RESUMO
Evaluar los factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno (DRR) en pacientes del Instituto Regional de Oftalmología "Javier Servat Univazo". Estudio observacional en una cohorte retrospectiva de 204 pacientes con DRR sometidos a diferentes técnicas quirúrgicas entre enero 2010-diciembre 2019, con al menos 6 meses de seguimiento. Éxito anatómico (re-aplicación primaria de retina) y éxito funcional (mejoría de agudeza visual (AV)); buscándose asociación entre estas variables y las demográficas, clínicas y tiempos de espera. Resultados: La edad promedio fue 50 + 16,5 (9-85) años. Éxito anatómico se alcanzó en 165 (80,9 %) pacientes y funcional en 110 (52,9 %). Hubo menor tiempo de espera quirúrgico en pacientes que lograron éxito anatómico (20,0 +/- 22,6 días (1-120)) vs. (29,8 +/- 40,1 días (1-210)) (p=0,04) y en los que tuvieron éxito funcional ( 13,3+/- 15,1 (1-100)) vs. (31,9 +/- 33,7 (1-210)) (p <0,001); y menor tiempo de enfermedad y menor tiempo total en los que tuvieron éxito funcional (29,7 +/-56,5 días (1-365) vs. (61,9 +/- 110,6 días (1-730)) (p=0,008) y (43,1 +/- 68,1 (5-465)) vs. 93,8 +/- 118,3 (3-766)) respectivamente (p<0,001). El menor tiempo de espera quirúrgico mostró asociación con el éxito anatómico y funcional de la cirugía por DRR. El menor tiempo de enfermedad y el menor tiempo total también mostraron asociación con el éxito funcional. Recomendamos implementar medidas para abreviar tiempos de espera e instaurar una terapia quirúrgica precoz y oportuna en estos pacientes.
To evaluate factors related to the anatomical and functional success of surgery for rhegmatogenous retinal detachment (RRA) in patients of the Regional Institute of Ophthalmology "Javier Servat Univazo". retrospective cohort study of 204 patients with RRD submitted to different surgical techniques between January 2010-December 2019, with at least 6 months of follow-up anatomical success (primary retinal reapplication) and functional success (improvement in visual acuity (VA)); looking for an association between these variables and demographics, clinics and waiting times. Results: The mean age was 50 + 16.5 (9-85) years. Anatomical success was achieved in 165 (80.9%) patients and functional in 110 (52.9%). There was a shorter surgical waiting time in patients who achieved anatomical success (20.0 +/- 22.6 days (1-120)) vs (29.8 +/- 40.1 days (1-210)) (p=0.04) and in those who had functional success (13.3+/- 15.1 (1- 100)) vs (31.9 +/- 33.7 (1-210)) (p <0.001); and shorter sick time and shorter total time in those who had functional success (29.7 +/-56.5 days (1-365) vs (61.9 +/- 110.6 days (1-730)) (p=0.008) and (43.1 +/-68.1 (5-465)) vs 93.8 +/- 118.3 (3-766)) respectively (p<0.001). The shorter surgical waiting time was associated with RRD surgery's anatomical and functional success. The shortest time of illness and the shortest total time were associated with functional success. We recommend implementing measures to shorten waiting times and establish early and timely surgical therapy in these patients.
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To determine efficacy of mydriatic-digital images (MDI) when screening retinal complications in people living with HIV, in this study, a consecutive series of 79 people living with HIV (PLHIV) were evaluated. Two series of MDI were taken: - macula and optic nerve - nine gaze fields, which findings were compared with those obtained by a retina specialist. Both examiners were unaware of each other's results. Average age was 32.2 years old, predominantly male (75.9%). Most frequent complications were HIV retina microangiopathies (6.3%) and toxoplasmosis (5.1%), followed by Cytomegalovirus and neuro-retinitis, optic neuritis and vitreitis, each one with 1.3%. Sensitivity with two MDI was 92.8% (CI 95% 66.0-100.0) and with nine 100% (CI 95% 77.0-100.0) and specificity of 95.4% (CI 95% 87.0-99.0) for both series. The positive predictive value was 81.3 and 82.4%, and negative predictive value was 98.4 and 100% respectively. The strength of agreement was substantial for the two series with the retina specialist examination (Kappa index of 0.836 and 0.888 respectively). Mydriatic-digital-images appear to be an effective method to screen for HIV-related retinal-complications in a regional hospital in Perú.
Assuntos
Infecções por HIV , Midriáticos , Adulto , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Fotografação/métodos , Retina/diagnóstico por imagem , Sensibilidade e EspecificidadeRESUMO
Background: Pterygium surgery is a procedure commonly performed by ophthalmologists. Valid, objective methods are needed to assess competence in this procedure. Methods: A panel of 5 specialists consisting of members from different regions of the world including Pakistan, United States, Iran, Mongolia and Peru was formed to create a rubric for assessment of pterygium surgery by residents. The assessment rubric was developed using the standard template of Ophthalmology Surgical Competency Assessment Rubrics (OSCARs) previously published. The rubric was designed using a modified Dreyfus model of skill acquisition on a four-point behavioral scale. Results: The rubric consisted of 14 essential steps in pterygium surgery and 5 global indices. The content and face validity of the rubric was refined by repeatedly reviewing the rubric on Googledocs and considering critiques by a panel of 10 cornea specialists from around the world. Each step was divided into four levels, from novice to competent. The skill required for each level was described specifically to help decrease rater subjectivity. Conclusions: The OSCAR for pterygium surgery has face-validity and can be used effectively for both teaching and assessing ophthalmology residents in training programs across the world.
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BACKGROUND: This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS: Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS: In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS: Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
Assuntos
Extração de Catarata/educação , Competência Clínica , Internato e Residência , Oftalmologia , Educação de Pós-Graduação em Medicina , Humanos , Laboratórios , Oftalmologia/educação , PeruRESUMO
Objetivo: Describir las características epidemiológicas de los traumatismos oculares atendidos en el Instituto Regional de Oftalmología (IRO). Materiales y métodos: Estudio descriptivo y prospectivo, en el cual se aplicó un protocolo estandarizado de registro de datos demográficos y clínicos de pacientes con traumatismos oculares que acudieron al servicio de emergencia del IRO, entre enero 2016 y abril 2017. Resultados: Un total de 1 288 pacientes cumplieron los criterios de selección, la edad promedio fue de 37 años, en su mayoría los afectados fueron varones (84,7 %) y el grupo etario más afectado fue el de 21 a 40 años (46,7 %). Los accidentes laborales fueron la causa más frecuente (63,7 %), ocurriendo principalmente en trabajadores de metalmecánica, construcción y albañilería; seguido de los accidentes domésticos (19,2 %). El 95,4 % fueron traumatismos cerrados, predominantemente con compromiso unilateral, ocupando el primer lugar los cuerpos extraños corneales (73,4 %), seguido de las contusiones (16,2 %). El 56,2 % de traumatismos abiertos fueron penetrantes restringiéndose el daño principalmente a la córnea (64,9 %). El 52,6 % de pacientes con traumatismo abierto terminaron con agudeza visual entre 4/200 y no percepción de luz. Conclusiones: Los traumatismos oculares cerrados fueron los más frecuentes y afectaron a pacientes jóvenes, de sexo masculino que laboraban en industria metalmecánica y construcción; siendo los cuerpos extraños corneales metálicos el principal tipo. La mayoría de los traumatismos abiertos tuvieron un pobre pronóstico visual luego de su reparación quirúrgica.
Objective: To describe the epidemiological characteristics of eye injuries treated at Regional Ophthalmology Institute (IRO). Material and Methods: A descriptive and prospective study, in which a standardized protocol was developed to obtain and record demographic and clinical data of patients with ocular trauma who attended the emergency department of IRO between January 2016 and April 2017. Results: 1 307 patients with eye injuries were evaluated, 19 were excluded due to incomplete information, resulting in a sample of 1 288 patients, aged between 5 and 70 years, mostly of male gender (84.7 %), being more frequent patients from 21 to 40 years (46.7 %). Occupational accidents were the most frequent cause (63.7 %), occurring mainly in metal-mechanic workers, welders and workers, followed by domestic accidents (19.2 %). A total of 95.4 % were closed injuries, mostly unilateral. Corneal foreign bodies accounted of 73.4 % of cases, followed by contusions (16.2 %). 56.2 % of open-globe injuries were penetrating, restricting damage mainly to the cornea (64.9 %). 52.6 % of patients with open-globe injury ended up with visual acuity between 4/200 and no light perception). Conclusions: Closed eye injuries were the most prevalent, mainly affecting young, male patients who working in metal-mechanical and construction industry. Metallic corneal foreign bodies were the main type. The majority of open-globe trauma had a poor visual prognosis after surgical repair.
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In order to determine the frequency and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (MD), a cross-sectional descriptive study was conducted in 3,239 patients of the Regional Institute of Ophthalmology in the city of Trujillo, La Libertad region, Peru. After pupil dilation, trained personnel took two photographs of each eye, centered on macula and optic nerve. The frequency of DR was 25.9%, with a higher proportion in men with DR (28.2%) and in those with more than 10 years of MD disease (49.0%). Most patients had mild to moderate non-proliferative diabetic retinopathy (NPDR) (79.3%); 10.1% had severe NPDR, and 9.7% had proliferative DR. We conclude that DR occurs in one in four patients and about 20% in advanced degrees. There is a need to expand screening coverage from the time of diagnosis of DM and to implement preventive measures such as metabolic control and periodic ocular fundus exam.
Para determinar la frecuencia y el grado de severidad de retinopatía diabética (RD) en pacientes con diabetes mellitus (DM) tipo 2 se realizó un estudio descriptivo transversal en 3239 pacientes del Instituto Regional de Oftalmología de la ciudad de Trujillo, región La Libertad, Perú. Previa dilatación pupilar, personal entrenado tomó dos fotografías de cada ojo, centrado en mácula y nervio óptico. La frecuencia de RD fue de 25,9 % con mayor proporción en varones con RD (28,2%) y en aquellos con más de 10 años de enfermedad por DM (49,0%). La mayoría de pacientes tuvieron retinopatía diabética no proliferativa (RDNP) leve a moderada (79,3%), el 10,1% tuvo RDNP severa y el 10,6 % RD proliferativa. Concluimos que la RD se presenta en uno de cada cuatro pacientes y alrededor del 20% en grados avanzados. Es preciso ampliar la cobertura de tamizaje desde el momento del diagnóstico de DM e implementar medidas preventivas como el control metabólico y el examen periódico del fondo de ojo.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Peru/epidemiologia , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores de TempoRESUMO
RESUMEN Para determinar la frecuencia y el grado de severidad de retinopatía diabética (RD) en pacientes con diabetes mellitus (DM) tipo 2 se realizó un estudio descriptivo transversal en 3239 pacientes del Instituto Regional de Oftalmología de la ciudad de Trujillo, región La Libertad, Perú. Previa dilatación pupilar, personal entrenado tomó dos fotografías de cada ojo, centrado en mácula y nervio óptico. La frecuencia de RD fue de 25,9 % con mayor proporción en varones con RD (28,2%) y en aquellos con más de 10 años de enfermedad por DM (49,0%). La mayoría de pacientes tuvieron retinopatía diabética no proliferativa (RDNP) leve a moderada (79,3%), el 10,1% tuvo RDNP severa y el 10,6 % RD proliferativa. Concluimos que la RD se presenta en uno de cada cuatro pacientes y alrededor del 20% en grados avanzados. Es preciso ampliar la cobertura de tamizaje desde el momento del diagnóstico de DM e implementar medidas preventivas como el control metabólico y el examen periódico del fondo de ojo.
ABSTRACT In order to determine the frequency and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (MD), a cross-sectional descriptive study was conducted in 3,239 patients of the Regional Institute of Ophthalmology in the city of Trujillo, La Libertad region, Peru. After pupil dilation, trained personnel took two photographs of each eye, centered on macula and optic nerve. The frequency of DR was 25.9%, with a higher proportion in men with DR (28.2%) and in those with more than 10 years of MD disease (49.0%). Most patients had mild to moderate non-proliferative diabetic retinopathy (NPDR) (79.3%); 10.1% had severe NPDR, and 9.7% had proliferative DR. We conclude that DR occurs in one in four patients and about 20% in advanced degrees. There is a need to expand screening coverage from the time of diagnosis of DM and to implement preventive measures such as metabolic control and periodic ocular fundus exam.
