An insight into the altered ophthalmic dynamics during the COVID-19 pandemic.

Purpose: The objective of this survey-based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods: The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results: A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic-appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion: The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department-based and surgical procedures in ophthalmology.

Evaluation of primary Ahmed Glaucoma valve implantation in post-traumatic angle recession glaucoma in Indian eyes.

PURPOSE: To highlight the efficacy of primary Ahmed glaucoma valve implantation in angle recession glaucoma following blunt ocular trauma in Indian eyes. DESIGN: A retrospective analytical study. MATERIALS AND METHODS: This study included 52 patients of angle recession glaucoma, who presented between Mar 2006 to Feb 2016, out of which 38 patients had undergone primary AGV implantation, while the rest were managed with topical anti-glaucoma medications. Preoperative data included age, sex, type and mode of injury, duration of injury, assessment of best-corrected visual acuity (BCVA) and intraocular pressure (IOP). The extent of angle recession was observed by gonioscopy. The intraocular pressure, visual acuity, and the number of anti-glaucoma medications were measured postoperatively. The success of this technique was analyzed by using a Kaplan-Meier cumulative survival curve. RESULTS: Following AGV implantation, the mean IOP was significantly reduced to 8.7 ± 2.2 at 1st day, 10.1 ± 2.2 at 7th day, 14.2 ± 3.4 at 3rd month, 15.6 ± 3.7 at 1 year, and 15.6 ± 3.6 at 3rd-year follow-up showing statistically significant values (p < 0.001) at each visit. The IOP was successfully controlled at the last follow-up without topical treatment. Mean BCVA at 3 years -post-AGV was 0.144 (0.151) (LogMAR) which was statistically significant (p < 0.001) as compared to the mean BCVA of 0.898 (± 0.205) LogMAR units at presentation. The success rate by Kaplan-Meier survival curve analysis was 90% at the mean follow-up duration of 29.47 ± 3.39 months. Overall surgical complications were noted in the form of prolonged hypotony, hyphema in 7 patients (13.5%). CONCLUSIONS: In medically uncontrolled post-traumatic angle recession glaucoma, primary AGV Implantation is a safe and effective surgical procedure with lesser complication rates providing long-term IOP control in a younger population.

Prevalence and effectiveness of innovative techniques in ophthalmic surgical training during COVID-19 pandemic in India.

PURPOSE: This study aimed to determine the various innovative surgical training techniques prevalent among ophthalmology residents in India during the COVID-19 pandemic. METHODS: This was a prospective cross-sectional study. An online survey questionnaire was completed by ophthalmology residents from different parts of the country. The survey consisted of questions related to the impact of the pandemic on training, innovative training techniques adapted during the pandemic and their effectiveness, and COVID-19 duty-related information. RESULTS: A total of 147 responses were obtained. The mean age was 29.3 years (range: 24-40 years, SD: ±3.82). Of which, 87 (59.2%) respondents were females. A total of 61 (41.5%) respondents reported practicing steps of ocular surgeries on goat eye, 69 (46.9%) on model eye/vegetables/fruits, 30 (20.4%) on surgical simulators, and 26 (17.7%) utilized 3-D virtual images and videos. In addition, 22 (15%) respondents reported never using any such techniques. Furthermore, 130 (88.4%) respondents reported practicing steps of cataract surgery, 52 (35.4%) practiced steps of open globe repair, and steps of trabeculectomy were reported by 24 (16.3%). The steps that were reported to be practiced most are incision or tunnel construction by 108 (73.5%), suturing by 92 (62.6%), capsulorrhexis by 91 (61.9%), primary wound repair by 82 (55.8%), and conjunctival peritomy by 75 (51%). CONCLUSION: The present study demonstrates that residents across the country are adapting to the present scenario by utilizing several innovative methods to sharpen their surgical acumen. The current pandemic situation can serve as an impetus to emphasize upon the institutes and medical regulatory bodies to appropriately remodel the residency curriculum.

Effect of complicated ocular surgery in stress-related parameters: A novel outlook into surgeon's health.

PURPOSE: To assess the stress-related physiological parameters of ophthalmic surgeons during complicated cataract surgery and compare them with uncomplicated routine cataract surgery. METHODS: In this cross-sectional observational study, 110 patients of various types of cataract were divided into two groups: Group 1 included 55 patients with simple cataract (Grade ≤3) with no ocular or systemic comorbidities, whereas Group 2 included 55 patients with complicated cataracts (Grade >3) and ocular/systemic comorbidities. All patients underwent phacoemulsification with intraocular lens implantation in the right eye only. The outcome measures were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2). RESULTS: The average SBP, DBP, MAP, and HR were significantly higher in the surgeon operating Group 2 (complicated cataract) compared with Group 1 (uncomplicated cataract; P < 0.05). The average SBP of the surgeon while operating Group 1 patients preoperatively and postoperatively was 125.42 ± 2.49 mmHg and 122.45 ± 2.10 mmHg, respectively, whereas in Group 2, the average SBP of the surgeon taken preoperatively and postoperatively was 145.98 ± 3.80 mmHg and 137.44 ± 3.45 mmHg, respectively (P < 0.05). The surgeon's SpO2 showed no significant difference between the two groups. CONCLUSION: There is a significant level of increase in stress-related parameters of operating surgeons while doing complicated cataract surgery.