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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2018; 10(01): e108-e113
DOI: 10.1055/s-0038-1667050
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluating Resident Training in Oculoplastic Surgery: A Case Series of 104 Eviscerations

Brittany A. Simmons
1   Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, New York
,
Anna Artymowicz
2   Department of Graduate Medical Education, University of Rochester School of Medicine and Dentistry, Rochester, New York
,
Mithra O. Gonzalez
1   Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, New York
3   Department of Oral and Maxillofacial Surgery, Eastman Institute of Oral Health, University of Rochester, Rochester, New York
4   Department of Otolaryngology, University of Rochester, Rochester, New York
› Author Affiliations Funding None.
Further Information

Publication History

30 January 2018

05 June 2018

Publication Date:
27 July 2018 (online)

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Abstract

Purpose The aim of this study is to evaluate resident surgical performance based on complications after ocular evisceration.

Methods A retrospective chart review of eviscerations performed between October 2011 and May 2017 by ophthalmology residents as the primary or assistant surgeon under the guidance of a single oculofacial plastic surgeon (M.O.G.) was completed. Data collected included reason for evisceration, resident participation in the case and resident's month of oculoplastic training, surgical technique, subsequent complications, and duration of follow-up.

Results There were no significant differences in complication rates or surgical sequelae in resident-led versus attending-led surgeries. The complication rate for all cases in total was 5.77%. A slight negative correlation existed between the resident's month of training and the presence of postoperative complications. The number of adverse events was found to be significantly correlated with the duration of patient follow-up.

Discussion Ocular eviscerations performed by ophthalmology residents as primary surgeons achieve outcomes equivalent to published reports, suggesting ocular eviscerations are a safe, effective procedure wherein residents can refine surgical skills. Some surgical sequelae may be linked to particular surgeons, implying evisceration outcomes can be used to assess resident surgical performance. Fewer adverse events arose as the resident's length of oculoplastic training increased, but this finding did not reach significance. Larger studies are needed to explore these trends.

Keywords

anophthalmic surgery - ocular evisceration - ophthalmology resident performance - oculoplastic training - ophthalmology resident outcomes
 

  • References

  • 1 Dortzbach RK, Woog JJ. Choice of procedure. Enucleation, evisceration, or prosthetic fitting over globes. Ophthalmology 1985; 92 (09) 1249-1255
    CrossrefPubMedGoogle Scholar
  • 2 Kostick DA, Linberg JV. Evisceration with hydroxyapatite implant. Surgical technique and review of 31 case reports. Ophthalmology 1995; 102 (10) 1542-1548 , discussion 1548–1549
    CrossrefPubMedGoogle Scholar
  • 3 Huang D, Yu Y, Lu R, Yang H, Cai J. A modified evisceration technique with scleral quadrisection and porous polyethylene implantation. Am J Ophthalmol 2009; 147 (05) 924-928 , 928.e1–928.e3
    CrossrefPubMedGoogle Scholar
  • 4 Yousuf SJ, Jones LS, Kidwell Jr ED. Enucleation and evisceration: 20 years of experience. Orbit 2012; 31 (04) 211-215
    CrossrefPubMedGoogle Scholar
  • 5 McAlinden C, Saldanha M, Laws D. Evisceration for the management of ocular trauma. BMJ Case Rep 2013; 2013: bcr2013201235
    CrossrefPubMedGoogle Scholar
  • 6 Lin CW, Liao SL. Long-term complications of different porous orbital implants: a 21-year review. Br J Ophthalmol 2017; 101 (05) 681-685
    CrossrefPubMedGoogle Scholar
  • 7 Nakra T, Simon GJ, Douglas RS, Schwarcz RM, McCann JD, Goldberg RA. Comparing outcomes of enucleation and evisceration. Ophthalmology 2006; 113 (12) 2270-2275
    CrossrefPubMedGoogle Scholar
  • 8 Gürdal C, Erdener U, Irkeç M, Orhan M. Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment. Ocul Immunol Inflamm 2002; 10 (03) 223-227
    CrossrefPubMedGoogle Scholar
  • 9 Blaydon SM, Shepler TR, Neuhaus RW, White WL, Shore JW. The porous polyethylene (Medpor) spherical orbital implant: a retrospective study of 136 cases. Ophthal Plast Reconstr Surg 2003; 19 (05) 364-371
    CrossrefPubMedGoogle Scholar
  • 10 Levine MR, Pou CR, Lash RH. The 1998 Wendell Hughes Lecture. Evisceration: is sympathetic ophthalmia a concern in the new millennium?. Ophthal Plast Reconstr Surg 1999; 15 (01) 4-8
    CrossrefPubMedGoogle Scholar
  • 11 Hansen AB, Petersen C, Heegaard S, Prause JU. Review of 1028 bulbar eviscerations and enucleations. Changes in aetiology and frequency over a 20-year period. Acta Ophthalmol Scand 1999; 77 (03) 331-335
    CrossrefPubMedGoogle Scholar
  • 12 Shah RD, Singa RM, Aakalu VK, Setabutr P. Evisceration and enucleation: a national survey of practice patterns in the United States. Ophthalmic Surg Lasers Imaging 2012; 43 (05) 425-430
    CrossrefPubMedGoogle Scholar
  • 13 Custer PL, Trinkaus KM. Porous implant exposure: incidence, management, and morbidity. Ophthal Plast Reconstr Surg 2007; 23 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 14 Alwitry A, West S, King J, Foss AJ, Abercrombie LC. Long-term follow-up of porous polyethylene spherical implants after enucleation and evisceration. Ophthal Plast Reconstr Surg 2007; 23 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 15 Masdottir S, Sahlin S. Patient satisfaction and results after evisceration with a split-sclera technique. Orbit 2007; 26 (04) 241-247
    CrossrefPubMedGoogle Scholar
  • 16 Smith RJ, Prazeres S, Fauquier S, Malet T. Complications of two scleral flaps evisceration technique: analysis of 201 procedures. Ophthal Plast Reconstr Surg 2011; 27 (04) 227-231
    CrossrefPubMedGoogle Scholar
  • 17 Jung SK, Cho WK, Paik JS, Yang SW. Long-term surgical outcomes of porous polyethylene orbital implants: a review of 314 cases. Br J Ophthalmol 2012; 96 (04) 494-498
    CrossrefPubMedGoogle Scholar
  • 18 Zhang Y, Zhang MN, Wang X, Chen XF. Removal of the eye in a tertiary care center of China: a retrospective study on 573 cases in 20 years. Int J Ophthalmol 2015; 8 (05) 1024-1030
    PubMedGoogle Scholar
  • 19 Kang MJ, Jung SK, Cho WK, Paik JS, Yang SW. Long-term surgical outcomes of the multi-purpose conical porous synthetic orbital implant. Korean J Ophthalmol 2015; 29 (05) 294-300
    CrossrefPubMedGoogle Scholar
  • 20 Ababneh OH, AboTaleb EA, Abu Ameerh MA, Yousef YA. Enucleation and evisceration at a tertiary care hospital in a developing country. BMC Ophthalmol 2015; 15: 120-127
    CrossrefPubMedGoogle Scholar
  • 21 Verhoekx JSN, Rengifo Coolman A, Tse WHW, Paridaens D. A single- versus double-layered closure technique in anophthalmic surgery. Ophthal Plast Reconstr Surg 2017; 33 (05) 329-333
    CrossrefPubMedGoogle Scholar
  • 22 Frost WA. What is the best method of dealing with a lost eye?. BMJ 1887; 1 (1378): 1153-1154
    CrossrefPubMedGoogle Scholar
  • 23 Green WR, Maumenee AE, Sanders TE, Smith ME. Sympathetic uveitis following evisceration. Trans Am Acad Ophthalmol Otolaryngol 1972; 76 (03) 625-644
    PubMedGoogle Scholar
  • 24 Lubin JR, Albert DM, Weinstein M. Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913–1978). Ophthalmology 1980; 87 (02) 109-121
    CrossrefPubMedGoogle Scholar
  • 25 Gasch AT, Foster CS, Grosskreutz CL, Pasquale LR. Postoperative sympathetic ophthalmia. Int Ophthalmol Clin 2000; 40 (01) 69-84
    PubMedGoogle Scholar
  • 26 Custer PL, Reistad CE. Enucleation of blind, painful eyes. Ophthal Plast Reconstr Surg 2000; 16 (05) 326-329
    CrossrefPubMedGoogle Scholar
  • 27 Phan LT, Hwang TN, McCulley TJ. Evisceration in the modern age. Middle East Afr J Ophthalmol 2012; 19 (01) 24-33
    CrossrefPubMedGoogle Scholar
  • 28 Le TD, Adatia FA, Lam WC. Virtual reality ophthalmic surgical simulation as a feasible training and assessment tool: results of a multicentre study. Can J Ophthalmol 2011; 46 (01) 56-60
    CrossrefPubMedGoogle Scholar
  • 29 Roohipoor R, Yaseri M, Teymourpour A, Kloek C, Miller JB, Loewenstein JI. Early performance on an eye surgery simulator predicts subsequent resident surgical performance. J Surg Educ 2017; 74 (06) 1105-1115
    CrossrefPubMedGoogle Scholar
  • 30 Taylor JB, Binenbaum G, Tapino P, Volpe NJ. Microsurgical lab testing is a reliable method for assessing ophthalmology residents' surgical skills. Br J Ophthalmol 2007; 91 (12) 1691-1694
    CrossrefPubMedGoogle Scholar
  • 31 Khalifa YM, Bogorad D, Gibson V, Peifer J, Nussbaum J. Virtual reality in ophthalmology training. Surv Ophthalmol 2006; 51 (03) 259-273
    CrossrefPubMedGoogle Scholar
  • 32 Thomsen ASS, Kiilgaard JF, la Cour M, Brydges R, Konge L. Is there inter-procedural transfer of skills in intraocular surgery? A randomized controlled trial. Acta Ophthalmol 2017; 95 (08) 845-851
    CrossrefPubMedGoogle Scholar
  • 33 Deuchler S, Ackermann H, Singh P, Kohnen T, Wagner C, Koch F. Key factors to improve the outcome of retinal reattachment surgery in proliferative vitreoretinopathy and proliferative diabetic retinopathy. J Ophthalmol 2017; 2017: 2323897
    PubMedGoogle Scholar
  • 34 Menda SA, Driver TH, Neiman AE, Blumberg S, Naseri A, Stewart JM. Risk factors for return to the operating room after resident-performed cataract surgery. Semin Ophthalmol 2018; 33 (02) 210-214
    PubMedGoogle Scholar
  • 35 Cremers SL, Lora AN, Ferrufino-Ponce ZK. Global rating assessment of skills in intraocular surgery (GRASIS). Ophthalmology 2005; 112 (10) 1655-1660
    CrossrefPubMedGoogle Scholar
  • 36 Cremers SL, Ciolino JB, Ferrufino-Ponce ZK, Henderson BA. Objective assessment of skills in intraocular surgery (OASIS). Ophthalmology 2005; 112 (07) 1236-1241
    CrossrefPubMedGoogle Scholar
  • 37 Fisher JB, Binenbaum G, Tapino P, Volpe NJ. Development and face and content validity of an eye surgical skills assessment test for ophthalmology residents. Ophthalmology 2006; 113 (12) 2364-2370
    CrossrefPubMedGoogle Scholar
  • 38 Mishra K, Mathai M, Della Rocca RC, Reddy HS. Improving resident performance in oculoplastic surgery: a new curriculum using surgical wet laboratory videos. J Surg Educ 2017; 74 (05) 837-842
    CrossrefPubMedGoogle Scholar
  • 39 Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach 2007; 29 (07) 648-654
    CrossrefPubMedGoogle Scholar