Indocyanine green toxicity.
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Cataract Extraction↗
Biomedical subjects
Thomas A Oetting
Publications and source records attributed to Thomas A Oetting.
Structured journal club as a tool to teach and assess resident competence in practice-based learning and improvement.
PURPOSE: To describe the use of the journal club as a tool to teach and assess competency in practice-based learning (PBL) and improvement among residents in ophthalmology. DESIGN: Interventional case series. PARTICIPANTS: Ophthalmology residents. SETTING: Three academic ophthalmology residency programs in the United States. METHODS: A survey was performed of self-assessed skills in PBL among residents in ophthalmology training before and after the implementation of a structured review checklist during a traditional resident journal club. The survey had 5 domains, including (A) appraise and assimilate evidence, (B) read a journal article critically, (C) use a systematic and standardized checklist, (D) apply knowledge of study designs and statistical methods, and (E) maintain a self-documented written record of compliance. The respondents scored their ability (range, 1-5). RESULTS: The use of a structured journal club tool was associated with a statistically significant improvement in self-assessed ability in all 5 domains. CONCLUSIONS: Although validity, reliability, and long-term efficacy studies are necessary, the structured journal club is one method of teaching and assessing resident competency in PBL and improvement.
Clinical Competence↗
Retained posterior segment indocyanine green dye after phacoemulsification.
We describe a patient who had indocyanine green (ICG) staining of the anterior capsule for phacoemulsification of a traumatic cataract. Intraoperatively, the ICG extended into the posterior segment. Postoperatively, the patient developed ICG toxicity to the retina and had a vitrectomy to remove the ICG. We believe ICG extended into the vitreous through an area of zonular dehiscence.
Adult↗
Bilateral Artisan lens for aphakia and megalocornea: Long-term follow-up.
We received approval from the U.S. implant Food and Drug Administration and the University's Institutional Review Board to the Artisan lens (Ophtec BV) in both eyes of a patient who was aphakic and had megalocornea. No other intraocular lens would easily solve this patient's need because of the large anterior segment. The patient was having increasing difficulty with aphakic contact lenses because of his work environment. We present almost 5 years of follow-up data of this patient.
Anterior Chamber↗
Protecting the haptic when a Monarch injector is used.
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Acrylic Resins↗
Interim results of the United States investigational device study of the Ophtec capsular tension ring.
PURPOSE: To evaluate the safety and efficacy of the Ophtec capsular tension ring (CTR) in providing capsular support during and/or after cataract extraction in cases of a weak or partially broken ciliary zonule. DESIGN: Phase III multicenter, nonrandomized, investigational device study. PARTICIPANTS: Twelve investigators at 9 sites enrolled 224 subjects and placed 255 CTRs. METHODS: Capsular tension rings were placed in patients who were found to have a weakened or partially broken ciliary zonule comprising <34% of the circumference of the lens capsule. Two CTR models were evaluated, with noncompressed diameters of 12 mm and 13 mm. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1 and months 1, 3, 6, and 12. MAIN OUTCOME MEASURES: Rate of successful stabilization of the capsular bag and intraocular lens (IOL) centration, complications, and adverse events. RESULTS: Interim results from this ongoing study indicate that immediately after surgery 98.8% of IOLs were centered and 1.2% of the IOLs implanted (3/251) were not centered. Subsequently, the prevalence of decentered IOLs was 1.7% (4/236) 3 months after surgery, 3.8% (8/211) 6 months after surgery, and 2.3% (4/172) 12 months after surgery. The primary complication was posterior capsular opacification, which is unlikely to be a complication of CTR insertion. Neodymium:yttrium-aluminum-garnet laser capsulotomies have been performed in 12.8% of eyes by 12 months (22/172). CONCLUSIONS: Ophtec CTR models 275 and 276 safely provided capsular support during and after cataract surgery in cases where the zonule was weak or partially broken.
Adult↗
Diamond iris retractor configuration for small-pupil extracapsular or intracapsular cataract surgery.
We describe a technique that uses flexible iris retractors in a diamond configuration for small-pupil extracapsular or intracapsular cataract surgery in eyes with unusually dense nuclear sclerosis. Advantages of this technique include ease of conversion from phacoemulsification, optimal orientation of the maximum pupil diameter for nucleus expression or intracapsular lens removal, and conservation of iris tissue.
Cataract↗
Pop-and-chop nucleofractis.
Horizontal chopping is effective for endocapsular nucleofractis. We describe pop and chop, a variant of chopping that enables an easy first crack and initial segment removal. It involves partial extracapsular prolapse of the nucleus prior to the initial chop. It is particularly useful when hydrodissection results in partial prolapse of the lens nucleus so that it is wedged into the anterior capsule opening. It is also helpful when beginning surgeons are learning phaco chop.
Anterior Chamber↗
Modified technique using flexible iris retractors in clear corneal cataract surgery.
Flexible nylon iris retractors are a useful adjunct to cataract surgery in cases of small pupil. We present a modification of the standard technique. Instead of approaching the square-shaped pupil formed by iris retractors from the side, we recommend an approach anterior to 1 of the retractor hooks. From the surgeon's viewpoint, the pupil goes from a square shape to a diamond shape. This modification minimizes the likelihood of iris prolapse and iris damage during phacoemulsification and increases the workspace for the phacoemulsification needle.
Cornea↗
Presumed iris hemangioma associated with multiple central nervous system cavernous hemangiomas.
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Brain Neoplasms↗
Using the Journal Club to teach and assess competence in practice-based learning and improvement: a literature review and recommendation for implementation.
The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.
Clinical Competence↗
Teaching and assessing surgical competency in ophthalmology training programs.
BACKGROUND AND OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) has mandated implementation of six new competencies in resident training in the United States. An implementation strategy is proposed to teach and assess cataract surgical competence. PATIENTS AND METHODS: An intradepartmental Task Force for the ACGME competencies reviewed the literature for assessment tools to develop an implementation matrix for assessing surgical competence. RESULTS: "Good practices" (gleaned from the literature) were adapted for the institution's needs and tested, including (1) written and explicit goals or objectives for each stage of training; (2) substitution of a criterion-referenced (Dreyfus model) scoring rubric for a norm-referenced, peer-benchmarked global evaluation; (3) use of formative rather than summative feedback; (4) incorporation of deliberate practice (Ericsson model); and (5) portfolio-based documentation of sentinel event markers and remediation. CONCLUSION: An implementation matrix for teaching and assessing surgical competence might be useful for local compliance with the ACGME mandate.
Cataract Extraction↗
Preventing and managing cataract complications: it takes a village.
Cataract surgery continues to be the most common surgical procedure done in the United States. Cataract surgery in today's sophisticated ophthalmic practices is typically a smooth operation, with rare complications. However, maintaining high-quality cataract surgery requires an orchestrated effort from the nurses and technicians in the offices and operating rooms of their ophthalmic surgeons. Preventing and managing complications is a team effort. Our aim is to discuss the common preoperative, operative, and postoperative complications of cataract surgery, with the hope that you will be better able to help with their prevention and management.
Cataract Extraction↗