Exenteration Research Articles

Determination of Correlated Color Temperature in Ex Vivo Porcine Eyes during Intraocular Illumination.

(1) Background: In ophthalmic surgery, white light is mostly applied to illuminate the intraocular space, and ophthalmologists are comfortable working with it. Diaphanoscopic illumination changes the spectral composition of light, resulting in a change in the correlated color temperature (CCT) of the intraocular illumination. This color change makes it difficult for surgeons to recognize the structures in the eye. CCT during intraocular illumination has not yet been measured before, and it is the aim of this study to perform such measurement. (2) Methods: CCT was measured inside ex vivo porcine eyes during diaphanoscopic illumination and endoillumination using a current ophthalmic illumination system with a detection fiber inside the eye. By applying pressure on the eye with a diaphanoscopic fiber, the dependency of CCT on pressure was examined. (3) Results: The intraocular CCT values during endoillumination were 3923 K and 5407 K for the halogen and xenon lamps, respectively. During diaphanoscopic illumination, a strong unwanted red shift was observed, resulting in 2199 K and 2675 K for the xenon and the halogen lamps, respectively. Regarding different applied pressures, the CCT did not differ considerably. (4) Conclusions: This red shift should be compensated for in the development of new illumination systems since surgeons are used to white light illumination, which also simplifies the identification of retinal structures.

Formulation And Evaluation of Controlled Release Bromfenac Sodium Ocular Insert

According to the World Health Organization, cataract operations are performed on one million people per year [1]. After cataract surgery, however, most patients still experience physiologically severe postoperative ocular inflammation. Uncontrolled intraocular inflammation causes discomfort, delayed recovery, poor visual results, and even more severe problems such as cystoid macular oedema and synechiae due to inflammatory cells and cytokines entering the aqueous humour. Topical non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat non-infectious ocular inflammation after ophthalmic surgery. As a result, NSAIDs appear to be potentially useful drugs for cataract surgery. [2] The U.S Food and Drug Administration has approved four ophthalmic NSAIDs to treat postoperative ocular inflammation followed by cataract surgery: bromfenac sodium, diclofenac sodium, Ketorolac tromethamine, and nepafenac.[3] The first approved NSAID for treating anterior chamber inflammation during cataract surgical treatment is bromfenac ophthalmic solution. Bromfenac is a more potent drug than other drugs for treating ocular inflammation. [4] The drug-loaded eye drop is easy to use. However, it has the inherent disadvantage that most medication is almost immediately diluted away in the tear film when the eye drops are introduced into the cul-de-sac and quickly exhausted from the precorneal cavity's constant tear flow. This process occurs more intensively in swollen eyes than in normal eyes and lachrymal-nasal drainage. [5,6] To avoid the previously stated side effects and increase the drug's effectiveness, a novel approach of an ocular insert that increases the drug's contact time in the eye should be chosen, thus improving patient compliance by increasing bioavailability and reducing frequent administration. [7] Ophthalmic inserts are skinny discs of polymeric substances that fit into the upper or lower conjunctiva sac. They have compensations over the conventional dosage forms and possess amplified ocular residence, discharge the drugs at a slow and consistent momentum, are capable of delivering precise dosing, lack preservatives, have augmented shelf life, and reduced systemic incorporation. [8] Our research intended to fabricate bromfenac sodium ocular inserts to amplify the contact time and offer a controlled release model that could advance patient compliance, cut dosing frequency, and attain superior curative usefulness.

Comparison of pathogenetically oriented methods aimed at activating the trabecular meshwork in the surgical treatment of cataract

In modern ophthalmic surgery, the "gold standard" recognized by most surgeons is ultrasound cataract phacoemulsification, which can’t be said about its antiglaucoma component. Some surgeons prefer to combine phacoemulsification with a filtering surgery, or follow the cyclodestructive approach, but taking into account that the main aqueous humor outflow pathway is through the trabecular meshwork, interventions on the Schlemm’s canal are the most relevant and pathogenetically valid. The article covers the main approaches to surgical interventions aimed at the trabecular meshwork in combination with phacoemulsification, and presents surgical techniques developed by the authors.

Survey and reduction of waste production from eye surgery

The health sector is facing new challenges due to the impact of climate change on health. At the same time, it significantly contributes to our society's climate footprint. Hospitals producing considerable amounts of waste are an important aspect of this burden. The aim of this work was to quantify the amount of waste produced by eye surgery and, as an optimization measure, to evaluate the effect of glass separation from residual waste. Over a2-week period, the waste generated by eye operations in the surgical theater of our university hospital was measured. Another 2‑week long measurement was conducted after the initiation of glass separation from general waste. The data obtained allowed acomparison of the two periods, the type of waste (residual and recyclable) as well as the type of operation (intraocular, extraocular). Considering regional waste disposal costs, an economic comparison was also performed. In the first measurement period (196 operations), atotal of 549.6 kg of waste was generated, 87% (478.3 kg) of which was residual waste, corresponding to 14.3tons of total waste annually. Intraocular procedures generated on average 80% more waste than extraocular procedures: 18.1 ± 3.9 kg and 11.4 ± 4.0 kg, respectively, per day and theater. Separation of glass from residual waste reduced its quantity by 7.2% in the second measurement period (197 procedures). As the disposal of glass is free of charge in the city of Essen, this resulted in asmall economic advantage (extrapolated to 112 € per year). The amount of waste generated by ophthalmic surgery is substantial, with apredominant proportion of non-recyclable residual waste. Intraocular operations are the cause of the majority of the waste produced. Simple measures, such as disposing of glass separately, are helpful and inexpensive to reduce the quantity of residual waste.

Disturbances in the ocular surface microbiome by perioperative antimicrobial eye drops.

We aimed to elucidate the effects of antimicrobial eye drops used in the perioperative period of ophthalmic surgery on the ocular surface microbiome by metagenomic analysis. Twenty-eight eyes from 15 patients (mean age 74.1 years) with no history of eye drop use within 3 months before cataract surgery were included in this study. Gatifloxacin eye drops were used in all patients in the perioperative period. The antimicrobial eye drops were started 3 days before surgery. They were discontinued after conjunctival sac specimen collection for 2 weeks after the surgery. Conjunctival sac specimens were collected to investigate the alterations in the ocular surface microbiome by meta-16S analysis targeting the V3-V4 region of the bacterial 16S rRNA gene. Principal coordinate analysis showed that the bacterial composition tended to be different before and 2 and 4 weeks after surgery. Individual observations on six eyes showed that the bacterial composition at 12 weeks after surgery was closer to that before surgery than to that at 4 weeks after surgery in two eyes, while the bacterial composition in the remaining four eyes was different at various time points. Before surgery, Firmicutes, Proteobacteria, and Bacteroidetes were predominant; however, 2 weeks after surgery, the proportion of Proteobacteria increased and that of Firmicutes decreased. A similar trend was noticed 4 weeks after surgery, although antibacterial eye drops had been discontinued 2 weeks after surgery. The Shannon-Weaver coefficient showed a decreasing trend at 2-, 4-, and 12-weeks post operation compared to that before operation. The diversity of the microbiome decreased significantly at 2- and 4-weeks after surgery when compared to that before surgery (p < 0.05). The ocular surface microbiome is easily disrupted by antimicrobial eye drops, and it needs recovery time. In such cases, the ocular surface microbiome is presumed to contain many antimicrobial-resistant bacteria. In some cases, it may not recover, and a new microbiome is formed.

Live 4D-OCT denoising with self-supervised deep learning

By providing three-dimensional visualization of tissues and instruments at high resolution, live volumetric optical coherence tomography (4D-OCT) has the potential to revolutionize ophthalmic surgery. However, the necessary imaging speed is accompanied by increased noise levels. A high data rate and the requirement for minimal latency impose major limitations for real-time noise reduction. In this work, we propose a low complexity neural network for denoising, directly incorporated into the image reconstruction pipeline of a microscope-integrated 4D-OCT prototype with an A-scan rate of 1.2 MHz. For this purpose, we trained a blind-spot network on unpaired OCT images using a self-supervised learning approach. With an optimized U-Net, only a few milliseconds of additional latency were introduced. Simultaneously, these architectural adaptations improved the numerical denoising performance compared to the basic setup, outperforming non-local filtering algorithms. Layers and edges of anatomical structures in B-scans were better preserved than with Gaussian filtering despite comparable processing time. By comparing scenes with and without denoising employed, we show that neural networks can be used to improve visual appearance of volumetric renderings in real time. Enhancing the rendering quality is an important step for the clinical acceptance and translation of 4D-OCT as an intra-surgical guidance tool.

An unusual presentation of Urrets-Zavalia syndrome after minimally invasive glaucoma surgery in a case of pigmentary glaucoma

Urrets-Zavalia syndrome (UZS) is a rare post-operative condition characterized by a fixed and dilated pupil after ophthalmic surgery. UZS syndrome was first appreciated by Castroviejo and was later published in 1963 by Alberto Urrets-Zavalia in patients who underwent penetrating keratoplasty (PKP). Though there are many risk factors for UZS, the most widely accepted theories are ischemia of the iris and acute rise in intraocular pressure (IOP), with possible spontaneous partial recovery expected in some of them. Contrastingly, permanent UZS was also rarely reported in the literature by Mocan et al. among the pigment dispersion syndrome (PDS) population. In this manuscript, we have reported an unusual presentation of UZS after iStent implantation (Glaukos Corporation, United States) with the following two possible risk factors, namely, acute post-operative IOP spike and pre-existing pigmentary dispersion syndrome condition, which, accordingly to our knowledge, has never been reported in the literature before.

Management of cataract in dry eye disease: Preferred practice pattern guidelines.

Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.

Systemic contraindications for laser vision correction surgery

Introduction: Laser refractive surgery corrects refractive errors by changing the shape of the anterior surface of the cornea and its refractive power by using a laser. Patients with refractive errors and systemic comorbidities pose a challenge for refractive surgeons. According to the guidelines of ophthalmological societies, the coexistence of autoimmune connective tissue diseases or hormonal disorders, some pharmacotherapies, pregnancy and lactation are contraindications for refractive procedures. These recommendations have been formulated on the basis of case reports or recommendations coming from other ophthalmic surgeries. Aim: The aim of the study was to summarise the current literature data on systemic contraindications for laser vision correction. Materials and methods: The literature review included the PubMed database. In the search for relevant articles, the following keywords were used: “refractive surgery”, “contraindications”, “LASIK”, “PRK”, “laser in situ keratomileusis”, “photorefractive keratectomy”. The references of articles that met the criteria were also analysed. Discussion: The main reason for considering some systemic conditions and pharmacotherapy as exclusion criteria for refractive surgery was the concern of an increased risk of postoperative eye inflammation, unpredictable healing and corneal remodelling, as well as a severe dry eye syndrome. In recent decades, a number of articles have been published supporting the safety profile of refractive procedures in patients with inactive autoimmune diseases, well-controlled diabetes or undergoing specific pharmacotherapy. These publications were based on either retrospective studies or case series, with short-term follow-up and their results should be interpreted with caution. Conclusions: Active or uncontrolled autoimmune diseases, pregnancy and lactation are absolute contraindications for laser vision correction. The decision to perform refractive surgery in patients with inactive and well- controlled systemic diseases or risk factors should be made individually and carefully by an experienced surgeon.

The impact of preloaded intraocular lens implantation system (TECNIS iTec®) in routine cataract surgery in China: a time-motion analysis

ObjectiveTo evaluate the impact on surgical efficiency and labor time cost of preloaded intraocular lens (IOL) implantation system compared with manual IOL implantation system in age-related cataract surgery in China.MethodsThis study was an observational, multicenter, prospective time-motion analysis. IOL preparation time, operation time, cleaning time, number and cost of cataract surgeries in eight participating hospitals were collected. The linear mixed model was used to explore factors associated with the difference in operation time between the preloaded IOL implantation system and the manual IOL implantation system. A time-motion model was constructed to convert the operation time cost saved by using preloaded IOL into economic benefits from hospital and social perspective, respectively.ResultsThere were 2,591 cases included in the study (preloaded IOL: 1,591 cases; manual IOL: 1,000 cases). The preloaded IOL implantation system was significant time-saving in both preparation time and operation time compared to the manual IOL implantation system (25.48s vs. 47.04s, P < 0.001 and 353.84s vs. 367.46s, P = 0.004, respectively). An average total of 35.18s can be saved by using preloaded IOL per procedure. The results of linear mixed model showed that the type of IOL was the main factor leading to the difference in preparation time between preloaded IOL and manual IOL implantation system. By switching from manual IOL to preloaded IOL, the model projected additional 392 surgeries can be performed each year and an increase in revenue of $565,282 per hospital, a 9% increase from hospital perspective. And the annual productivity loss saved by using preloaded IOL was $3,006 in eight hospitals from perspective of society.ConclusionCompared with manual IOL implantation system, the preloaded IOL implantation system reduces lens preparation time and operation time, which increases potential surgical volume and revenue, and reduces the loss of work productivity. This study provides real-world evidence to support the advantages of the preloaded IOL implantation system in improving efficiency of ophthalmic surgery in China.

Reducing Topical Drug Waste in Ophthalmic Surgery: Multisociety Position Paper.

Reducing Topical Drug Waste in Ophthalmic Surgery: Multisociety Position Paper.

Результаты реконструктивно-восстановительной хирургии после тяжелой сочетанной травмы глаза, век и глазницы

Purpose. Presentation of the clinical result of complex surgical rehabilitation in a patient with combined traumatic injury of the eye, its adnexa and orbit. Material and methods. A clinical case is presented. Described step by step: surgical reconstruction of orbital walls with «Ekoflon» material (Russia), of lacrimal duct by Taumi method, of medial palpebral ligament, of upper eyelid coloboma with free skin graft, evisceration with plastic surgery of the musculoskeletal stump and ocular prosthetics. Results. Evaluation of the results of the surgical treatment performed at the final examination 14 months after the injury showed that the dimensions of the patient’s palpebral fissure had no obvious differences from the healthy side, the mobility of the upper eyelid was restored, and the lacrimal drainage function was preserved. There was a normal position and good mobility of the ocular prosthesis. Conclusion. Complex specialized rehabilitation of patients after a severe concomitant injury of the organ of vision using the achievements of modern reconstructive ophthalmic surgery makes it possible to restore the anatomy and function of the adnexal apparatus of the eye as much as possible, to carry out cosmetic prosthetics with a satisfactory aesthetic outcome. Key words: combined ocular injury, reconstructive and cosmetic eyelid surgery, lacrimal duct reconstruction; periorbital reconstruction; eye prosthesis

A Pilot Investigation Evaluating Relative Changes in Fronto-Occipital Alpha and Beta Spectral Power as Measurement of Anesthesia Hypnotic Depth.

Other than clinical observation of a patient's vegetative response to nociception, monitoring the hypnotic component of general anesthesia (GA) and unconsciousness relies on electroencephalography (EEG)-based indices. These indices exclusively based on frontal EEG activity neglect an important observation. One of the main hallmarks of transitions from wakefulness to GA is a shift in alpha oscillations (7.5-12.5 Hz activity) from occipital brain regions toward anterior brain regions ("alpha anteriorization"). Monitoring the degree of this alpha anteriorization may help to guide induction and maintenance of hypnotic depth and prevent intraoperative awareness. However, the occipital region of the brain is completely disregarded and occipital alpha as characteristic of wakefulness and its posterior-to-anterior shift during induction are missed. Here, we propose an application of Narcotrend's reduced power alpha beta (RPAB) index, originally developed to monitor differences in hemispheric perfusion, for determining the ratio of alpha and beta activity in the anterior-posterior axis. Perioperative EEG data of 32 patients undergoing GA in the ophthalmic surgery department of Bern University Hospital were retrospectively analyzed. EEG was recorded with the Narcotrend® monitor using a frontal (Fp1-Fp2) and a posterior (T9-Oz) bipolar derivation with reference electrode over A2. The RPAB index was computed between both bipolar signals, defining the fronto-occipital RPAB (FO-RPAB). FO-RPAB was analyzed during wakefulness, GA maintenance, and emergence, as well as before and after the intraoperative administration of a ketamine bolus. FO-RPAB was compared with a classical quantitative EEG measure-the spectral edge frequency 95% (SEF-95). A significant shift of the FO-RPAB was observed during both induction of and emergence from GA ( P < .001). Interestingly, the additional administration of ketamine during GA did not lead to a significant change in FO-RPAB ( P = 0.81). In contrast, a significant increase in the SEF-95 in the frontal channel was observed during the 10-minute period after ketamine administration ( P < .001). FO-RPAB appears to qualify as a marker of unconsciousness, reflecting physiological fronto-occipital activity differences during GA. In contrast to frontal SEF-95, it is not disturbed by additional administration of ketamine for analgesia.

Объем и разновидности офтальмохирургических вмешательств, выполняемых в детском офтальмологическом отделении, их эффективность

Purpose. To evaluate volume and nosological forms of ophthalmic surgery cases in the pediatric department of the ophthalmology surgery and analyze their effectiveness. Material and methods. A continuous retrospective number of all ophthalmic surgery in the pediatric ophthalmology department of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution for three years (from January 2019 to December 2021). Results. 5025 children aged from 1 month to 18 years old were operated. Surgical treatment of pathology of oculomotor apparatus was performed in 2304 (45.9%) patients, scleral remodeling in progressive myopia – 1088 (21.7%) people, probing for congenital lacrimal ducts obstruction – 619 (12.3%) children. In 463 (9.2%) children, surgical removal of the chalazion was performed. 166 (3.3%) children were operated for eyelid, conjunctival and orbital tumors. 120 patients (2.4%) underwent surgical revascularization for optic nerve atrophy of various origins. 96 children underwent surgical correction of various congenital eyelid anomalies. During this period, 169 premature babies (3.4%) were under observation in the department. Of these, at threshold stages of retinopathy of prematurity (ROP), 34 patients underwent laser coagulation of avascular areas of retina, 22 patients received intravitreal ranibizumab injection, 14 children with stage 4 or 5 ROP underwent endovitreal intervention of traction retinal detachment. Conclusion. The volume of ophthalmic surgery performed in the pediatric department is quite high, the largest proportions are various methods for eliminating the pathology of oculomotor apparatus and scleral remodeling in progressive myopia. In most cases of strabismus and ptosis surgery, it was possible to achieve complete or partial elimination of pathology. Stabilization of the progressive course of myopia was achieved in 67.9% of cases, threshold stages of ROP – in 91.7%. The high demand of population for surgical treatment of pediatric ophthalmopathology indicates the need for further development and improvement of this area. Key words: pediatric ophthalmology, structure of surgical pathology, main trends of ophthalmic surgery

A dexamethasone ophthalmic insert (Dextenza) for allergic conjunctivitis.

The FDA has approved Dextenza (Ocular Therapeutix), a dexamethasone ophthalmic insert, for treatment of ocular itching associated with allergic conjunctivitis. Dextenza was approved earlier for treatment of ocular inflammation and pain following ophthalmic surgery.

Traditional analogue vs. three-dimensional digital visualization used in ophthalmic surgery

The visualization of the surgical process remains a topical issue in cataract surgery. The review presents the history of visualization technique in ophthalmic surgery and compares the main current analogue and 3D digital technologies. The advent of 3D imaging systems in clinical practice has helped solve many issues associated with the use of standard analogue microscopes. These issues include limited focus and field of vision, the need to use a large amount of light, which increases the risk of iatrogenic retinal phototoxicity, the surgeon's attachment to the microscope and, consequently, a high load on the surgeon's visual apparatus when using eyepieces, as well as on their back and neck muscles.

Features of the local cytokine profile of patients with bullous keratopathy by using personalized therapy with cellular technologies

Background. Today we have active development of ophthalmic surgery, but the role of cytokines in the pathogenesis of bullous keratopathy of the cornea remains insufficiently studied at present.The aim. To study the dynamics of the local cytokine profile in bullous keratopathy by using personalized treatment with suspension of autologous blood mononuclears.Material and methods. Two groups of patients with bullous keratopathy were formed: the main group (30 people, 30 eyes), who received an intrastromal injection of a suspension of autologous blood mononuclears and comparison (28 people, 28 eyes), who received a course of pharmacotherapy. The level of interleukins (IL) – IL-10, IL-4, IL-6, IL-1ß, transforming growth factor beta-2 (TGF-β2), tumor necrosis factor alpha (TNF-α) was determined in the lacrimal fluid of the patient’s eye by enzyme immunoassay.Results. All patients before treatment showed an increase of IL-1ß in the lacrimal fluid by 3.3 times, IL-6 – by 4.2 times, TNF-α – by 2.0 times (p &lt; 0.05); an increase in the level of IL-4, IL-10 and TGF-β2 by 1.1 times (p &gt; ˂ 0.05). In the main group, after treatment, there was a decrease in IL-1ß by 2.0 times, IL-6 – by 2.1 times and TNF-α – by 1.8 times, and an increase in IL-10 by 1.5 times, IL-4 – by 1.9 times, TGF-β2 – by 1.4 times (p &lt; 0.05), persisting for 12 months. There was a short-term decrease of IL-1ß by 1.7 times, IL-6 and TNF-α – by 1.2 times and an increase of IL-10, IL-4, TGF-β2 by 1.2 times (p &gt;&lt; 0.05) in the comparison group which then reached the initial values. Conclusion. There is an imbalance in the system of pro- and anti-inflammatory cytokines in bullous keratopathy in the lacrimal fluid. Injection of autologous mononuclear cells in the stroma of the cornea reduces the severity of the imbalance of the local cytokine system compared to the course of pharmacotherapy. Key words: bullous keratopathy, cellular technologies, autologous mononuclear leukocytes, cytokines&gt;˂ 0.05), persisting for 12 months. There was a short-term decrease of IL-1ß by 1.7 times, IL-6 and TNF-α – by 1.2 times and an increase of IL-10, IL-4, TGF-β2 by 1.2 times (p ˂ 0.05) in the comparison group which then reached the initial values.Conclusion. There is an imbalance in the system of pro- and anti-inflammatory cytokines in bullous keratopathy in the lacrimal fluid. Injection of autologous mononuclear cells in the stroma of the cornea reduces the severity of the imbalance of the local cytokine system compared to the course of pharmacotherapy.

Pre-operative anxiety in the ophthalmological surgery

IntroductionThe question of preoperative anxiety in an ophthalmological patient and its relief in an outpatient setting is becoming increasingly relevant due to the improvement of the technique and equipment of ophthalmic surgery, when the practice of «one-day surgery» is becoming increasingly common. It could not only affecting the course of the operation, but also a factor limited the availability of this type of medical care to patients. Purpose. To analyze the relationship between the level of anxiety during preoperative preparation and the choice of the optimal approach for the relief of preoperative anxiety in an ophthalmological patient in a «one day» clinic.Objectives89 adult patients of both sexes aged from 20 y.o. referred for outpatient surgery (refractive and cataract surgery) and were included into trials, all of them are divided into main - 45 and control - 44 groups. Clinical psychotherapeutic interviewing, a scale of situational and personal anxiety C.D. Spielberger (adapted by Y.L. Khanin), a questionnaire for analyzing satisfaction with the quality of medical services provided in outpatient settings were used. Statistical: Microsoft Excel spreadsheet editor for Windows; the STATISTICA application software package version 6.1. were taken. The condition for determining statistically significant differences is the value р≤0,05.MethodsTwo-stage study by the method of contiuous sampling. Clinical psychotherapeutic interviewing, a scale of situational and personal anxiety C.D. Spielberger (adapted by Y.L. Khanin), a questionnaire for analyzing satisfaction with the quality of medical services provided in outpatient settings were used. Statistical: Microsoft Excel spreadsheet editor for Windows; the STATISTICA application software package version 6.1. were taken. The condition for determining statistically significant differences is the value р≤0,05.ResultsThe level of anxiety in patients who received anxiolyticsLevel of anxietyexamination day, %day of operation %SAPASAPAlow22*22,535*21medium53,564,55767high24,5*138*13*- р≤0,05; SA-situational anxiety; PS – personal anxietyThe study revealed an average and high level of situational anxiety in 66% of patients referred for refractive surgery, in 81% of patients referred for cataract surgery. Into main group, against the background of the performed anxiolytic therapy in the preoperative period, the proportion of people with a high level of reactive anxiety decreased significantly (p≤0.05) (from 24% to 8%), while personal anxiety did not significantly change. Among control group patients show a lower level of satisfaction with the quality of medical services provided in an outpatient setting.ConclusionsThe study showed the possibility of providing better quality medical services in «one-day» eye surgery, which expands the availability of outpatient ophthalmic surgical care to patients with high level of anxiety and anxiety disorders.Disclosure of InterestNone Declared

Commentary: Retinal changes after internal limiting membrane peeling.

The internal limiting membrane (ILM) is the innermost of the 10 retinal layers. It is a transparent membrane measuring nearly 10 microns and is formed by the basement membrane of the Müller cells. It is peeled as a standard treatment of full-thickness macular hole (FTMH). However, many reports have shown that peeling the ILM may actually damage the retina. Wollensak et al.[1] showed that ILM removal reduces the mean strength of the central retina by almost half. Histological studies performed on human and primate eyes have shown that ILM peeling causes damage to the processes and end feet of the Müller cells. A selective delay has been noted in the B-wave recovery of focal macular electroretinogram in eyes that have undergone ILM peeling. Several anatomical changes have been described after ILM peeling.[2] Swelling of the arcuate nerve fiber layer (SANFL): It was first described by Clark et al.[3] as an early postoperative change. It is seen as hypoautofluorescent arcuate striae in the macular region on fundus autofluorescence (FAF) and infrared (IR) imaging; however, it cannot be detected on either biomicroscopic fundus examination or color photograph. It is seen as a hyperreflectant swelling on spectral domain optical coherence tomography (SD-OCT). It usually disappears gradually over a period of 2–3 months. It does not seem to affect the best-corrected visual acuity (BCVA) or retinal sensitivity. Dissociated optic nerve fiber layer (DONFL): It was first described by Tadayoni et al.[4] in 2001. It is also known as “concentric macular dark spots (CMDS)” or “inner retinal dimpling”.[2] It gives the macula a ‘‘moth-eaten’’ appearance due to the presence of small depressions on the retinal contour situated along the course of retinal nerve fibers on the en face scan. SD-OCT scans show that the depth of these dimples is limited to the RNFL only. Liu et al. found three distribution patterns, namely, papillomacular bundle-dominated, scattered, and temporal raphe-spared patters.[5] Ye et al.[6] showed that DONFL appeared within two months of surgery. The number progressed during the next four months and then slowed down. The number did not change after 12 months since the surgery. It has not been found to have association with either BCVA or retinal sensitivity. Steel et al.[7] showed that the use of a diamond-dusted membrane scraper to initiate the peel is a risk factor for the formation of DONFL. The extent of DONFL has been seen to be positively associated with the amount of cellular debris on the retinal side of the peeled ILM.[8] The perioperative optical coherence tomography (OCT) for ophthalmic surgery (PIONEER) study showed that the immediate increase in the inner retinal layer thickness on intraoperative OCT following ILM peeling was associated with the development of DONFL, while the technique used for peeling did not.[9] Foveal displacement: Several authors have reported a nasal shift of the fovea, that is, shortening of the foveopapillary distance (FPD). Ishida et al.[10] reported that the displacement was greater in the temporal retina compared to the nasal retina. They further reported that the degree of the retinal displacement significantly correlated with the maximum base diameter of the FTMH. However, Nair et al.[11] reported that a temporal foveal shift may be seen in around 25% of the eyes, especially those with a longer temporal segment. Ohta et al. reported that the steepness of the foveal slope increased after ILM peeling in an asymmetrical pattern as the nasal side became significantly steeper than the temporal one.[12] None of these findings seem to affect the BCVA or retinal sensitivity. Retinal thinning: Several studies have shown that the macular volume, especially that of the temporal macula, shows a progressive reduction.[2] It has been proposed that hemi-temporal ILM peeling is as effective as conventional 360-degree peeling for the treatment of FTMH. Additionally, it is associated with less retinal displacement, lesser DONFL formation, lower rates of subjective metamorphopsia, faster visual rehabilitation, and greater safety.[13–15] We congratulate the authors for their study showing that the outcomes of papillomacular bundle sparing ILM peeling is comparable to conventional ILM peeling in terms of hole closure rates and visual gain, with the advantage of less retinal damage for the treatment of idiopathic FTMH ≤400 microns.[16] Studies with larger sample size and larger macular hole size will help validate the surgical technique.

Implementation and Methodology of a Pilot, Localized Video Library of Cataract Surgeries for Residency Training in a Tertiary Philippine Eye Institute

Objectives. Video-based learning of surgical skills is a useful complement in training programs. This is more evident where direct patient exposure is limited due to multiple factors. In ophthalmic surgery, access to high quality ocular surgery videos such as for cataract operations, can provide significant learning points for trainees in an institutional program. Creation therefore of a local, curated, and indexed library of cataract surgery would support alternative means to maximize training of new ophthalmic surgeons. The objective of the project was to develop a local library of cataract surgery videos as an adjunct teaching tool for resident trainees in a Philippine tertiary eye care center.Methods. A collection of cataract surgery videos from 2013-2020 were compiled into a single workstation. Videos were reviewed and catalogued using set keywords for easy searchability and labelling.Results. 256 videos of cataract surgeries were compiled into the library. 6 main headings for the keywords, with 159 total subheadings were established to provide robust tagging and search options to index the video.Conclusion. Particularly in Ophthalmic surgery, refinement of surgical technique is essential in ensuring better postoperative visual outcomes. This is achieved through repetition and careful dissection of operative technique. The use of a library with multiple videos of a similar procedure allows trainees more exposure to certain cases. This ultimately affords trainees, better experience and confidence in their own surgeries.