Prachi Nilraj Bakare

Abstract

Background: Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. Aims & Objectives:. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Materials and Methods: Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. Result: OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student & Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries & constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. Conclusion: The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee. Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons. Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent. This will ultimately improve the overall quality of patient care.   Keywords: OSCAR tool, Feedback, Assessment.

Open full article page

Abstract

Aim: To compare the short term and long term efficacy of using releasable sutures versus the conventional permanent sutures for scleral flap suturing in trabeculectomy in terms of incidence of short term hypotony and its related complications, short term shallowing of anterior chamber, long term IOP control after operations by both techniques and post-operative bleb scores. Materials and Methods: This is a prospective study carried out to compare the safety, efficacy and long term success rate of trabeculectomy with releasable suture verses trabeculectomy with permanent sutures. 60 eyes of primary uncontrolled glaucoma were subjected to trabeculectomy surgery, 30 using permanent sutures and 30 using releasable sutures. Patient were randomly assigned into 2 groups for conventional trabeculectomy with interrupted suture (group 1) and trabeculectomy with releasable suture (group 2). Patients were assessed postoperatively on visual acuity, intraocular pressure, anterior chamber depth, immediate complications, anterior chamber depth, post-operative lens changes. Results: Majority patients were male. Age occurrence of open angle glaucoma was between 51-60 years while angle closure glaucoma was between 40 to 50 years. None of the eyes had severe hyotony (IOP less than 6 mmHg in trabeculectomy with releasable suture, while hypotony was a major complication in trabeculectomy with permanent sutures group. Post-operative mean IOP from the end of 3 months till 12 months was found to be equivalent in both groups. In group 1, 5 eyes (16.66%) anterior chamber was well formed compared to 21 eye in group 2. Bleb scores in both the groups suggested, none of the patients in Group 1 had high bleb score between 2-5 days while 13 patients (43.33%) in group 2 had high bleb score. Visual field loss progressed in 5 eyes, 16.66% in group 1. While none of patients had progressive field loss in group 2. Gross hypotony in immediate post-operative period was observed in group 1 while none pts in group 2 showed post-operative hypotony. Conclusion: Suture release after trabeculectomy has been a useful adjunctive to conventional filtration surgery. It enables the filtration capacity to increase post operatively, decreasing the IOP without another invasive procedure or special instrumentation. It allows surgeon to achieve tighter closure of scleral flap with the assurance that filtration capacity can be increased as needed during post-operative period. Keywords: Glaucoma, Releasable sutures, Trabeculectomy.

Open full article page