Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Chiasma syndrome in acromegalic patients--correlation of neuroradiologic and neuroophthalmologic findings.

The study evaluated neuroophthalmologic and computerized tomography (CT) findings in 100 patients with somatotrophic adenoma and clinical picture of acromegaly, who underwent transsphenoidal adenomectomy. Prior to the surgery, visual field was normal in 77 patients. The diameter of adenoma in these patients ranged from 8 to 30 mm on CT, and the average value was 13.5 mm. Various kinds of visual field disturbances were present in 23 patients. The diameter of their adenomas ranged between 18 to 35 mm, with the average of 24.7 mm. Compared to visual field defects, CT findings of suprasellar adenoma extension were better correlated with chiasma syndrome (p < 0.001). All patients with suprasellar mass greater than 10 mm had chiasma syndrome. Degenerative adenoma changes (hemorrhagic necrosis), which precipitate abrupt increase in size of the tumor, were more frequently seen in patients with chiasma syndrome. The incidence of chiasma syndrome directly correlates with the degree of suprasellar extension of the tumor.

Is lipoprotein(A) a risk factor for atherosclerosis of the retinal arteries?

Elevated plasma Lp(a) has been linked to development of coronary artery disease (CAD). There is no data about plasma Lp(a) and atherosclerosis of the retinal arteries. Therefore the purpose of this study was to assess the risk of retinal vessels atherosclerosis conferred by elevated plasma Lp(a) levels in 73 adult males. The results were compared with those in 45 matched apparently healthy males with no retinal vessel changes. The atherosclerotic changes of the retinal vessels were determined by direct ophthalmoscopy and graded (1-4) according to Scheie. Plasma levels of Lp(a) were measured by radial immunodiffusion. The results were compared using chi-square test. Although a very weak correlation between plasma Lp(a) levels and the incidence of retinal atherosclerosis was found, no significant association between the degree of atherosclerotic changes and plasma Lp(a) levels could be proven. Thus it could be concluded that plasma Lp(a) level is not a significant risk factor for atherosclerosis of the retinal arteries.

Plasma cortisol in men--relationship with atherosclerosis of retinal arteries.

The production of cortisol increases in acute stress but the effects of chronic stress on plasma cortisol are still controversial. Stress on the other hand plays a role in coronary artery disease (CAD) and carotid atherosclerosis. Since there is no data about plasma cortisol and atherosclerosis of the retinal arteries, the purpose of this study was to explore the relationship between plasma cortisol in 101 adult males with the degree of their retinal vessels atherosclerosis. The results were compared with those in 47 matched apparently healthy men with no retinal vessels changes. The atherosclerotic changes of retinal vessels were determined by direct ophthalmoscopy and graded (1-4) according to Scheie. Morning plasma cortisol levels were determined by radioimmunoassay using commercial kits. The results were compared by using chi-square test. No association between morning plasma cortisol concentrations and retinal vessels atherosclerosis could be found. The results of this study do not support a role for physiological levels of plasma cortisol in the development of atherosclerosis, at least of the retinal arteries, in men.

Amniotic membrane transplantation for ocular surface reconstruction.

The purpose of this study is to analyze the clinical experience and the effect of human amniotic membrane transplantation on pterygium excision and bullous keratopathy. From January 1999 to January 2001 at University Hospital "Sestre milosrdnice" amniotic membrane transplantation was performed consecutively in 21 eyes: 11 eyes with bullous keratopathy and 10 with recurrent pterygia. In the group with bullous keratopathy epithelization took place in 19.6 days in 72.7% and the reduction of pain was satisfactory. Recurrence rate in group with recurrent pterygia was 20%. Based on the presented results it could be concluded that amniotic membrane transplantation can be considered as an effective alternative for treating severe ocular surface diseases and as an alternative for penetrating keratoplasty if there is a lack of grafts.

Comparative study of pterygium surgery.

The aim of this study was the comparison of recurrence rates of pterygia following different surgical methods. Twenty-one patients were operated by the bare sclera technique, with the application of mitomycin C (0.25 mg/ml for 2 min). Twenty-seven patients were operated by limbal stem cell transplantation. The third group contained 13 patients who were operated by amniotic membrane transplantation. Five recurrences of pterygia were noted in the mitomycin C group and 2 each in the limbal stem cell transplantation group and the amniotic membrane group. The mean time to recurrence was 5.4 +/- 4.12 months in the mitomycin C group versus 10.5 +/- 3.5 months in the group of patients with limbal transplantation. In the third group, both recurrences were evident 4 months after the operation.

Value of color-Doppler imaging in diagnosis of intrabulbar and intraorbital tumors.

Patients with intrabulbar and intraorbital tumours have been investigated by colour Doppler imaging. In the first group there were 20 patients with malignant melanoma of the uvea and in the second group there were 19 patients with cavernous hemangioma. The third group was a control group represented by 20 healthy individuals. In the group of patients with uveal melanoma it has been established that every patient, except one, has a blood flow inside of tumour tissue. Internal blood flow of intraorbital hemangioma was slower than inside the melanoma and the resistance index was lower. Comparison of blood flow in all patients has shown that there is no statistically significant difference between ophthalmic artery, central retinal artery and posterior ciliary arteries except in maximal blood flow in central retinal artery and posterior ciliary arteries.

Color Doppler flow imaging of ocular tumors.

AIM: To analyze the usefulness of color Doppler flow imaging in the differentiation of benign and malign ocular tumors. METHODS: Blood flow in tumor and ocular blood vessels was assessed by color Doppler flow imaging in 20 patients with malignant melanoma of the uvea and 19 patients with cavernous hemangioma. Blood velocity measurements in orbital vessels in these patients were compared with the same measurements in 20 healthy individuals. RESULTS: Blood flow inside the tumor tissue was observed in all patients, except in a single case of uveal melanoma. Internal blood flow of intraorbital hemangiomas was slower and their resistance index lower than that of melanomas. Patients with a tumor did not differ from the controls in blood flow velocities in the ophthalmic artery, central retinal artery, and posterior ciliary arteries. Only the patients with uveal melanoma had higher maximal blood flow in central retinal artery and posterior ciliary arteries compared to other patients. CONCLUSION: Color Doppler flow imaging of blood flow can be a useful method to assess the vascularization of ophthalmological tumors, and to differentiate uveal melanoma from orbital hemangioma.

Glaucoma triple procedure: a one-site vs. a two-site approach.

The purpose of this study is to describe and evaluate the success rate of combined glaucoma and small cataract surgery by means of a one-site versus two-site approach. Fifty-eight eyes of fifty-five patients undergoing combined surgery were operated: thirty-one eyes underwent two-site approach and twenty-seven eyes underwent one-site approach. Short term and long term mean intraocular pressure (IOP) was similar in both groups. There was no significant difference in postoperative inflammation and complication rates between two groups. There is no significant difference in the postoperative results in those two different approaches to perform combined operations of cataract and glaucoma.

Laser photocoagulation of neovascular lesions in senile macular degeneration.

Eighty-four eyes with aging macular degeneration were included in this five-year retrospective study (1989-1994). Sixty-four eyes were treated with laser, whereas in 20 eyes photocoagulation was not performed because these patients refused laser treatment. The latter served as a control group. Out of 64 laser-treated eyes, 48 (75%) eyes had extramacular choroidal, and 15 (25%) juxtafoveal neovascular membrane. A comparable percentage and alterations were recorded in the control group of eyes. At the beginning of the study, the mean visual acuity distribution was 0.5 in both the treated and untreated group of eyes, which was not statistically significant (p > 0.16). Recurrent neovascularization developed in 33 (52%) out of 64 eyes at the end of the first and in the second year after photocoagulation, being the main cause of severe vision impairment. At the beginning of the second year, the risk of severe vision loss by six or more Snellen's lines was recorded in 14 (41%) out of 33 eyes with the vision of 0.15, and after five years in 22 (73%) out of 33 eyes with the vision of 0.08. A the end of the study, unchanged or slightly deteriorated visual acuity (0.5-0.4) was found in 27 (42.1%) out of 64 laser-treated eyes, and in only 2 (10%) out of 20 untreated eyes. At the end of the five-year study, total risk of severe vision loss by six or more Snellen's lines was present in 30 (52.8%) out of 64 laser-treated eyes, and in 15 (74%) out of 20 untreated eyes. Study results showed laser treatment of neovascular aging macular degeneration to be absolutely useful in decreasing visual acuity reduction as compared to the untreated control group.

[Postoperative astigmatism after extracapsular cataract extraction]. / Postoperativni astigmatizam nakon ekstrakapsularne ekstrakcije katarakte.

The authors analysed the occurrence and changes of postoperative astigmatism in three groups of patients after the performed extracapsular cataract extraction, regarding the type of the applied sutures: single, continuous double row and combined suture. One hundred and fifty-eight eyes were followed up over the period of 6 months. The quickest decreasing of astigmatism and its lowest values were recorded in the application of the combined suture. A statistically significant decrease of astigmatism values (p < 0.01) was already found after 1 month, and after 6 months 98.7% of the operated eyes had the postoperative astigmatism lower than 0.9 D.