Ophthalmologic Operation Research Articles

Survey on prescriptions of similar-looking formulations to patients requiring ophthalmological operations

Survey on prescriptions of similar-looking formulations to patients requiring ophthalmological operations

Ophthalmology Operation Note Encoding with Open-Source Machine Learning and Natural Language Processing

Introduction: Accurate assignment of procedural codes has important medico-legal, academic, and economic purposes for healthcare providers. Procedural coding requires accurate documentation and exhaustive manual labour to interpret complex operation notes. Ophthalmology operation notes are highly specialised making the process time-consuming and challenging to implement. This study aimed to develop natural language processing (NLP) models trained by medical professionals to assign procedural codes based on the surgical report. The automation and accuracy of these models can reduce burden on healthcare providers and generate reimbursements that reflect the operation performed. Methods: A retrospective analysis of ophthalmological operation notes from two metropolitan hospitals over a 12-month period was conducted. Procedural codes according to the Medicare Benefits Schedule (MBS) were applied. XGBoost, decision tree, Bidirectional Encoder Representations from Transformers (BERT) and logistic regression models were developed for classification experiments. Experiments involved both multi-label and binary classification, and the best performing model was used on the holdout test dataset. Results: There were 1,000 operation notes included in the study. Following manual review, the five most common procedures were cataract surgery (374 cases), vitrectomy (298 cases), laser therapy (149 cases), trabeculectomy (56 cases), and intravitreal injections (49 cases). Across the entire dataset, current coding was correct in 53.9% of cases. The BERT model had the highest classification accuracy (88.0%) in the multi-label classification on these five procedures. The total reimbursement achieved by the machine learning algorithm was $184,689.45 ($923.45 per case) compared with the gold standard of $214,527.50 ($1,072.64 per case). Conclusion: Our study demonstrates accurate classification of ophthalmic operation notes into MBS coding categories with NLP technology. Combining human and machine-led approaches involves using NLP to screen operation notes to code procedures, with human review for further scrutiny. This technology can allow the assignment of correct MBS codes with greater accuracy. Further research and application in this area can facilitate accurate logging of unit activity, leading to reimbursements for healthcare providers. Increased accuracy of procedural coding can play an important role in training and education, study of disease epidemiology and improve research ways to optimise patient outcomes.

Analysis of pupil size by repeat dilation at shrinkage stage.

To compare the pupil size of the original mydriasis and repeat mydriasis at the pupil shrinkage stage. Randomized prospective study. In total, 60 eyes of 30 patients aged 50-70 with age-related cataracts were included. Pupil sizes were measured by the Sirius system before mydriasis, after the first batch of mydriasis, and after the second batch of mydriasis which was 5h later. Statistical analysis was performed using MedCalc statistical software version 20.0.3 RESULTS: The pupil size of the second batch of mydriasis 5h later was smaller than the first batch of mydriasis (3.94 ± 0.88mm vs 5.12 ± 0.96mm, P < 0.0001). Less efficiency repeat mydriasis several hours later compared with original mydriasis in our study suggests that preparation of mydriasis at an appropriate time is necessary for ophthalmological operations. The effect of repeat mydriasis again by tropicamide at the shrinkage stage still needs to be explored.

The influence of dexmedetomidine on the emergence agitation of pediatric patients after the operations of sense organs under general anesthesia using sevoflurane.

We investigated the influence of dexmedetomidine on the emergence agitation of pediatric patients after ophthalmologic operation under general anesthesia using sevoflurane. We selected 90 patients that were administered pediatric ophthalmologic operation for the study. The patients were randomly divided into 3 groups according to the administration way of drugs, i.e. the normal saline group (group S, N.=30), the midazolam group (group M, N.=30) and the dexmedetomidine group (group D, N.=30). For all patients, anesthesia induction was performed using sevoflurane before anesthesia, and the anesthesia was maintained in the operation with a combination of sevoflurane and remifentanil; laryngeal mask airway (LMA) was used for assisted ventilation. Ten minutes before the end of operation, 15 mL of 0.9% normal saline, 0.05 mg/kg of midazolam and 0.5 μg/kg of dexmedetomidine were administered to group S, group M and group D, respectively. After the operation, we observed the awakening time, time of the LMA removal as well as the recovery time in the Post Anesthesia Care Unit (PACU) of patients in all three groups. We evaluated the postoperative condition of sedation and agitation of the patients using Ramsay Sedation Scale, 5-point scale and Pediatric Anesthesia Emergence Deliriums Scale (PAED) and performed statistical analysis. In the comparisons of awakening time, time of the LMA removal as well as the recovery time, we found that group M was the longest sequentially followed by group D and group S with statistically significant differences (P<0.05). While the comparison of the scores of Ramsay Sedation Scale revealed that group D scored highest followed by group M and group S with statistically significant differences (P<0.05), both of the comparisons of the scores of 5-point scale and PAED Scale showed that group D scored the lowest, followed by group M and group S in sequence with statistically significant differences (P<0.05). Dexmedetomidine can significantly lower the incidence of emergence agitation of pediatric patients after the ophthalmologic operation under sevoflurane anesthesia.

Surgical treatment options for congenital/infantile corneal opacities and anterior segment dysgenesis

Due to the risk of amblyopia congenital and infantile corneal opacities have anarrow therapeutic window, frequently with a complex surgical treatment. The present study gives an overview of the current treatment options for congenital and infantile corneal opacities. The results of aliterature search are presented and own clinical data and examples are shown. In children ophthalmologic operations are surgically more demanding and the prognosis is generally worse. Surgical options include phototherapeutic keratectomy, crosslinking, corneal sutures, sectoral iridectomy, block excision and lamellar, penetrating, and auto-keratoplasty. An equally important part of the treatment is conservative treatment, when necessary with bandage lenses, glasses, contact lenses and occlusion. Whenever possible treatment of congenital and infantile corneal opacities should be limited to the affected layers/areas. Nevertheless, children and parents have to be prepared for many examinations, sometimes with the patient under anesthesia and should be well-informed about the prognosis and the risks.

Dependence of the heating effect on tissue absorption coefficient during corneal reshaping using different UV lasers: A numerical study

Corneal reshaping using laser ablation effect is a well-known ophthalmologic operation implemented to correct many vision disorders. UV pulsed lasers are utilized in this surgery due to their high absorption in corneal tissue without affecting the other parts of the eye. Ideally ablation may not be associated with heat transport, since high temperature is the enemy of soft tissues. However, the thermal effect of this procedure can cause tissue damage if the temperature rises above the safety level without appropriate handling. In the present study, we try to find the trade-off between efficient ablation and minimal temperature rise. So the thermal effect on the corneal tissue after applying five UV wavelengths; 193, 210, 213, 223 and 248nm has been simulated and investigated by solving Penne's bio-heat transfer equation using the finite element method. A 3D model of the human cornea is constructed using COMSOL Multiphysics computer software and the temperature rise is determined at the end of the laser pulse. The same spot size and pulse duration are used for each wavelength. While the absorption coefficient of the corneal tissue is the only variable as it is a wavelength dependent. The proposed results show that, the heating effect is directly proportional to the absorption coefficient. The highest recorded temperature was 259°C at 193nm, while, the minimum value was (70.1°C) recorded at 248nm at which the cornea has the lowest absorption coefficient.

Management of Post-DALK Recipient Posterior Stromal Scarring: A Novel Approach.

Management of recipient posterior stromal scarring following deep anterior lamellar keratoplasty (DALK) by a novel approach. A side port knife bent at the tip is used to make a linear incision in the host posterior stroma. Plane between host posterior stroma and DALK tissue is separated using a reverse sinskey hook and multiple radial incisions are made using microvitroretinal scissors. The recipient posterior stromal wedges are removed using 20G vitrector with a cut rate of 800 cuts/min. A Descemet stripping endothelial keratoplasty lenticule is inserted into the anterior chamber and apposed to the posterior surface of DALK tissue using air tamponade. This technique was used in 10 patients who showed clearing of the scarring after the surgery with good apposition of the donor graft to the previous DALK tissue. Conclusion: This is a sutureless, relatively simple, inexpensive, and effective novel surgical technique that avoids complications of open sky procedure and can be replicated in any ophthalmologic operation theatre setup.

Assessment of corneal and fatty tissues biomechanical response in dynamic tonometry tests by using inverse models.

The assessment of corneal biomechanics is essential for studying ophthalmological operations, such as refractive surgeries, and for more accurate estimation of intraocular pressure. The chief aim of the current study is to characterize corneal and fatty tissues in order to construct a model to predict eye globe behavior during dynamic tonometry tests. In the present study, images from corneal deformation, acquired from Corvis ST tonometer, were processed. Then, corneal pure displacement and eye globe retraction were calculated. Utilizing inverse finite element method, corneal material properties were calculated in order to predict pure deformation obtained from Corvis ST. Using a similar approach, material parameters of fatty tissue were estimated in order to predict the eye globe retraction. The model used for fatty tissue was considered as corneal boundary condition in a forward finite element model to create a joint model, which could simulate corneal behavior in dynamic tonometry tests. It was shown that an isotropic material model is accurate enough to predict corneal deformation in dynamic tonometry tests. Moreover, effects of IOP on the estimated material properties were investigated. Finally, utilizing the joint model, it was demonstrated that there is strong correlation between corneal stiffness and the biomechanical parameter introduced by Corvis ST. An eye globe model was constructed and characterized by two distinct inverse models for corneal and fatty tissue. This model can be utilized for predicting eye globe behavior during dynamic tonometry tests besides other ophthalmological operations.

Application of combination of laryngeal mask airway and modified airway evaluation method in airway safety management of infants and young children with general anesthesia in minor ophthalmological operations

Objective To explore the application effect of combination of laryngeal mask airway and modified airway evaluation method in airway safety management of infants and young children with general anesthesia in minor ophthalmological operations. Methods 252 infants and young children undergone minor ophthalmological operations with general anesthesia in Beijing Tongren Hospital, Capital Medical Univering from January to December. 2015 were retrospectively analyzed, with 120 cases 0-12 months old, and 132 cases 1-3 years old, among whom, 73 cases (29.0%) were evaluated with high risk of difficult airway. All the young patients were anesthetized with laryngeal mask airway. On the basis of traditional preoperative assessment, according to characteristic of children development and operation requirements, preoperative nursing evaluation was redesigned to better airway safety management and nursing measures were refined. Results It can be found by case analysis that high-risk factors of airway safety involved abnormal development of patients, complications and difficult airway. Advert events happened to no patient due to accurate evaluation on nursing difficulty and airway safety risk, and measures taken accordingly. Conclusions Combination of laryngeal mask airway and modified airway evaluation method can guarantee airway safety of infants and young children with general anesthesia in minor ophthalmological operations. Key words: Airway management; Laryngeal mask airway; Infants and young children patients; Airway evaluation

Effects of povidone-iodine solution with different concentration on the conjunctival sac washing before intraocular operation

Objective To investigate the effect of different concentration of povidone-iodine solution on preoperative irrigation of the conjunctival sac .Methods A total of 150 patients were randomly divided into Group A, B and C, each group had 50 cases.All patients were performed with conventional intraocular surgery＇s preparation.First, 0.5%iodine solution was used to disinfect all patients＇eyelid, surrounding skin and limbi palpebralis after entering operation room .Second, irrigation of the conjunctival sac was performed （ three different concentration separately ） before operation.1 minute later, bacterial culture of conjunctiva sac and immediately corneal fluorescein staining was done .The degree of conjunctival hyperemia and corneal epithelial damage under slit lamp were compared among groups .Results The negative rate of bacterial culture of conjunctiva sac of the groups using 0.025% iodine solution and 0.05% iodine solution were 92.0% and 94.0%.The effects were better than 78.0%of 0.01%iodine solution group.There were significant differences between groups （χ2 =7.197,P〈0.05）.0.05% iodine solution had a more serious effects and worse corneal epithelial damage compared with the other groups .There were significant differences between groups （χ2 =20.257,18.656, respectively;P〈0.05）.Conclusions 0.025% iodine solution has better bactericidal effect and higher efficiency , and has little damage to the cornea and conjunctiva , so it is more suitable to preoperative disinfection of conjunctival sac in operation in ophthalmology . Key words: Povidone-iodine; Concentration; Irrigation of conjunctival sac; Ophthalmological operation

Surgery, Pathology, and Art in Pietro Gradenigo’s Ophthalmologic Waxworks

Pietro Gradenigo (1831-1904) represents one of the greatest eras of cultural and scientific activity in Italian ophthalmology. Padua's Vincenzo Pinali Medico-historical Library preserves 2 series of ophthalmologic wax models. Made by Pietro Gradenigo in 1884-1889, the first consists of 18 waxes and shows different eyes diseases, such as neoplasm and tenonitis, and ophthalmologic surgical operations, such as some interesting cases of blepharoplasty. The second series from Vienna Medical School was created by Johann Hofmayer, ophthalmologist of the Josephinum in Vienna. The ideas at the foundation of wax modeling and operations represented in these series have some original and significant implications related to the role of medical imaging in didactic and research.

Impact factors analysis of standardized perioperative antibiotic application on nosocomial infection and drug-resistance bacteria

To investigate the impact factors and clinical significance of standardized perioperative antibiotic application on nosocomial infection and drug-resistant bacteria strains in eye hospital. It was a retrospective series case study. The inpatients underwent ophthalmologic operation of one year before standardized application (from Sep. 2009 to Aug. 2010) and one year after standardized application (from Sep. 2010 to Aug. 2011) in Tianjin Eye Hospital were selected and the incidence rate of nosocomial infection and types of drug-resistant strains in these two years were analyzed. From Sep. 2009 to Aug. 2010, the prophylactic antibiotics application rate for type I incisional surgeries was 80.29% (12937/16 111), the nosocomial infection rate was 0.011% (2/17 563). From Sep. 2010 to Aug. 2011, the same values were 44.50% (7968/17 905) and 0.005% (1/19 441). There was a significant decrease of prophylactic antibiotics application comparing these two years (χ(2) = 4587.78, P < 0.05). However, there was no significant difference in nosocomial infection rate (χ(2) = 0.44, P > 0.05). Average antibiotics application rate for inpatient (type I-IV incisional surgeries) was 76.69% (13 469/17 563) from Sep. 2009 to Aug. 2010, and 49.40% (9604/19 441) from Sep. 2010 to Aug. 2011. There was a significant decrease over these two years (χ(2) = 2927.19, P < 0.05). The results of isolation and cultivation of bacteria in these two years showed that staphylococcus epidermidis predominated in gram-positive bacteria, pseudomonas aeruginosa predominated in gram-negative bacteria. Drug resistance rate of staphylococcus was 42.86% (33/77) from Sep. 2009 to Aug. 2010 and 39.19% (39/74) from Sep. 2010 to Aug. 2011. Drug resistance rate of pseudomonas aeruginosa was 2/11 from Sep. 2009 to Aug. 2010 and 2/13 from Sep. 2010 to Aug. 2011. There were no significant differences in drug resistance rate of staphylococcus and pseudomonas aeruginosa between these two years (χ(2) = 0.09, P > 0.05, χ(2) = 0.03, P > 0.05). By standardizing the perioperative antibiotics application in eye hospital, the rate of systemic administration of antibiotics declined gradually. The Choices and the administrative mode of antibiotics were more rational than before. In the meanwhile, the rate of nosocomial infection and drug-resistance did not increase. Therefore, avoiding the drug abuse ensured the medical safety, which was worthy of further study.

Effects of health education on ophthalmological operation or examination in elderly outpatients

Objective To investigate the effects of health education on ophthalmological operation or examination in elderly outpatients. Methods According to check-in time, 1 268 elderly outpatients were divided into control group ( n =641 ) and health education group ( n =627 ). The former followed routine medical procedures while the latter was given health education. Level of cooperation was documented and compared.Results The scores of cooperation during ophthalmological operation or examination in the health education group were significantly higher than those in the control group, such as slit lamp examination, and the differences were statistically significant [(2.21 ±0.59) vs (2.74±0.44);t=6.901,P＜0. 05]. Conclusions Health education is critical for favorably completing ophthalmological operations and examinations on elderly patients and embodies the humanistic concerns of nurses for elderly patients. Key words: Health education; Elderly patients; Ophthalmology

Nursing of elderly patients during ophthalmological operation under local infiltration anesthesia

Objective To discuss the effect of nursing measure that was carried out among elderly patients during ophthalmological operation under local infiltration anesthesia, in order to improve the quality of nursing. Methods To analyze and summarize the preoperative visit and intraoperative nursing among 251 elderly patients. Results There was no nursing mistake and accident happened in all 251 patients during operations. Postoperative visit showed that there were 216 elderly patients felt very satisfied or satisfied with the nursing (86%), and 16 felt dissatisfied (6%), and 19 lost contact because of discharge (8%). Conclusions There are lots of demands from elderly patients during operation under local in-filtration anesthesia, which are different with others. Particular nursing during operation can make them live through operation safely. Key words: Elderly patients; Ophthalmology; Local infiltration anesthesia; Nursing; Operation

Anatomical overview of the ophthalmic anaesthesia

AbstractAs the opening presentation of the ophthalmolgiacal anaesthesia course the thorough review of the anatomy of the orbit is discussed. It includes the bone structure, capsula of Tenon, the blood vessels and finally the nerves. With the knowledge of these the best method of anaesthesia of the different kinds of ophthalmological operations can be planned and applied. This way reducing the number of complications while improving patient satisfaction.

Effect of Total Intravenous Anesthesia with Remifentanil-Propofol on Ophthalmologic Operation of Children

Objective To introduce the advantages of remifentanil-propofol anaesthesia in ophthalmologic operation of children.Mathod A total of 50 cases of children with Ⅰ to Ⅱ degrees of ASA were randomly divided into two groups,i.e.the observation group and control group.These children,aged from 2 to 13 years,were prepared to be operated with selective ophthalmologic operation.The observation group was induced and maintained with remifentanil-propefol,while the control group was induced with remifentanil-propofol and maintained with propofol-isoflurane.The hemodynamics changes,extuhation time and analepsia time of the two groups during anesthesia period were observed;moreover,after extubation,the incidence rates of dyspnea,restlessness during analepsia period,nausea and vomiting after operation were also observed.Result The values of SBP,DBP and HR of the groups at 1min after intubation,the beginning of the surgery,extubation period,surgery period and regaining consciousness period were.signifi-candy different(P<0.05 or P<0.01).The hemodynamics of observation group during anesthesia period was more stable than that of control group;the time from withdrawal to extubation and analepsia of observation group Was obviously shorter than that of control group(P<0.05);after operation,the incidence rate of restlessness of observation group was less than that of control group(P<0.05).Conclusion Total intravenous anesthesia with remifentanil-propofol is a kind of anesthesia method with quick effect,good stability during operation,and quick and smooth reeovery of the patients.Therefore,this anaesthesia method is deserved to be recommended in the ophthalmologic operation of children. Key words: Children; Ophthalmologic operation; Remifentanil; Propofol

Chronic Maxillary Sinusitis Occurred after Reconstruction of Inferior Orbital Wall Fracture

A 27-year-old man presented with symptoms of chronic postnasal drip and nasal obstruction, which had begun one year earlier. He had undergone an ophthalmologic operation due to inferior orbital wall fracture 12 years ago. During physical examination, mucopurulent discharge was observed from the right middle meatus. On the paranasal sinus computed tomography, a sheet-like foreign material was observed inside the right maxillary sinus and haziness was found in the right maxillary, ethmoid, and frontal sinuses. Endoscopic sinus surgery was performed and a silastic sheet, which had been inserted during previous surgery, was removed. After surgery, the patient's symptoms disappeared gradually. We report a case of maxillary sinusitis that occurred after orbital wall reconstruction with a silastic sheet and discuss about the efficacy of the silastic implant.

Tiny ferromagnetic intraocular foreign bodies detected by magnetic resonance imaging: A report of two cases

We report two cases with tiny ferromagnetic intraocular foreign bodies (FBs) that were demonstrated only on magnetic resonance imaging (MRI) and confirmed by subsequent ophthalmologic operation. Both of the patients had a history of ocular trauma and their clinical symptoms were compatible with an intraocular FB. Plain x-ray film, 3 mm slice thickness computed tomography (CT) scans (Toshiba TXT 600 system and GERP22 system), B-scan ultrasonography, and an MRI study (Siemens Impact 1.0 MR system) were acquired. MR examinations were performed using spin-echo (SE) T1, T2, and PD-weighted axial and sagittal or coronal images with 3 mm slice thickness. Plain x-ray film, 3 mm slice thickness CT scans and B-scan ultrasonography all failed to demonstrate any tiny intraocular FBs in these two patients, whereas MRI revealed tiny ferromagnetic FBs due to their characteristic magnetic susceptibility artifact. A ferromagnetic FB was found in the vitreous body of each patient, which were 0.375x0.3x0.15 mm and 0.5x0.4x0.2 mm, respectively, and there was no evidence of MR-induced damage. We suggest that tiny ferromagnetic fragments with a diameter below 0.5 mm, which are too small to be visualized by x-ray plain films and CT images, may be visualized on MR images. These tiny ferromagnetic particles may not be large enough to cause ocular damage during a 1.0T MRI examination. MRI may be a useful tool in the evaluation of tiny intraocular ferromagnetic FBs if other imaging modalities such as plain s-ray, CT scan, and ultrasonography failed to do so. Further evaluation with a large-scale study (in vitro and in vivo animal study) for the safety of detecting tiny (<0.5 mm) intraocular ferromagnetic particles is warranted.

The importance of screening for laser-assisted in situ keratomileusis operation (LASIK) before prescribing isotretinoin

I n an age where isotretinoin (Accutane, Roche Laboratories Inc., Nutley, NJ) has revolutionized the treatment of nodulocystic and refractory acne, the number of prescriptions each year has increased from approximately 800,000 in 1992 to more than 2 million in 2000. Although an effective drug if used under the proper guidelines, these guidelines do not warn dermatologists or patients of the potential dangers if prescribed before or after laser-assisted in situ keratomileusis (LASIK) eye operation. LASIK is an ophthalmologic corneal operation that has soared in popularity since its initial approval in 1992. The American Academy of Ophthalmology reports that 500,000 Americans had LASIK operations in 1999 and it is estimated that more than 1.1 million LASIK cases were performed in the United States in 2003. Although the average age of patients undergoing LASIK is 40 years, many are between the ages of 18 and 30, which overlaps with the population of patients with acne, whose average age is 24 years. LASIK is a revolutionary procedure allowing for vision correction by use of an excimer laser to ablate the corneal stroma. A well-known and documented complication of LASIK operation is dry eye. Given that isotretinoin can also cause dry eye, it is a contraindication to perform LASIK operation on a patient taking isotretinoin. The complications of severe acute and chronic dry eye can be serious including structural corneal damage and ulceration, infection, decreased vision, and loss of vision. The general consensus from a survey of 50 ophthalmologists

Hygienic procedures in operation theatres--guidelines and reality. Data obtained on hygiene control measures by public health service at Frankfurt am Main

Good hygienic practice in hospitals and other medical institutions is mandatory to avoid or to minimise nosocomial infections. In Germany, official recommendations of the commission for hospital hygiene and infection control have been published as guidelines for hygiene management in hospitals as well as guidelines for control measures of the public health services who are obliged by law to control the hygienic situation in hospitals. In this paper the degree of implementation of these guidelines in the hospitals is studied in respect of the hygiene management in the operation theatre. The constructive and functional situation and the personal hygienic management were documented in 22 community and private hospitals in Frankfurt am Main, including 40 operation suites with 111 operation theatres. Data of the layout of the rooms were obtained by questionnaire and the hygienic management was observed by means of standardised checklists. Layout of rooms was not compatible with the recommendations of the Guidelines of 1990 and 2000 in many cases--especially with regard to the demand that doors to the operating theatres be closed. Automatic door closers were often either not available or defective. In some theatre areas correct hand disinfection while entering the suite was not possible for lack of disinfectant distributors at appropriate sites. Recommendations regarding surgical drapes and gowns were correctly observed in most cases, with the exception of changing gowns after having gone to the toilet room. Quite often, omission of hand disinfection after glove removal was observed. A discrepancy in hygienic procedures of nursing service and physicians was seen. In 40 % of the operation suites, powdered gloves were still in use. Though in all but one suite air conditioning systems were available, they were not correctly serviced in many cases. Cleaning and disinfection after single operations and at the end of the operating day were carried out correctly in most cases--except in operation theatres for ophthalmologic operations. Here too, manual preparation and disinfection/sterilisation of surgical instruments was common, and inappropriate use of sterilisers as well as the use of so-called "quick"-sterilisers. The recommendations of the commission for hospital hygiene and infection prevention are generally accepted as guidelines, although the degree of translation into practice was often unsatisfactory.