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Rigshospitalet - a part of Copenhagen University Hospital
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Quantifying surgical skill in macular surgery

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@article{5c896b192436461e8a3741b918e49330,
title = "Quantifying surgical skill in macular surgery",
abstract = "PURPOSE: To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina.METHODS: We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol.RESULTS: Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 106 μm3 (IQR: 22.77 × 106 -44.81 × 106 μm3 ), 8.42 × 106 μm3 (IQR: 4.86 × 106 -10.03 × 106 μm3 ) and 3.55 × 106 μm3 (IQR: 1.44 × 103 -7.94 × 106 μm3 ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02).CONCLUSIONS: Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.",
keywords = "ILM peeling, macular hole, surgical training, vitreoretinal surgery",
author = "Mark Alberti and Jacobsen, {Mads Forslund} and Hermann, {Martin Nissen} and Lars Konge and Christensen, {Ulrik Correll} and Thomsen, {Ann Sofia Skou} and {la Cour}, Morten",
note = "{\textcopyright} 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",
year = "2021",
month = sep,
day = "22",
doi = "10.1111/aos.15023",
language = "English",
journal = "Acta Ophthalmologica",
issn = "1755-375X",
publisher = "Wiley-Blackwell Munksgaard",

}

RIS

TY - JOUR

T1 - Quantifying surgical skill in macular surgery

AU - Alberti, Mark

AU - Jacobsen, Mads Forslund

AU - Hermann, Martin Nissen

AU - Konge, Lars

AU - Christensen, Ulrik Correll

AU - Thomsen, Ann Sofia Skou

AU - la Cour, Morten

N1 - © 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2021/9/22

Y1 - 2021/9/22

N2 - PURPOSE: To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina.METHODS: We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol.RESULTS: Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 106 μm3 (IQR: 22.77 × 106 -44.81 × 106 μm3 ), 8.42 × 106 μm3 (IQR: 4.86 × 106 -10.03 × 106 μm3 ) and 3.55 × 106 μm3 (IQR: 1.44 × 103 -7.94 × 106 μm3 ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02).CONCLUSIONS: Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.

AB - PURPOSE: To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina.METHODS: We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol.RESULTS: Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 106 μm3 (IQR: 22.77 × 106 -44.81 × 106 μm3 ), 8.42 × 106 μm3 (IQR: 4.86 × 106 -10.03 × 106 μm3 ) and 3.55 × 106 μm3 (IQR: 1.44 × 103 -7.94 × 106 μm3 ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02).CONCLUSIONS: Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.

KW - ILM peeling

KW - macular hole

KW - surgical training

KW - vitreoretinal surgery

UR - http://www.scopus.com/inward/record.url?scp=85115221752&partnerID=8YFLogxK

U2 - 10.1111/aos.15023

DO - 10.1111/aos.15023

M3 - Journal article

C2 - 34549889

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

SN - 1755-375X

ER -

ID: 67679558