AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retros...AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy(PDT) as needed. The main outcome measures were best-corrected visual acuity(BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2 mo(range 12-35 mo). Mean BCVA at baseline(2.16±0.39 logM AR)had improved significantly, both 3 mo after surgery(1.42±0.66 log MAR, P<0.001) and by the last visit(1.23±0.74 logM AR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes(16.3%) and ciliary body detachment in 4 eyes(4.7%).Nineteen eyes(22.1%) received following treatment with ranibizumab injections without/with PDT, and 15(17.4%)were resolved. Four eyes(4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis,thicker SRH(beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis(beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.展开更多
In a rapidly changing world,there is an increased need to cultivate ophthalmologists who are not only technically capable but also possess the leadership skills required to be at the forefront of change.Ophthalmologis...In a rapidly changing world,there is an increased need to cultivate ophthalmologists who are not only technically capable but also possess the leadership skills required to be at the forefront of change.Ophthalmologists make daily frontline decisions that determine the quality and efficiency of care based on their leadership qualities.However,they also educate,advocate,perform research,run departments and work in practices-all of which require the practice of effective leadership.Although the need for ophthalmic leadership has been recognised,few training programs offer leadership skills as a component of their core curricula,focussing on clinical knowledge with less emphasis on teaching of non-clinical professional competencies.Clinicians who participate in leadership development are more likely to feel empowered to provide patient-centred care,develop a greater self-awareness and confidence to initiate positive change and promote better team alignment.In turn,the ophthalmic profession collectively benefits from effective leadership as organizations are better run,issues are advocated more globally and challenges are address holistically by ophthalmologists who are not merely technically capable surgeons or researchers,but effective communicators and collaborators.In this paper,we explore the role of leadership in the spheres of healthcare and ophthalmology.We discuss the value of leadership across clinical,educational and organisational levels,with specific emphasis on the current state of development and conclude with a series of recommendations to ensure the continued development of effective ophthalmic leaders into the future.展开更多
基金Supported by the National Natural Science Foundation of China (No.81271009)the Science and Technology Planning Project of Guangdong Province, China (No.2017A030303016)
文摘AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage(SRH) management for massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy(PDT) as needed. The main outcome measures were best-corrected visual acuity(BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2 mo(range 12-35 mo). Mean BCVA at baseline(2.16±0.39 logM AR)had improved significantly, both 3 mo after surgery(1.42±0.66 log MAR, P<0.001) and by the last visit(1.23±0.74 logM AR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes(16.3%) and ciliary body detachment in 4 eyes(4.7%).Nineteen eyes(22.1%) received following treatment with ranibizumab injections without/with PDT, and 15(17.4%)were resolved. Four eyes(4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis,thicker SRH(beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis(beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.
文摘In a rapidly changing world,there is an increased need to cultivate ophthalmologists who are not only technically capable but also possess the leadership skills required to be at the forefront of change.Ophthalmologists make daily frontline decisions that determine the quality and efficiency of care based on their leadership qualities.However,they also educate,advocate,perform research,run departments and work in practices-all of which require the practice of effective leadership.Although the need for ophthalmic leadership has been recognised,few training programs offer leadership skills as a component of their core curricula,focussing on clinical knowledge with less emphasis on teaching of non-clinical professional competencies.Clinicians who participate in leadership development are more likely to feel empowered to provide patient-centred care,develop a greater self-awareness and confidence to initiate positive change and promote better team alignment.In turn,the ophthalmic profession collectively benefits from effective leadership as organizations are better run,issues are advocated more globally and challenges are address holistically by ophthalmologists who are not merely technically capable surgeons or researchers,but effective communicators and collaborators.In this paper,we explore the role of leadership in the spheres of healthcare and ophthalmology.We discuss the value of leadership across clinical,educational and organisational levels,with specific emphasis on the current state of development and conclude with a series of recommendations to ensure the continued development of effective ophthalmic leaders into the future.
