The Only Eye Study (OnES): a qualitative study of surgeon experiences of only eye surgery and recommendations for patient safety

OBJECTIVE: Performing surgery on patients with only one seeing-eye, where complications may result in catastrophic vision loss, presents unique challenges for the ophthalmic care team. There is currently no evidence regarding how surgeons augment their care when treating only eye patients and no guidelines for how these patients should be managed in hospital eye services. This study aimed to explore ophthalmic surgeons' experiences of only eye surgery and perceptions of current practice. DESIGN AND PARTICIPANTS: Ten ophthalmic surgeons were asked to relate their experiences and views on performing only eye surgery in indepth, semistructured interviews. Interviews were audio-recorded and transcribed. Qualitative data were subjected to thematic analysis to identify key themes. SETTING: Hospital eye service. RESULTS: Five key themes emerged relating to surgeons' experiences and perceptions of only eye surgery: (1) differences in approach to consent, (2) strategies for risk reduction, (3) unmet training needs, (4) value of surgical mentor and (5) emotional impact of unsuccessful outcomes. Recommendations for improving the surgical journey for both the patient and the surgeon related primarily to better recognition and understanding of the complexities inherent with only eye surgery. CONCLUSIONS: Outcomes of only eye surgery may be improved through a number of methods, including development of purpose-designed training fellowships, adoption of stress-reducing strategies and enhancement of available support services. The findings identify emerging themes unique to only eye surgery and the need for guidelines on the provision of care for these high-stakes surgical patients

Eye Surgery Light

During eye surgery, the surgeon uses an illuminating instrument called an opthalmoscope for close examination of the retina or the interior of the eye. Ordinarily, electric power for the head-mounted light is supplied through a cord from an overhead swivel arm or a floor pedestal. Within limits of cord length and swivel arm movement, the surgeon has considerable freedom of motion. But when more than one opthalmoscope is involved, tangling and interference of the power cords becomes a problem. St. Luke's Hospital, Cleveland, Ohio asked Lewis Research Center for assistance in finding a solution. Lewis responded with a battery-powered system that totally frees the surgeon of attached cords and swivels. Borrowing from space technology, Lewis used small, lightweight nickel-cadmium batteries that can deliver high intensity light for an hour and can be recharged overnight. The Opthalmoscope Powerpack consists of eight batteries in three containers affixed to a webbed belt, and a novel on-off switch equipped with a springloaded plexiglass "flapper." The belt pack is worn underneath the surgical gown and the flapper permits the doctor to activate the switch by elbow pressure. Lewis built five units and they have been in service at St. Luke's Hospital for a year. Used for routine examinations as well as for surgery, they have demonstrated excellent reliability

Eye Surgery in Africa

No Abstract

Vision Correction and Eye Surgery

This book focuses on the current approaches in the medical and surgical treatment of the most diffuse and important ocular diseases. It reports the latest developments in surgery (anterior segment surgery, posterior pole surgery, etc.) for various types of ocular disease, including glaucoma, corneal diseases, and vitreoretinal disease. the latest developments in the surgical field of ocular disease from the anterior segment to the posterior pole going through the main ocular disease (cataract surgery in normal and/or complicated conditions, glaucoma, corneal diseases, and vitreoretinal disease), with the latest developments in the treatment of ocular disease that enable improved surgical outcomes and fewer complications

Time-trend and variations in the proportion of second-eye cataract surgery

<p>Abstract</p> <p>Background</p> <p>Despite recommendations for greater use of second-eye cataract surgery and the bilateral progression of the disease, there is a substantial proportion of unmet need for this treatment. Few studies have explored the factors associated with second-eye cataract surgery utilisation. The objective of our study was to estimate the proportion of second-eye cataract surgery, evaluate its time-trend, and explore differences in utilisation by patients' gender, age, and region of residence.</p> <p>Methods</p> <p>All senile cataract surgeries performed between 1999 and 2002 in the public health system of Catalonia (Spain) were obtained from the Minimum Data Set. The proportion of second-eye surgery from November 2000 to December 2002 was calculated. The time-trend of this proportion was characterised through linear regression models with the logarithmic transformation of time.</p> <p>Results</p> <p>The proportion of second-eye surgery was 30.0% and showed an increasing trend from 24.8% (95% Confidence Interval [CI] 21.6; 26.1) in November 2000 to 31.8% (95% CI 31.4; 33.6) in December 2002. This proportion was 1.9% (95% CI 0.9; 2.9) higher in women (p < 0.001) and held constant across time. Male patients aged less than 60 had the lowest proportion (22.6%; 95% CI 22.4; 22.9) and females between 70 and 79 had the highest proportion (27.4%; 95% CI 26.9; 27.9). The time-trend for the proportion of second-eye surgery in those aged over 80 years was greater than for younger ages, showing an increase of 9% at the end of the period for both males and females. Variations between regions decreased over time because regions with the lowest initial proportions of second-eye surgery (approximately 17%) showed a greater increase over the study period.</p> <p>Conclusion</p> <p>We predict greater utilization of second-eye surgery in patients aged 70 to 79 years and in women. A greater increase in the utilisation rates of second-eye surgery is expected in the regions with lower proportions and in older patients. The observed trend suggests that there will be a substantial proportion of unmet need for bilateral surgery.</p

Safe Eye Surgery : Non-technical aspects

Peer reviewedPostprin

Jednodnevna očna kirurgija i antikoagulantna terapija - noviji pristupi

One of the most common surgeries in elderly patients is eye surgery. An increasing number of patients undergoing ambulatory eye surgery are on antithrombotic therapy. These drugs may increase the risk of perioperative bleeding associated with ophthalmic needle blocks and/or eye surgery. Intraoperative bleeding and postoperative hemorrhagic complications may lead to the loss of vision or even eyes. On the other hand, stopping anticoagulants and antiplatelets before the surgery may increase the risk of thrombotic events with potentially life-threatening complications. The aim of this narrative review is to provide a systematic review of the published evidence for the perioperative antithrombotic management of patients undergoing different types of eye surgery in ambulatory settings. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 2015 to December 2018 was performed. The database searches included studies providing evidence relevant to ambulatory eye surgery and perioperative antiplatelet medications and anticoagulants. Updated recommendations will be given for continuation, discontinuation, and modification of antithrombotic agents in order to optimize the management of antithrombotic therapies in outpatients scheduled for eye surgery.U populaciji bolesnika starije dobi očni kirurški zahvati su jedni od najčešćih kirurških zahvata. Sve više bolesnika kojima je potreban kirurški zahvat na očima su starije dobi i većinom su na kroničnoj terapiji lijekovima uključujući antitrombocitne lijekove. Ti lijekovi mogu povećati rizik od perioperacijskog krvarenja prilikom izvođenja regionalnih očnih blokova ili kirurškog zahvata. Krvarenje tijekom operacije oka i hemoragijske komplikacije poslije zahvata mogu dovesti do gubitka vidne funkcije ili čak samog oka. S druge strane, prekidanje uzimanja antitrombocitnih i antikoagulacijskih lijekova prije kirurškog zahvata dovodi do povećanog rizika za nastanak ozbiljnih i za život opasnih tromboembolijskih komplikacija. Cilj ovoga narativnog preglednog članka je sustavni pregled objavljenih dokaza o perioperacijskom antitrombotskom liječenju očnih bolesnika planiranih za različite zahvate u dnevnoj očnoj kirurgiji. Pretražene su baze medicinskih podataka pomoću PubMed, Ovid Medline® i Google Scholar za razdoblje od siječnja 2015. godine do prosinca 2018. godine. Obuhvaćene su studije relevantne za planirane očne operacije u jednodnevnoj kirurgiji i perioperacijsko liječenje antitrombocitnim i antikoagulacijskim lijekovima s naglaskom na sadašnje stavove u pogledu nastavka, prekida ili modifikacije antitrombotske terapije kako bi se pospješila priprema bolesnika za očne zahvate

Markerless monocular tracking system for guided external eye surgery

This paper presents a novel markerless monocular tracking system aimed at guiding ophthalmologists during external eye surgery. This new tracking system performs a very accurate tracking of the eye by detecting invariant points using only textures that are present in the sclera, i.e., without using traditional features like the pupil and/or cornea reflections, which remain partially or totally occluded in most surgeries. Two known algorithms that compute invariant points and correspondences between pairs of images were implemented in our system: Scalable Invariant Feature Transforms (SIFT) and Speed Up Robust Features (SURF). The results of experiments performed on phantom eyes show that, with either algorithm, the developed system tracks a sphere at a 360◦ rotation angle with an error that is lower than 0.5%. Some experiments have also been carried out on images of real eyes showing promising behavior of the system in the presence of blood or surgical instruments during real eye surgery. © 2014 Elsevier Ltd. All rights reserved.Monserrat Aranda, C.; Rupérez Moreno, MJ.; Alcañiz Raya, ML.; Mataix, J. (2014). Markerless monocular tracking system for guided external eye surgery. Computerized Medical Imaging and Graphics. 38(8):785-792. doi:10.1016/j.compmedimag.2014.08.001S78579238