Background: Unlike in the USA and Europe, there are no work hour limitations for residents training or working in hospitals in the Philippines and most Asia. There is also no baseline data on the quantity and quality of working hours of residents in the Philippines. To determine and analyze the work and non-work activities among surgical residents in the country, a prospective study was done in selected accredited training programs. Methods: The study involved first year and graduating (4th or 5th year) general surgery residents in selected training hospitals in Manila, Cebu and Mindanao. The subjects were asked to accomplish a 24-hour diary describing the details of their activity for a period of 14 consecutive days. The residents likewise completed a survey regarding satisfaction with their lifestyle and their training activities. The work and non-work hours, and the various activities of the residents were analyzed using appropriate statistical tests. Results: A total of 85 residents (29 senior and 56 first years) from 11 hospitals participated in the study. The average total working hours was 111.2 per week and overall average sleep time was 4.7 hours per day. There were significant differences in total work hours and the amount of time spent for various activities between senior and first year residents, and between residents in private hospitals and government hospitals. There was a significant correlation between total work hours and satisfaction with lifestyle but no correlation with the level of satisfaction within their training activities and desire to reform training. Conclusions: During their training, a significant number of surgery residents in the Philippines experience: 1) Prolonged working hours and potential sleep deprivation, 2) wide disparity in the working hours between senior and first year residents, 3) high proportion of time four scut work and 4) low proportion of time form academic activity, study and out-patient work. Reforms need to be instituted not only to reduce the working hours of surgical residents but also to improve their educational experience in order to promote patient safety, quality of care and the health and well- being residents. Key words: Residents work hours, surgical training
WORKING HOURS

Objective: To report a case of a suture-related corneal abscess caused by Enterococcus casseliflavus on a phacoemulsification corneal incision. Method: This is a case report. Results: An elderly female underwent complicated phacoemulsification surgery on the left eye requiring sutures to seal the corneal incisions. Suture removal was incomplete at the side port, and a suture abscess developed after 9 weeks. Cultures revealed heavy growth of Enterococcus casseliflavus which was initially treated with an empiric broad-spectrum antibiotic (levofloxacin 1.5%) administered via intrastromal and subconjunctival injections, followed by culture-guided topical and oral medications. The corneal infection resolved but significant corneal thinning led to perforation, requiring a modified Gunderson flap procedure to repair the defect. Conclusion Intrastromal and subconjuctival injection of levofloxacin 1.5% may be a viable empiric treatment option for Enterococcus casseliflavus suture-related corneal abscess.
Phacoemulsification

Objective: To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries Methods: This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability. Results: A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision. Conclusion The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries.
Eye Injuries, Penetrating

Objective: To report three consecutive cases of ophthalmia nodosa due to caterpillar hair (setae). Methods: This is a brief report. Results: Three cases of ocular surface injury with history of contact with caterpillar setae are reported. The first case is that of a child with right upper lid swelling, papillary conjunctivitis, and setae embedded in the upper palpebral conjunctiva causing multiple distinct linear abrasions on the cornea. The second patient was an adult male who had setae embedded in the corneal stroma, palpebral conjunctiva, and bulbar conjunctiva, resulting in corneal epithelial defect and a conjunctival granuloma. The last was an adult male who had a subconjunctival hemorrhage due to setae penetration. All were managed with setae removal, topical antibiotic and steroid eyedrops, and other symptomatic treatment strategies as needed. Conclusion Clinical features of ophthalmia nodosa vary depending on the site of setae penetration. Meticulous setae removal is key to successful management in addition to inflammation control and infection prophylaxis.
Sensilla

Objectives: To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis. Methodology: This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. Results: Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group. Conclusions DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.
Dry Eye Syndromes ; Philippines

Objective: We reported a case of Descemet's membrane detachment (DMD) following ripcord removal of a Baerveldt shunt in a post-corneal transplant eye, and the interventions done. Method: This is a case report Results: A 65-year-old male with multiple surgeries (phacoemulsification, two corneal transplants, and Baerveldt shunt implantation) in the right eye developed increased intraocular pressures, prompting removal of the intraluminal stent (ripcord) of the shunt. This was complicated by hypotony and DMD. Ripcord reinsertion and viscoelastic injection were performed to reattach the Descemet's membrane (DM) but failed. 0.1mL of 14% perfluoropropane (C3F8) gas was injected into the anterior chamber that successfully reattached the DM with return to pre-operative best-corrected visual acuity after 1 week. Conclusion Injection of an expansive gas (C3F8) was effective in repairing a corneal graft DMD in an eye with a Baerveldt shunt.
Glaucoma Drainage Implants ; Corneal Transplantation