Choroidal thickness changes in non-treated eyes of patients with diabetes: swept-source optical coherence tomography study

To measure choroidal thickness (CT) in diabetic eyes and its correlation with metabolic status and the severity of diabetic retinopathy (DR). Prospective cross-sectional study using swept-source optical coherence tomography. CT maps of 96 treatment na < ve eyes of 48 patients with diabetes were compared to 46 eyes of 23 healthy controls. CT changes and their relation to diabetes, age, gender, disease duration, hypertension (HT), hemoglobin A1c level, type and severity of DR were evaluated. A significantly thinner choroid was measured in patients with diabetes compared to controls (p < 0.009). In the diabetic group age, gender, disease duration and HT were significantly correlated with CT in univariable regression models (p < 0.05). In multivariable analysis, the duration of diabetes significantly negatively correlated with CT (p = 0.02). According to analysis of variance, there was a significant difference among means of CT in different stages of DR (p = 0.002), with thinner CT in cases with more advanced DR. In a multivariable predictive model, thinner CT was associated with an increased risk for the presence of DR (p = 0.02). Diabetes mellitus itself and the severity of DR affect CT significantly, even after adjusting for the effects of confounding systemic factors. Disease duration seems to be associated with a reduction of choroidal thickness. Decreased CT proved to be correlated with the severity of DR

Confidence of UK Ophthalmology Registrars in Managing Posterior Capsular Rupture: Results from a National Trainee Survey

IntroductionTo establish the level of confidence amongst UK ophthalmology specialist registrars (residents) in managing posterior capsule rupture (PCR) during cataract surgery. Methods: An online nine-item questionnaire was distributed to all registrars, recruited nationwide via regional representatives. Data collected included stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs independently managed, understanding of vitrectomy settings and fluidic parameters and access to simulation. Respondents self-evaluated their confidence in managing PCR with vitreous loss. ResultsComplete responses were obtained from 248 registrars (35% response rate). Mean number of phacoemulsification procedures performed was 386. For senior registrars (OST 6–7), 35 out of 70 (50%) felt confident to manage PCR independently and 55 out of 70 (78.6%) were either quite confident or very confident at deciding when to implant an intraocular lens during PCR management. Lower confidence levels were noted for junior trainees (OST 1–2). Over 65% of survey respondents had access to relevant simulation. ConclusionsOur results represent the largest UK survey analysing the confidence of PCR management amongst registrars. Confidence improves with duration of training and increased exposure to management of PCR. However, 50% of senior registrars still lacked confidence to independently manage PCR and vitreous loss. A specific competency-based framework, potentially using a simulator or simulating a PCR event, incorporated into the curriculum may be desirable.</div