2 research outputs found
Étude de l'efficacité et du workflow de la chirurgie de la cataracte assistée par laser femtoseconde dans un hôpital public espagnol
Background. – To assess the time-efficiency of a designated operating room (OR) workflow in the introduction of femtosecond laser-assisted cataract surgery (FLACS, LenSx, Alcon®). The study was carried out in a public hospital a with high-volume of procedures. Methods. – We performed this prospective, controlled, surgical intervention study in the ophthalmology department of a Spanish tertiary referral public hospital. A total of 167 eyes were enrolled, including 62 eyes undergoing conventional phacoemulsification surgery. In phase I, patients were assigned either to FLACS-I (n = 63) or conventional phacoemulsification surgery (n = 62). One surgeon operated the femtosecond laser, and another completed the procedure, while a third performed conventional phacoemulsification. In the second phase (FLACS-II), all the surgeries were FLACS (n = 42). One surgeon performed the FLACS procedure, and two different surgeons completed the surgeries in separate ORs. Surgical and turnover times of all the patients were recorded. Results. – Preparation time was statistically significantly lower in FLACS-I and FLACS-II (P < 0.001), whereas the duration of the cataract procedure per se was higher in FLACS-II compared to conventional phacoemulsification (P = 0.03). Phacoemulsification energy was higher in FLACS-II compared to FLACS-I (P = 0.01), whereas laser-related surgical time was lower (P = 0.001). Surgical complications and total surgical time showed no statistically significant differences between any of the three groups. Conclusions. – This study suggests a time-efficient and suitable workflow model for FLACS, considering the specific requirements and restrictions of a fully booked public hospital. Even so, we have shown that the FLACS procedure does not take longer than conventional phacoemulsification when following a detailed plan for OR workflow. In addition, our data reflect an improvement in FLACS surgical times with ongoing experience. Trial registration. – NCT03931629 (retrospectively registered).Contexte. – Évaluer le gain de temps d’un flux de travail en salle d’opĂ©ration dĂ©signĂ©e (RO) dans l’introduction de la chirurgie de la cataracte assistĂ©e par laser femtoseconde (FLACS, LenSx, Alcon®). L’étude a Ă©tĂ© rĂ©alisĂ©e dans un hĂ´pital public avec un volume Ă©levĂ© de procĂ©dures. MĂ©thodes. – Nous avons rĂ©alisĂ© cette Ă©tude d’intervention chirurgicale prospective et contrĂ´lĂ©e dans le service d’ophtalmologie d’un hĂ´pital public espagnol de rĂ©fĂ©rence tertiaire. Un total de 167 yeux ont Ă©tĂ© inclus, dont 62 yeux subissant une chirurgie conventionnelle de phacoĂ©mulsification. Dans la phase I, les patients ont Ă©tĂ© assignĂ©s soit Ă FLACS-I (n = 63) soit Ă une chirurgie de phacoĂ©mulsification conventionnelle (n = 62). Un chirurgien a opĂ©rĂ© le laser femto-seconde, un autre a terminĂ© l’intervention, tandis qu’un autre a rĂ©alisĂ© une phacoĂ©mulsification conventionnelle. Dans la deuxième phase (FLACS-II), toutes les chirurgies Ă©taient des FLACS (n = 42). Un chirurgien a effectuĂ© la procĂ©dure FLACS et deux chirurgiens diffĂ©rents ont effectuĂ© les chirurgies dans des salles d’opĂ©ration sĂ©parĂ©es. Les temps de chirurgie et de roll-over de tous les patients ont Ă©tĂ© enregistrĂ©s RĂ©sultats. – Le temps de prĂ©paration Ă©tait statistiquement significativement infĂ©rieur dans FLACS-I et FLACS-II (p <0,001) alors que le temps de la procĂ©dure de la cataracte en soi Ă©tait plus Ă©levĂ© dans FLACS-II par rapport Ă la phacoĂ©mulsification conventionnelle (p = 0,03). L'Ă©nergie de phacoĂ©mulsification Ă©tait plus Ă©levĂ©e dans FLACS-II par rapport Ă FLACS-I (p = 0,01) alors que le temps chirurgical liĂ© au laser Ă©tait plus faible (p = 0,001). Les complications chirurgicales et le temps chirurgical total n’ont montrĂ© aucune diffĂ©rence statistiquement significative entre les trois groupes. Conclusion. – Cette Ă©tude suggère un modèle de flux de travail efficace et appropriĂ© pour le FLACS compte tenu des exigences et des restrictions spĂ©cifiques d’un hĂ´pital public saturĂ©. MalgrĂ© cela, nous avons montrĂ© que la procĂ©dure FLACS ne prend pas plus de temps que la phacoĂ©mulsification conventionnelle après une planification dĂ©taillĂ©e du flux de travail de la salle d’opĂ©ration. De plus, nos donnĂ©es reflètent une amĂ©lioration des temps chirurgicaux dans les FLACS avec une expĂ©rience continue. Enregistrement de l’essai. – NCT03931629 (enregistrĂ© rĂ©trospectivement).Marina RodrĂguez-Calvo-de-Mora, Cristina PĂ©rez-Casaseca, Emilio Espejo-de-los-Riscos and Gustavo Fernández-Baca-Vaca G received an Investigator Initiatied Trial from Alcon
Age-Related Macular Degeneration: Clinical Findings following Treatment with Antiangiogenic Drugs
Purpose. To survey the management of patients with neovascular age-related macular degeneration (nvAMD) in Spain. Methods. An observational retrospective multicenter study was conducted. The variables analyzed were sociodemographic characteristics, foveal and macular thickness, visual acuity (VA), type of treatment, number of injections, and the initial administration of a loading dose of an antiangiogenic drug. Results. 208 patients were followed up during 23.4 months in average. During the first and second years, patients received a mean of 4.5±1.8 and 1.6±2.1 injections of antiangiogenic drugs, and 5.4±2.8 and 3.6±2.2 follow-up visits were performed, respectively. The highest improvement in VA was observed at 3 months of follow-up, followed by a decrease in the response that stabilized above baseline values until the end of the study. Patients who received an initial loading dose presented greater VA gains than those without. Conclusions. Our results suggest the need for a more standardized approach in the management and diagnosis of nvAMD receiving VEGF inhibitors. To achieve the visual outcomes reported in pivotal trials, an early diagnosis, proactive approach (more treating than follow-up visits), and a close monitoring might be the key to successfully manage nvAMD