Freda Sii

Modified cow-hitch suture fixation of transscleral sutured posterior chamber intraocular lenses: long-term safety and efficacy.

PURPOSE: To evaluate the long‐term safety and efficacy of a new technique using a modified cow‐hitch knot for transscleral suture fixation of posterior chamber intraocular lenses (PC IOLs). SETTING: Public hospital in Brisbane, Australia. METHODS: A retrospective chart review was conducted of consecutive patients who had transscleral sutured PC IOL implantation from March 2000 to June 2006 using the new technique, which was modified to eliminate free suture ends and minimize the risk for knot slippage. Data collected included demographic data, ocular history, preoperative and final best corrected visual acuities (BCVAs), preoperative and postoperative intraocular pressure (IOP), and postoperative complications. RESULTS: Eighty‐two eyes of 79 patients (51 men, 28 women) with a mean age of 62.5 years ± 18.9 (SD) were included in the study. The mean follow‐up was 22.9 ± 21.2 months (range 5 to 76 months). The BCVA was 20/40 or better in 45 eyes (54.9%) and 20/200 or worse in 10 eyes (12.2%). The final BCVA was largely determined by the preoperative underlying ocular pathology. Postoperative complications included temporary increased IOP in 14 eyes (17.1%), escalated glaucoma in 7 eyes (8.5%), temporary hypotony in 7 eyes (8.5%), and retinal detachment, hyphema, and irregular astigmatism in 1 eye (1.2%) each. The PC IOLs remained well centered and without tilt in all eyes. CONCLUSIONS: The technique provided excellent PC IOL centration in the presence of no adequate capsule support. It was effective and safe for transscleral suturing of PC IOLs.

Retinopathy associated with photodynamic therapy for treatment of idiopathic choroidal neovascularization

A case of retinopathy with retinal pigment epithelial alterations due to photodynamic therapy for the treatment of idiopathic choroidal neovascularization is reported. The possible mechanisms are discussed.

Fibrin glue in the management of corneal melt

Human fibrin glue aids physiological healing thereby reducing corneal vascularization and scarring compared with cyanoacrylate tissue adhesive. A 40‐year‐old intellectually disabled man with a corneal melt is reported who was managed successfully using human fibrin glue, alleviating the need for emergency penetrating keratoplasty.

What do patients with glaucoma think about personal health records

Putting patients in control of their records is one way of promoting patient centred care and patients with chronic health problems may benefit most from personal health records (PHRs). Glaucoma management is often complicated by incomplete understanding and poor adherence to treatment, two areas which a PHR may help to address. This study aimed to discover what patients with glaucoma think about PHRs and what type of information a glaucoma PHR should contain.

ReGAE 7: long‐term outcomes of augmented trabeculectomy with mitomycin C in African Caribbean patients

Background:  To evaluate long‐term outcomes and complication rates following trabeculectomy with mitomycin C in a case series of African Caribbean patients.

Preventing avoidable glaucoma blindness in African‐Caribbeans

Glaucoma is a blinding disease which disproportionately affects some communities, particularly African‐Caribbeans. The ‘ReGAE’ project: Research into Glaucoma and Ethnicity was set up in 1999 and is based at the Birmingham and Midland Eye Centre. Among its aims are to provide ethnically‐sensitive evidence‐based information to help inform the future commissioning and training of glaucoma care with ethnic groups and to develop a national programme of glaucoma education.

Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania

Purpose: The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania. Methods: A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP>21 mm Hg). Results: Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (>100 km) was a significant risk factor for trabeculectomy failure (P=0.031). Conclusions: A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (>100 km) possibly leading to late presentation with advanced disease and erratic follow-up.

Trabeculectomy with Mitomycin C in Refractory Glaucoma Associated with Nonnecrotizing Anterior Scleritis

Surgically induced necrotising scleritis (SINS) following sequential laser-assisted in situ keratomileusis (LASIK) and pterygium excision with conjunctival autograft. Purpose: To report a case of SINS occurring 1 month after uncomplicated pterygium excision with conjunctival autograft. Setting: Department of Ophthalmology, Singleton Hospital, Abertawe Bro Morgannwg University NHS trust, United Kingdom Method: A 70-year-old male presented with a 10 day history of redness and reduced vision in the right eye. Bilateral hyperopic LASIK and right eye pterygium excision with conjunctival autograft had been performed elsewhere, 6 months and 1 month prior to presentation. BCVA were 6/60 OD and 6/6 OS. A 2mm full thickness nasal corneal perforation with adjacent scleral melt (6.5x4mm) was evident. Tectonic full thickness corneal and scleral patch grafting with amniotic membrane graft overlay was performed with systemic immunosuppression (prednisolone 60mg od). Results: Recurrence of the corneascleral melt occurred one month postoperatively on reduction of prednisolone to 15mg od. This was initially managed successfully with cyclophosphamide 100mg and prednisolone 80mg. Two months postoperatively recurrent corneal perforation required the application of cyanoacrylate glue. At latest follow up four months postoperatively the corneal glue is insitu with no evidence of recurrent melt. Conclusions: SINS following pterygium excision with conjunctival autograft is rare with only 2 case reports in the literature. This is the first reported case of SINS occurring after pterygium excision with conjunctival autograft with preceeding LASIK.

The UK Paediatric Ocular Trauma Study 2 (POTS2): demographics and mechanisms of injuries

Purpose Pediatric ocular trauma is an important cause of visual morbidity worldwide, accounting for up to one-third of all ocular trauma admissions. It has long-term implications for those affected and significant economic consequences for healthcare providers. It has been estimated that 90% of all ocular trauma is preventable. Targeted strategies are required to reduce the incidence and the severity of pediatric ocular trauma; this requires an understanding of the epidemiology and characteristics of these injuries and the children involved. Methods Prospective, observational study of pediatric ocular trauma cases presenting to UK-based ophthalmologists over a 1-year period; reporting cards were distributed by the British Ophthalmological Surveillance Unit, and clinicians were asked to report incidents of acute orbital and ocular trauma in children aged ≤16 years requiring inpatient or day-case admission. A validated, standardized questionnaire was sent to reporting ophthalmologists to collect data on the demographics and circumstances of injury. Results Median age at presentation was 7.7 years, with boys more than twice as likely to be affected than girls (M:F =2.1:1.0). Almost 50% of injuries occurred at home, with 25% occurring in school or nursery. A total of 67% of injuries occurred during play, and 31% involved a sharp implement. Conclusion Pediatric ocular trauma remains an important public health problem. At least three-quarters of all injuries are preventable through measures, including education of children and responsible adults, restricting access to sharp implements, improving adult supervision, and appropriate use of eye protection.

The UK Paediatric Ocular Trauma Study 1 (POTS1): development of a global standardized protocol for prospective data collection in pediatric ocular trauma

Background Ocular trauma is an important cause of visual morbidity in children worldwide. Pediatric ocular trauma accounts for up to one third of all ocular trauma admissions, with significant economic implications for health care providers. It is estimated that 90% of all ocular trauma is preventable. Development of strategies to reduce the incidence and severity of pediatric ocular trauma requires an understanding of the epidemiology of these injuries and their characteristics. This will enable appropriate targeting of resources toward prevention and allow effective service planning. At present, there is no standardized methodology for the collection of global cross-sectional data in pediatric ocular trauma, and the ability to undertake detailed epidemiological and health-economic analyses is limited. Furthermore, it is difficult to draw international comparisons in incidence, etiology, and outcomes of pediatric ocular trauma due to the range of published reporting criteria. This study describes two novel questionnaires for standardized data collection in pediatric ocular trauma, which can be adopted across a range of health care settings internationally. Methods Two standardized data collection questionnaires have been developed from previously reported templates. The first enables collection of demographic and incident data on serious pediatric ocular trauma requiring hospitalization, and the second enables follow-up outcome data collection. Both the questionnaires are designed to collect primarily categorical data in order to increase ease of completion and facilitate quantitative analysis. These questionnaires enable acquisition of standardized data on the incidence, etiology, and outcomes of pediatric ocular trauma. Discussion These questionnaires enable collection of standardized data and are designed for global use across all health care settings. Through prospective data collection, epidemiological trends can be determined, allowing health care providers to develop collaborative global preventive strategies. Furthermore, the same questionnaires may be used in future studies to draw comparisons with baseline data, allowing assessment of the efficacy of targeted preventative interventions.