Mainak Bhattacharyya

Ocular Decompression Retinopathy : A Case Series

INTRODUCTION Ocular decompression retinopathy (ODR) is a relatively rare entity with variable prognosis depending on extent and pre-existing condition. This article describes profile of two cases with a brief review of the condition. CASE REPORT Case 1 highlights extensive choroidal detachment with subhyaloid haemorrhage and multiple intra-retinal hemorrhages in the posterior pole seen on first post-operative day in a 6 year old child with congenital glaucoma who underwent Trab & Trab. Case 2 describes multiple intraretinal hemorrhages seen at posterior pole on second post-operative day in a 24 year old pregnant lady with post traumatic cataract and secondary glaucoma who underwent cataract extraction with Cionni ring. Both patients had complete resolution of the haemorrhages with topical steroids. CONCLUSION Ocular decompression retinopathy is mostly seen after operations on cases with advanced glaucoma and those with vulnerable blood flow fluidics. Adequate precautions to prevent this entity should be adopted during surgery and management of the manifest entity is conservative with good prognosis.

Epidemiology and Implications of Ocular Trauma Admitted to a Tertiary Care Hospital in North India

Purpose: To study the aetiology, epidemiological profile of patients presenting with ocular trauma and compare the visual outcomes of early versus late presentation. Study Design: Prospective observational study performed over a fifteen month interval. Materials and Methods: Patients’ epidemiological characteristics were evaluated along with cause of trauma, place of injury, time lag post injury and postoperative management. Injuries were classified by Birmingham Eye Trauma Terminology (BETT). Final visual and anatomical outcome after providing tailored surgical management was evaluated. All patients had a minimum follow up of 6 months. Statistical Analysis: All the data collected was analysed using SPSS version 17.0 software. Results: One hundred and three cases of incident ocular injury were included in the study. Open globe: closed globe injuries were 78:22% respectively with intraocular foreign body present in 14%. Actively working adults younger than 25 years of age were the commonest age group affected at 62%.The commonest place of injury was at home (32%) followed by outdoor (29%) and workplace environment (26%). Good outcome (vision of > 6/60 Snellen) could be achieved in 50% cases, of which 53% had anterior segment injury and 20% concomitant retinal injury. Good outcome had a direct correlation with early presentation in 56% and poor outcome with late presentation seen in 38% cases. Conclusion: Serious ocular trauma frequently occurs at home with the younger population maximum at risk. Good visual acuity is associated with early intervention and pure anterior segment injuries.

Using role-plays as an empathy education tool for ophthalmology postgraduate

Purpose: To assess the role of an “empathy sensitizing module” (ESM) in ophthalmology postgraduates in promoting effective empathetic communication. Methodology: Thirty-nine ophthalmology postgraduates were taught effective empathetic communication using specially designed module, comprising of five illustrative role-plays. We evaluated the impact of the training by (a) self-assessment of empathy quotient by residents using Jefferson Scale of Empathy (JSE scale) before and 6 weeks after ESM training and (b) nonparticipant observation (NPO) by trained faculty in real-life settings over the next 4 months. A peer-validated, self-designed checklist was used for NPO. The change in score was analyzed using Students paired t-test. The faculty observed the use of empathy in real-life patient encounters of the trainees over the next 6 months. In addition, secondary qualitative data were collected and analyzed to assess the impact of the module on other stakeholders such as the role-playing undergraduate students and core faculty. Results: Pretraining assessment revealed that concept of empathy during patient communication was understood by only 10% students. PostESM training, the self-rated mean empathy score, on JSE, significantly increased from 95.9 to 106.7 (of a maximum of 140). This was also confirmed by a significant improvement in externally rated empathy and soft skills scores (from 29.3 to 39.1; of a maximum of 55) using the NPO tool. Focus group discussion was done on the continued display of empathy by the trainees in real-life situation over 6 months of observation by the faculty. The group agreed that there was a gradual attrition of initial gain in empathy behavior over the observation period of 6 months. The spillover benefits of the training process were observed among the role-playing undergraduates as well. A thematic analysis of their reflections on the process revealed a substantial change with an improved understanding of effective communication. Conclusions: There is a definite scope for introducing empathetic communication in medical training. Empathetic communication can be improved by effective training in a contextual manner with a need for regular reinforcement. Sensitization at all levels including the faculty is required to implement effective communication skills in medical profession.