Ophthalmic Surgical Procedures Research Articles

Anesthesia Applications In Experimental Neurological Disease Modeling

Neuroscience, which covers the molecular mechanisms employed by the brain to cause neurological diseases and how they can be treated, remains current as the subject of high-budget investigations to develop early diagnosis and new treatment modalities with multidisciplinary approaches. For this purpose, creating the appropriate model with the correct modality and anesthesia in neurological in vivo experimental models is the most important phase to obtain accurate results and ensure animal welfare. To manage anesthesia in rodents, knowing the physiological characteristics of anesthetics and their risks will strengthen experimental procedures. Among the injectable anesthetics, ketamine, xylazine, and pentobarbital are the most frequently preferred agents for general anesthesia in short surgical procedures. Isoflurane and sevoflurane are inhaler anesthetics that are administered through a vaporizer because they are liquids. Important advantages of inhaled anesthetics, such as rapid induction and rapid withdrawal, make inhaled anesthetics stand out in neuroscience studies. In this review, the properties of frequently used anesthetic agents in rodents, their usage methods, and which model they are preferred will be discussed. For this purpose, the selection of appropriate anesthetics in animal models such as epilepsy, Alzheimer's disease, ischemia-reperfusion injury, traumatic brain injury, ischemic stroke, experimental autoimmune encephalomyelitis, and ophthalmic surgical procedures and their side effects will be reviewed.

Wetting of the retinal surface by perfluorocarbon liquid: implications for its use as an endotamponade agent and intraoperative tool in retinal detachment surgery

Perfluorocarbon liquids (PFCLs) are essential in ophthalmology due to their unique properties, such as higher density than water, inert chemical nature, and optical transparency. They serve as crucial tools in retinal detachment surgery, acting as both intraoperative aids and short-term tamponade agents. However, the interactions between PFCLs and the retinal surface are not fully understood, limiting insights into potential complications. This study investigates the interfacial interaction between perfluorodecalin (PFCL) and the retinal surface. Wetting behavior of animal retinas by water and PFCL was analyzed, revealing water droplets’ floating phenomenon in PFCL and calculating the critical radius for this effect. Dynamics of water spreading over the retina were examined. A model experiment demonstrated that water’s tendency to float over PFCL, interacting with a hydrophilic surface like the retina, could create traction and damage the retinal surface. These findings enhance our comprehension of physical processes at the PFCL/retina interface and offer practical insights for improving ophthalmic surgical procedures.

Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study

BackgroundThe COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.MethodsThis is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.ResultsThere were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories.ConclusionThis study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Frequency and Distribution of Ophthalmic Surgical Procedures among Patients with Inherited Retinal Diseases

Objective or PurposeIn this study, we aimed to characterize the frequency and distribution of ocular surgeries in patients with inherited retinal diseases (IRDs) and evaluate associated patient and disease factors. DesignRetrospective cohort. ParticipantsSubjects 18 years and older who were followed at the Johns Hopkins Genetic Eye Disease (GEDi) Center. MethodsWe studied a retrospective cohort of patients with an IRD diagnosis to analyze the occurrence of laser and incisional surgeries. Subjects were categorized into two groups: central dysfunction (macular/cone/cone-rod dystrophy, "MCCRD group") and panretinal or peripheral dysfunction (retinitis pigmentosa-like, "RP group"). Genetic testing status was recorded. The association of patient and disease factors on the frequency, distribution, and timing of surgeries was analyzed. Main outcome MeasurePrevalence, prevalence odds ratio (POR), hazard ratio (HR) of ophthalmic procedures by phenotype. ResultsA total of 1472 eyes of 736 subjects were evaluated. Among them, 31.3% (n = 230) had undergone ocular surgery, and 78.3% of those (n=180/230) had a history of more than one surgery. A total of 602 surgical procedures were analyzed. Cataract extraction with intraocular lens implantation (CEIOL) was the most common (51.2%), followed by YAG capsulotomy, refractive surgery, retinal surgery, and others. CEIOL occurred more frequently in RP than in MCCRD subjects (POR 2.59, p = 0.002). RP subjects underwent CEIOL at a younger age than MCCRD patients (HR = 2.11, p < 0.001). ConclusionApproximately one-third of IRD patients had a history of laser or incisional surgery. CEIOL was the most common surgery; its frequency and timing may be associated with IRD phenotype. This data may inform the design of prospective research. Such efforts may illuminate routine clinical decision-making and contribute to surgical strategy development for cell and gene therapy delivery.

TFOS lifestyle report: Effects of elective medications and procedures on the ocular surface and adnexa

This presentation summarizes the findings of the Elective Medications and Procedures Subcommittee of the recent Workshop of the Tear Film &amp; Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease” (www.tearfilm.org). Elective medications and/or procedures are “elected” by patients to improve disease and/or cosmetic appearance to enhance quality of life. They include topical ophthalmic and periocular medications, systemic medications, ophthalmic surgical procedures of the peri‐orbit, the lids, the conjunctiva, the cornea as well as the lens, non‐ophthalmic surgical procedures such as neurosurgery, bariatric surgery and radiation, and a number of non‐surgical ophthalmic procedures and devices. This report describes the impact of these medications and/or procedures on the ocular surface, discusses possible pathogenetic mechanisms involved, and proposes management options.

An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area.

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.

Perioperative COVID-19 Screening at a Tertiary Ophthalmic Institution.

Purpose: To characterize the rate of COVID-19 positivity during presurgical screening and the surgical outcomes of ophthalmic patients who were positive for COVID-19 and to report the overall cost. Methods: This retrospective study included patients 18 years or older who had ophthalmic surgical procedures at a tertiary institution between May 11, 2020, and December 31, 2020. Patients without a valid presurgical COVID-19 test within 3 days before their scheduled procedure, who had incomplete or mislabeled visits, or who had incomplete or missing data in their file were excluded. COVID-19 screening was completed using a polymerase chain reaction (PCR) kit. Results: Of the 3585 patients who met the inclusion criteria, 2044 (57.02%) were women; the mean age was 68.2 years ± 12.8 (SD). Thirteen asymptomatic patients (0.36%) tested positive for COVID-19 via PCR screening. Three patients had a known positive COVID-19 infection within the 90 days before surgery; thus, 10 patients (0.28%) were found to have asymptomatic naïve COVID-19 infection via PCR testing. Testing was associated with a total charge of US $800 000. Five of the 13 patients (38.46%) who tested positive for COVID-19 experienced a delay in their surgery; the mean delay was 17.23 ± 22.97 days. Conclusions: Asymptomatic ophthalmic surgical patients had a low positivity rate with a limited impact on surgery scheduling at a significant cost. Further studies would be valuable in evaluating a targeted presurgical screening population as opposed to universal testing.

Intraocular pressure and cardiovascular effects of dexmedetomidine premedication and tiletamine-zolazepam for anesthetic induction in dogs.

The effect of anesthetic drugs on intraocular pressure (IOP) is an important concern in ophthalmic surgery. The impact of dexmedetomidine (DEX) combined with tiletamine-zolazepam on IOP is scarcely studied. This study aimed to evaluate IOP and cardiovascular effects in dogs after premedication with 5 μg/kg (DEX5) or 10 μg/kg (DEX10) of intramuscular DEX followed by intravenous tiletamine-zolazepam administration for induction of anesthesia in healthy dogs. Eighteen dogs, American Society of Anesthesiologists I or II, without ocular abnormality were investigated. All dogs were randomly divided into the DEX5 (n = 9) and DEX10 groups (n = 9). The IOP, heart rate (HR), systolic blood pressure (SBP), oxygen saturation, and sedation scale were measured before premedication (baseline), after premedication at 5, 10, 15, and 20 min, after tiletamine-zolazepam administration, after endotracheal intubation, and post-operative. There were no significant differences between the groups at any time point. The DEX5 and DEX10 groups had significantly decreased HR values at 10 min compared with baseline. The IOP at 20 min was significantly lower compared to the baseline in the DEX10 group. Moreover, the DEX10 group showed increased IOP, HR, SBP, and sedation scale values after induction and intubation compared with 20 min, but these values did not differ significantly from baseline. All parameters of both groups did not change significantly between post-operative and baseline. Intramuscular DEX (10 μg/kg) is an appropriate premedication in ophthalmic examination or surgical procedures. Moreover, it could be combined with tiletamine-zolazepam for generalized anesthesia in dogs with an ophthalmic problem, as it had no clinically significant effects on IOP or cardiovascular values.

Potential Cost Savings Associated with a Multiuse Preoperative and Preinjection Eyedrop Protocol

To calculate the cost savings associated with a multiuse preoperative and preinjection eyedrop protocol. Economic analysis. Adults undergoing ophthalmic surgical procedures requiring preoperative dilation and intravitreal injections. Economic modeling with scenario analysis was used to derive the value for cost savings secondary to a protocol in which perioperative mydriatic eyedrop bottles are used across multiple patients versus the current protocol in which drop bottles are wasted after single-patient use. Similar analyses were performed for a multiuse povidone-iodine protocol for intravitreal injections. Sensitivity analyses were used to test baseline model assumptions with varying degrees of waste and patient volume. The multiuse mydriatic protocol allowed for a 97.1% reduction in the number of eyedrop bottles required for the single-use protocol (1037 bottles vs. 35 850 bottles). This led to an estimated 5-year cost savings of approximately $240 000 (nominal) per institution (performing an average of 1434 cases/year) in the base case. This savings varied minimally in sensitivity analyses accounting for practical limitations (loss, expiration, or contamination) of multiuse containers, with savings of 97.54% to 95.00% for excess supply ranges from 0% to 100% in the multiuse protocol. Likewise, the cost savings varied minimally in sensitivity analyses for eyedrop sizes, with savings of 99.23% to 96.69% for mydriatic eyedrop sizes of 15 μl per drop to 65 μl per drop, respectively, in the multiuse protocol. Over a 5-year period, for povidone-iodine drops before performing intravitreal injection, the multiuse protocol required 153 bottles compared with 41 954 bottles (99.6% reduction) for the current single-use protocol, resulting in a nominal cost savings of $41 801, which varied minimally in sensitivity analyses. Multiuse perioperative mydriatic eyedrops are a viable option for cost and environmental waste reduction for ophthalmologic procedures and surgeries requiring dilation. Likewise, multiuse povidone-iodine may allow for large relative cost reduction for in-office procedures. The total potential savings over 5 years was estimated at more than $280 000 before adjusting for inflation.

SARS-CoV-2 RNA Detected in Vitreous Samples Obtained at Autopsy.

This work aims to examine the vitreous of autopsy patients with COVID-19 for the presence of SARS-CoV-2 RNA. Four deceased patients with COVID-19 had an autopsy at Massachusetts General Hospital. Two control specimens were obtained from patients undergoing retinal detachment repair with negative preoperative polymerase chain reaction (PCR) testing for SARS-CoV-2 RNA. Vitreous specimens were obtained from autopsy patients with COVID-19 after povidone was placed on the ocular surface to decrease the risk of contamination of the vitreous specimen. SARS-CoV-2 RNA for gene N (nucleocapsid) was tested using reverse transcription-PCR. SARS-CoV-2 RNA was detected in the vitreous of 2 of 4 autopsy patients who died from complications of COVID-19. SARS-CoV-2 RNA can penetrate into the vitreous of systemically infected patients, which might present risks to operating room personnel during ophthalmic surgical procedures.

Effect of General Anesthesia on Intra-ocular Pressure during Ophthalmic Procedures in Our Population

Aim: To determine changes in intraocular pressures (IOP) associated with drugs used for general anesthesia (GA) induction in eye surgery. Study design: Observational prospective study Place and duration of study: Department of Ophthalmology, CMH Rawalpindi from 1st March 2015 to 31st May 2016. Methodology: Eighty subjects that were advised to undergone various ophthalmic surgical procedures under GA were included in the study. Visual acuity, intraocular pressure (IOP), extra ocular motility, anterior and dilated posterior segment examination were carried out to determine the ophthalmic status. Mixed anesthetics were used in all patients. IOP was recorded at T1 (10 min before induction of anesthesia), T2 (10 min after intubation), and T3 (at the conclusion of surgery before extudation) using Perkins tonometers. Changes in IOP before induction of GA, after intubation, and just before extubation were recorded. Results: Mean pre-anesthesia IOP for patients of age was 42.3 years with a range of 9-70 years and mean IOP was 16.4 with a range of 10-23 mmHg. There was a significant decrease in the mean IOP at T2 (Perkins: 4-6 mmHg) and T3 (Perkins: 5-8mmHg) as compared to the IOP at T1 (10-18mmHg. The decreases in IOPs at T2 and T3 were similar in both anesthetic groups (T2: P=4-6mmHg; T3: P = 5-8 mmHg). Conclusion: Significant decrease in IOP after GA was observed with mixed anesthetic agents. For management decisions this aspect of general anaesthesia drugs on IOP as noted with currently used anesthetic agents has to be accounted for and decisions are taken accordingly. Keywords: General anesthesia, inhalation anesthetics, intraocular pressure, Perkins tonometers

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

AimTo evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery.MethodsPatients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis.ResultsThe level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon's, anesthesiologist's, and patients' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range.ConclusionsFor patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.Clinical trial numberNCT 03251222

The Ophthalmology Surgical Competency Assessment Rubric for External Dacryocystorhinostomy Surgery.

The International Council of Ophthalmology (ICO) is currently developing a series of standardized, internationally validated, teaching tool for key ophthalmic surgical procedures called the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs). This study aims to develop an OSCAR for external dacryocystorhinostomy (ExDCR). An international panel of content experts, representing Argentina, India, U.A.E., United Kingdom, and the U.S.A. was established and worked to develop the rubric using a range of online collaboration tools. The team used the standardized OSCAR template as a baseline, developing explicit behavioral descriptors (the behavior and performance expected for each step) that were reviewed and modified with successive models. Learners were scored on a modified 4-point Dreyfus scale of skill acquisition (novice, beginner, advanced beginner, competent) with the removal of the expert domain. The tool was then reviewed by a secondary panel of international content experts, representing Brazil, India, Iran, Singapore, United Kingdom, and the U.S.A. The final OSCAR ExDCR tool was developed in alignment with the ICO-OSCAR standard. Nineteen agreed and weighted stems were produced. Specific comments with regards to the parameters and wording were incorporated to formulate the final rubric, which was internationally agreed and demonstrated face and content validity. The OSCAR ExDCR is skill and behavior based, has ICO agreed standards for assessment, and provides learners with specific targets for improvement. Although the OSCAR tool has face and content validity, further development could better elucidate its precise role.

A custom virtual reality training solution for ophthalmologic surgical clinical trials

We present a summary of the development and clinical use of two custom designed high-fidelity virtual-reality simulator training platforms. This simulator development program began in 2016 to support the phase III clinical trial Archway (ClinicalTrials.gov identifier, NCT03677934) intended to evaluate the Port Delivery System (PDS) developed by Genentech Inc. and has also been used to support additional clinical trials. The two simulators address two specific ophthalmic surgical procedures required for the successful use of PDS and provide state-of-the-art physical simulation models and graphics. The simulators incorporate customized active haptic feedback input devices that approximate different hand pieces including a custom hand piece specifically designed for PDS implantation. We further describe the specific challenges of the procedure and the development of corresponding training strategies realized within the simulation platform.

Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States During the COVID-19 Pandemic

The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.

Pre-Operative SARS CoV-2 Rapid Antigen Test and Reverse Transcription Polymerase Chain Reaction: A conundrum in surgical decision making.

Purpose:Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario.Methods:This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed.Results:204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample.Conclusion:Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

Impact of reduced elective ophthalmic surgical volume on U.S. hospitals during the early coronavirus disease 2019 pandemic.

To estimate the financial impact of coronavirus disease 2019 (COVID-19)-related shutdowns on ophthalmic surgery performed at hospital outpatient departments (HOPDs) in the United States. Nationally representative sample of U.S. hospital payment and cost data. Retrospective review and economic impact analysis. The Nationwide Ambulatory Surgery Sample (NASS) was used to identify ophthalmic surgical procedures and associated charges, which were performed at HOPDs. The highest volume elective ophthalmic procedures were identified. The total hospital cost and payment amount was calculated for each procedure using the Hospital Outpatient Prospective Payment System (OPPS) maintained by the Centers for Medicare & Medicaid Services. Net facility income (estimated payments less OPPS rates) was determined for each elective surgical procedure category and stratified by hospital teaching status. In 2017, elective cataract, strabismus, and keratoplasty surgeries were performed 1 230 992 times at HOPDs. The total cost of these elective surgeries was 2350 million U.S. dollars (USD), with a total hospital payment of 3624 to 3786 million USD. This led to an estimated net income of 1278 to 1440 million USD overall to U.S. hospitals in the NASS dataset from elective ophthalmic surgery (approximately 107 to 120 million USD per month), with a larger proportion performed in teaching hospitals. The cessation of elective ophthalmic surgeries at HOPDs during COVID-19 resulted in a significant loss of income for hospitals in the United States and teaching experiences for trainees at academic medical centers.

&lt;p&gt;A Novel Method of Video Recording Ophthalmic Surgical Procedures&lt;/p&gt;

BackgroundModern surgical microscopes are equipped with video recording and broadcasting capability. We present a simple method for utilizing these systems even in circumstances where the surgeon is operating with surgical loupes.MethodsA divergent lens is suspended immediately below the objective of the microscope, thereby increasing the microscope’s working distance. The microscope can be suspended high above the patient, out of the surgeon’s field of view, yet still provide excellent video recording of the surgical procedure.ResultsThe technique has been used successfully in over 30 surgical cases.ConclusionThis method offers a simple solution for recording surgical procedures that do not use the operating microscope. The implications are relevant to surgeons who operate with surgical loupes.

Clinical experience of using the NGENUITY three-dimensional surgery system in ophthalmic surgical procedures.

To assess the clinical experience of using a three-dimensional (3D) system for ophthalmic surgical procedures. We retrospectively analysed video recordings of patients who underwent 3D ophthalmic surgery, using the NGENUITY® 3D visualization system, or traditional microsurgery at our hospital, from August 2017 to February 2018. Patients underwent phacoemulsification or phacoemulsification combined with vitrectomy. Diagnoses, operation type, duration of continuous curvilinear capsulorhexis (CCC), number of forceps nips during CCC and capsulorhexis complications were recorded. Five surgeons and four assistants answered a 3D surgery questionnaire. Twenty-six of 46 patients who underwent 3D surgery, and 31 of 51 patients who underwent traditional microsurgery (control group) were enrolled. The mean CCC duration in the study and control groups was 31.2±10.8 and 28.7±13.2seconds (p=0.071), and the mean number of forceps nips was 5±2 and 5±2 (p=0.634), respectively. The anterior capsular rupture rate of phacoemulsification under 3D and traditional conditions was 3.85% (1/26 cases) and 3.23% (1/31 cases), respectively. The complication rate was similar between the two groups (p>0.999). Four of five surgeons and two of four assistants believed the clarity of 3D surgery was similar or better than that of traditional microsurgery. The occurrence of dizziness (p>0.999), shoulder and neck pain (p=0.262), backache (p=0.471) and visual fatigue (p=0.347) did not differ significantly between the two methods. The 3D surgical system facilitated similar operation speed and stability as the traditional microscope and provided reliable support for ophthalmic surgery.

Cosmetic blepharoplasty and dry eye disease: a review of the incidence, clinical manifestations, mechanisms and prevention.

Dry eye disease is a multifactorial disease of the ocular surface and can be caused by a variety of iatrogenic interventions, especially ophthalmic surgical procedures. This article reviews the incidence, clinical manifestations, mechanisms and prevention of dry eye disease caused or worsened by cosmetic blepharoplasty, and focus on how to reduce and prevent the occurrence of postoperative dry eye disease and provide the basis for the selection of operation methods and the rational drug during the perioperative period.