818 patients (94.4%) having noncataract procedures. Of these, 384 results (49.7%) had abnormal values, and 10 patients (2.6%) required additional intervention. No significant differences were observed for the rate of surgery cancellations between the cataract and noncataract patient groups (0.6% vs 1.0%; P = .24). Of the 12 patients (0.5%) who had complications, all had undergone preoperative testing. CONCLUSIONS: No differences in outcomes and complications were observed among patients who underwent cataract or noncataract surgery. It is reasonable to consider avoiding preoperative testing in patients undergoing ophthalmologic surgery.

Paralisia do VI nervo (abducente) / VI nerve palsy (abducens palsy)

Neste trabalho foi realizada uma revisão da literatura com o objetivo de integrar e compilar artigos disponíveis sobre a paralisia do VI nervo (abducente) para rever suas características clínicas, etiologias possíveis e os procedimentos clínicos, farmacológicos e cirúrgicos para seu tratamento. Primeiramente, descreve-se sua ação, localização, trajeto e possíveis lesões, depois seus principais fatores etiológicos para em seguida abordar-se o diagnóstico e o tratamento. Proposta de transposição de Carlson-Jampolsky isolada no tratamento cirúrgico da paralisia do VI nervo é também apresentada.

The authors review the basic aspects, etiology, clinical signs, diagnosis and treatment of the VI nerve palsy. Review the possible causes of abducent paralysis and location of determinant lesions. The clinical signs and clinical follow up are also observed in order to guide the etiology and therapeutic. The authors describe the clinical, pharmacological and surgical treatment. The authors emphasizes their proposal of VI nerve palsy correction using the isolated Carlson-Jampolsky transposition.

Algunos aspectos básicos de la anestesia convencional en oftalmología / Some basic aspects of conventional anesthesia in ophthalmology

Se realizó una revisión bibliográfica con el objetivo de describir algunos aspectos básicos de los diferentes tipos de anestesia utilizadas en Oftalmología: anestesia general, regional y local, teniendo en cuenta sus indicaciones, objetivos a alcanzar, ventajas, desventajas y principales complicaciones. En general, todas las técnicas anestésicas son altamente efectivas, pero en la especialidad se prefiere, siempre que sea posible, la utilización de la local con la cooperación del paciente, en especial, en la cirugía de cataratas. El decidir qué tipo de anestesia se debe utilizar en cada caso no es algo predeterminado y rígido: es importante pensar en las motivaciones y estado del paciente, las características anatómicas del ojo y la órbita, la técnica quirúrgica, el "tiempo quirúrgico", y la habilidad del cirujano. Toda la información obtenida a través de la literatura disponible durante enero y febrero de 2010 fue representada en Microsoft Word.

A bibliography review was made to describe some basic aspects of the different kind of anesthesia used in ophthalmology: general, regional and local taking into consideration its indications, objectives, advantages, disadvantages and main complications. On the whole, all anaesthesic techniques are high effective, but in our specialty are preferred when possible, local anesthesia with patient cooperation especially in cataract surgery is. To decide what kind of anaesthesia is going to use in each case is not predetermined and rigid: is very important to think in patients' motivations and conditions, anatomical characteristics of eye and orbit, surgical technique, "surgical time" and surgeon skills. All obtained information found in bibliography during January and February 2010 was represented in Microsoft Word.