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Rectal cancer: Is the surgeon the variable in the outcome  [PDF]
Ignjatovi? D.,Bergamaschi R.
Acta Chirurgica Iugoslavica , 2004, DOI: 10.2298/aci0402093i
Abstract: Four factors influence the outcome of rectal surgery: tumour biology, stage of lesion, type of surgery performed and the performing surgeon himself1. Tumour biology and tumour stage depend on each other and are not influenced on by the surgeon, while he seems to have a great influence on the latter two factors. This influence mainly consists of the following: training, volume, individual skill and experience.
Visual Outcome Of Traumatic Cataract Surgery In Ibadan, Nigeria
CO Bekibele, O Fasina
Nigerian Journal of Clinical Practice , 2008,
Abstract: To review the visual outcome of traumatic cataracts operated at the University College Hospital, Ibadanwith the view to making recommendations for improved outcome. All patients operated at the University College Hospital Ibadan, Nigeria between May 1999 and April 2004with traumatic cataractwere reviewed retrospectively to determine visual outcome andmain causes of poor visual outcome <6/18, using a structured data entry form and information obtained from the operation register and case notes of patients 32 patients, age range 2 to 71years, mean age 25.6 SD 16.1years were reviewed. 22 (68.8%) were maleswhile 10(31.2%)were females.Causes of traumatic cataract includedwood /stick splinters in 7 (21.9%), cane/ whiplash injury 6(18.8%), and propelled missile injuries, 5(15.6%). Less important cause of injuries were gun shot, road traffic accident and fist injuries. 11 (35.6%) of the patients had best corrected post operative visual acuity of >6/18, 10 (32.2%) < 6/18-3/60,while 32.2%of the cases reviewed remained blind or had vision <3/60 in the affected eye. Cause of poor post operative visual acuity (less than 6/18) in 64.4% of the subjects included cornea opacity 12.5%, posterior capsule opacity 12.5%, retinal detachment 9.4%, and glaucoma 6.9% Useful vision can be restored in a proportion of traumatic cataracts through surgery, although sight-limiting complications, which may be related to the severity of the trauma or prolonged post op inflammation may be present, many are potentially treatable with further intervention. The need for adequate health education to prevent ocular injuries and preoperative diagnosis of associated posterior segment complications thatmay prevent optimal post-operative visual acuity is also noted.
Visual outcome following cataract surgery in rural punjab.  [cached]
Anand R,Gupta A,Ram J,Singh U
Indian Journal of Ophthalmology , 2000,
Abstract: In a cluster sample survey in rural areas of Punjab visual outcome after cataract surgery was assessed. Three hundred patients (428 cataract operated eyes) were included in the study from 24 sampled villages. The mean age at cataract extraction was 61.70 +/- 9.82 years. The average interval since the cataract surgery was 7.05 +/- 5.86 years (range 0.11-32 years). Of the 428 operated eyes, 72 (16.82%) were blind (VA < 3/60), 162 (37.85%) had low visual acuity (VA 3/60-< 6/18) and 194 (45.33%) eyes gained good visual acuity (VA > or = 6/18). Cataract surgery related complications were the principal causes leading to blindness in 50 of 72 eyes; these included corneal oedema, (17/72;23.3%), retinal detachment (14/72;19.4%), and aphakic glaucoma (13/72;18.05%). This study emphasizes the need to improve the qualitative aspect of cataract surgery including long-term follow up in rural India.
Outcome of Cataract Surgery in Patients Treated for Retinopathy of Prematurity  [PDF]
Huy Nguyen, Kimberly G. Yen
Open Journal of Ophthalmology (OJOph) , 2017, DOI: 10.4236/ojoph.2017.74038
Background/Aims: Pediatric patients with treated retinopathy of prematurity (ROP) may develop visually significant cataracts. We report the outcome of cataract surgery in patients who had ROP treatment. Method: Retrospective chart review of 19 eyes from 16 patients who had ROP treatment and subsequent cataract surgery between August, 2002 and March, 2015. Results: Eighteen of 19 eyes received laser treatment for ROP; 1 eye received intravitreal bevacizumab. 5 eyes received lens-sparing pars plana vitrectomy (LSPPV) in addition to laser. Average follow up was 10.1 ± 5.5 years. Average visual acuity improved from 20/324 prior to and 20/110 after cataract surgery (p = 0.06). 13/19 (68%) of the eyes received laser only and developed cataracts an average of 6.2 ± 5.6 years after laser treatment. 5/19 (26%) eyes developed cataracts an average of 6.4 ± 4.2 years after LSPPV and laser. In one eye, a cataract developed after a bevacizumab injection 2.9 years after the injection. Visual axis opacification (VAO) developed in 2/5 (40%) eyes after Ce/PCIOL/PPC-Antvx, 8/10 eyes (80%) after CE/IOL, and in 0/4 eyes after CE/PPC-AntVx. Ocular comorbidities included strabismus, nystagmus, amblyopia, optic atrophy, corneal band keratopathy, and phthisis bulbi. Conclusion: Cataract surgery in patients who have a history of ROP can be complicated by anatomical changes from prematurity and prior vitreoretinal surgeries. Vision improvement is limited by other ocular comorbidities.
Cataract complications
David Yorston
Community Eye Health Journal , 2008,
Abstract: Any eye surgeon, no matter how experienced, will occasionally encounter a serious cataract complication. Although complications may be devastating for the patient and are always distressing for the surgeon, are they really a major issue for VISION 2020? The evidence says that they are.
Visual outcome of cataract surgery with pupillary sphincterotomy in eyes with coexisting corneal opacity
Rajesh Sinha, Namrata Sharma, Rasik B Vajpayee
BMC Medicine , 2004, DOI: 10.1186/1741-7015-2-10
Abstract: Patients with leucomatous corneal opacity with significant cataract were enrolled for the study. The uncorrected visual acuity and best-corrected visual acuity (BCVA) were recorded and the anterior segment was thoroughly evaluated by a slit lamp biomicroscope before the surgery. Only those patients who had some amount of clear peripheral cornea were selected. Posterior segment pathology was ruled out by indirect ophthalmoscopy after pupillary dilatation, if possible, or by B-scan ultrasonography. Conventional extracapsular cataract extraction with pupillary sphincterotomy was performed and an intraocular lens was implanted. Postoperatively, the eyes were evaluated on day 1, and 1 week and 6 weeks following surgery for similar parameters.Fourteen eyes of 14 patients were included in the study, of which 13 (92.85%) patients were male. The mean age of the patients was 47.85 ± 7.37 years. All the eyes had a dense central leucomatous corneal opacity. Twelve (85.71%) eyes had two or more quadrants of deep vascularisation. Sphincterotomy was performed mostly (71.42%) in the nasal or inferonasal quadrant. The intraocular lens was implanted in 13 (92.85%) eyes, and one (7.1%) eye was left aphakic due to the occurrence of a large posterior capsular tear. Preoperatively, all eyes had BCVA < 6/60. At 6 weeks after surgery, all eyes had BCVA ≥ 6/60 and four (28.57%) eyes had BCVA ≥ 6/18. The mean BCVA preoperatively in these eyes was 0.015 ± 0.009, which changed to 0.249 ± 0.102 at 6 weeks following surgery.Extracapsular cataract extraction and intraocular lens implantation with pupillary sphincterotomy provides ambulatory and useful vision to patients of cataract with coexisting central leucomatous corneal opacity.Corneal opacity is an important cause of blindness, especially in third world countries. Around 3% of the blindness in India is secondary to corneal opacity [1]. A cataract is often associated with corneal opacity and contributes to the poor visual acuity. Although co
Visual outcome after cataract surgery at the University College Hospital, Ibadan
OO Olawoye, AO Ashaye, CO Bekibele, BGK Ajayi
Annals of Ibadan Postgraduate Medicine , 2011,
Abstract: Aim: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. Methodology: This is an observational descriptive, longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively, 1st day postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind in the operated eye, while 39 patients (23.6%) were blind in both eyes at presentation. At 1st day postoperatively, 87 patients (47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8%) had good vision while 28 patients (17.4%) had borderline vision, and six patients (3.8%) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6%) to one (0.6%). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1% of patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients.
The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature  [cached]
Lau Rick L,Perruccio Anthony V,Gandhi Rajiv,Mahomed Nizar N
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-250
Abstract: Background A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes. Methods We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language. Results Studies were variable in defining surgeon volume (‘low’: <3 to <52 total knee arthroplasty per year; ‘high’: >5 to >70 total knee arthroplasty per year). Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher), procedure time (165 min versus 135 min), longer length of stay (0.4 - 2.13 days longer), transfusion rate (13% versus 4%), and worse patient reported outcomes. Conclusions Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.
The Professional Medical Journal , 2010,
Abstract: Objective: To observe the tendency of corticosteroids to raise the intraocular pressure after prolonged use of 0.1% dexamethasone eye drops during post operative period of cataract extraction. Study Design: Observational study. Period: From August 2008 to December 2009. Subjects and Setting: In the study 50 patients were included. These patients had age related cataract in one or both eyes.The IOP of every patient was measured preoperatively with the help of Goldman applanation tonometer. After cataract extraction, every patient received 0.1% dexamethasone eye drops four times a day for one month. The IOP was measured fortnightly. Setting: Department ofOphthalmology, Allied Hospital, Faisalabad and the clinics of the authors. Results: Topical administration of 0.1% Dexamethasone EyeDrops ,four times a day for one month after age related cataract extraction caused elevation of intraocular pressure more than 21 mm Hg in 8% of general population.
Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome  [cached]
Gupta Sanjiv,Kumar Ajay,Kumar Deepak,Agarwal Swati
Indian Journal of Ophthalmology , 2009,
Abstract: The authors here describe manual small incision cataract surgery (MSICS) by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. Aims: To evaluate the patients′ and surgeons′ experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. Settings and Design: Prospective interventional case series. Materials and Methods: Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. Statistical Analysis Used: Statistical analysis software "Analyseit." Results: There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD ± 0.97, range 0-5, median 0.0, and mode 0.0). Fifty-one patients (53%) had pain score of zero, that is, no pain. Ninety-one patients (~95%) had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon′s experience was favorable in terms of patient′s cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. Conclusions: MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.
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