Severe Corneal Damage After Minor Eyelid Surgery: A Case Series.

OBJECTIVES: To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery. METHODS: These cases emphasize the real-world risk of corneal damage after oculoplastic surgery. RESULTS: The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty of both upper and lower eyelids. The second case concerns a 51-year-old woman who suffered an accidental coagulation of the cornea during the removal of upper eyelid papillomas, and the third case is a 55-year-old woman who had severe corneal thinning accompanied by visual loss after an upper lid blepharoplasty. All patients were stabilized without the need for corneal transplantation, although there were significant corneal scars and sequelae. CONCLUSIONS: Although complications after esthetic oculoplastic surgery are rare, the reported cases show that corneal damage can have a major impact on the patient's vision and quality of life. Strategies such as the use of a corneal shield can be used to mitigate these risks, but their use is debated. Nevertheless, diligent postoperative care is paramount. At the first postoperative visit, a basic visual acuity measurement should be performed. In cases where reduced vision is reported, particularly when accompanied by pain, patients should be urgently referred for specialized eye care.

Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey.

BACKGROUND: Measuring quality indicators (QI's) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI's, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed. METHODS: To quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice. RESULTS: The survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI's (13,9%) did not reach the cut-off of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI's that were not considered as relevant by the specialists and 3 additional 3 QI's that we were considered to be superfluous, we obtained an optimized QI list. CONCLUSION: As QI's gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI's for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI's that can be used in future studies, audits and benchmarking.

Quality indicators for the management of endometrial, cervical and ovarian cancer.

OBJECTIVE: Measuring quality indicators improves the quality of care. The aim of this review is to identify a set of quality indicators (QIs) that can be used to measure the standard of treatment for patients with endometrial, cervical and ovarian cancer. METHODS: A systematic literature search was performed in the Pubmed and Google Scholar database. Articles related to the field of interest, which covered QIs for the management of endometrial, cervical and ovarian cancer, were included if they were written in English and available in full text. Articles related to prevention, screening, diagnosis, quality of life and patient satisfaction were excluded. RESULTS: A total of 57 suitable articles was found: 13 for endometrial cancer, 17 for cervical cancer and 27 for ovarian cancer. An overview of the selected QIs was made and classified by type of indicator. Relevant QIs related to the structural organisation of health care are: referral to high volume specialists in high volume hospitals, treatment by specialized gynecological oncologists and discussion of treatment plan by a multidisciplinary team according to current guidelines. Important process measures are: a patient report of high quality, an adequate pretreatment staging and an adherence to treatment guidelines. The ultimate goal is to reduce treatment related morbidity and increase the survival rate, which can be measured as outcome indicators. CONCLUSION: The proposed set of QIs should be validated and can be implemented into quality assurance programmes to improve the quality of care and the outcome of patients with a gynecological cancer.