Background: Primary open-angle glaucoma (POAG) is a leading cause of blindnes s. High intraocular pressure (IOP) has been shown to be a key risk factor for PO AG. Topical application of angiotensin 1-converting enzyme...Background: Primary open-angle glaucoma (POAG) is a leading cause of blindnes s. High intraocular pressure (IOP) has been shown to be a key risk factor for PO AG. Topical application of angiotensin 1-converting enzyme (ACE) inhibitors has been shown to lower IOP, and angiotensin-induced increase in vascular tone has been implicated as a pathogenetic mechanism in glaucomatous cupping and damage to the optic nerve. The objective of this study was to investigate the associati on between the deletion polymorphism in the ACE gene and ocular signs of POAG. M ethods: Baseline data from the Rotterdam Study was used. The ACE genotype was de termined in 6,462 subjects. We used univariate and multiple variable statistical techniques to examine associations between ACE genotype and each of ocular hype rtension, glaucomatous optic neuropathy, glaucomatous visual field defects and P OAG diagnosis. Results: We found no consistent evidence between ACE genotype and ocular signs of POAG.We did, however, find evidence of an association betweenAC E genotype and optic disc area, subjects homozygous for the deletion allele tend ing to have fractionally smaller optic disc areas than those with a single delet ion allele subjects, who in turn tended to have fractionally smaller optic discs than those with no deletion alleles (P=0.01) Conclusions: The data provided lit tle evidence of any association between ocular signs of POAG and the deletion po lymorphism of ACE. Therewas, however, evidence that ACE may be associated with o ptic disc size-this was an unexpected finding.展开更多
PURPOSE: To investigate the long-term visual outcome and the complication rate following transscleral suture fixation of posterior chamber intraocular lenses (sutured PC-IOLs). DESIGN: A retrospective case-series desc...PURPOSE: To investigate the long-term visual outcome and the complication rate following transscleral suture fixation of posterior chamber intraocular lenses (sutured PC-IOLs). DESIGN: A retrospective case-series descriptive study.METHODS: Records of patients who underwent combined pars plana vitrectomy and sutured PC-IOLs at Moorfields Eye Hospital and who had at least 12 months of follow-up were examined for recorded complications. RESULTS: Sixty-one eyes of 48 patients (33 males and 15 females) were identified and included in the analysis, with mean follow-up of 6 years. The mean final best-corrected visual acuity remained at preoperative levels (P=.211) and was largely determined by the underlying ocular pathology before sutured PC-IOL. Overall 30 of 61 (49%) eyes, two or more procedures were performed to reverse a significant peri-or postoperative complication. Breakage of polypropylene sutures was the main indication accounting for 17 of 30 (57%) of those reoperations. Subgroup analysis showed that younger patients were more likely to suffer the above complication (P=.009). The multivariate analysis also showed that longer follow-up was significantly associated with suture breakage (P=.014), with the mean time to breakage approximately 4 years after surgery. CONCLUSIONS: Long-term follow-up of patients undergoing sutured PC-IOLs appears to be associated with a high rate of postoperative complications and significant need for further surgery,which should be discussed during their informed consent process.展开更多
Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or ...Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). Design: Prospective, interventional, comparative, clinical case series. Participants: Adult patients with involutional entropion. Methods: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. Main Outcome Measures: Patients’symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. Results: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%)-had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P > 0.4). Conclusions: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.展开更多
PURPOSE: The Drusen Laser Study evaluated macular laser to prevent choroidal neovascularization (CNV) and vision loss in high-risk age-related maculopathy (ARM). DESIGN: Prospective, interventional, randomized, contro...PURPOSE: The Drusen Laser Study evaluated macular laser to prevent choroidal neovascularization (CNV) and vision loss in high-risk age-related maculopathy (ARM). DESIGN: Prospective, interventional, randomized, controlled clinical trial in five hospital centers. METHODS: Patients in the unilateral group had neovascular ARM and drusen in the study eye. Study eyes were randomized to laser-treated or no-laser groups. For patients in the bilateral drusen group, eyes were randomized to right eye, laser or no laser; and left eye, alternative. Laser treatment comprised 12 argon spots. Outcome was best-corrected visual acuity and CNV signs, which were monitored for 3 years. RESULTS: In the unilateral group, vision loss occurred in 21 (28.8%) of 73 patients in laser vs 13 (19.7%) of 66 no-laser patients (P=.214). Incidence of CNV was 27 (29.7%) of 91 in laser vs 15 (17.65%) of 85 no-laser patients (P=.061). CNV onset was approximately 6 months earlier in laser-treated compared with no-laser patients (P=.05). In the bilateral group, vision loss occurred in six (8.3%)-of 72 laser-treated vs 10 (13.9%) of 72 fellow eyes (P=.3877). CNV incidence was 12 (11.6%) of 103 in laser-treated vs seven (6.8%) of 103 fellow eyes (P=.225). There was no difference in onset of CNV. CONCLUSIONS: Results do not support prophylactic laser of the fello weye of patients with neovascular ARM. Its role in patients with bilateral drusen remains unclear.展开更多
Background/aim: Sub-Tenon’s block (STB) or topical anaesthesia alone (TOP) are popular techniques employed during cataract surgery. TOP is often preferred b y healthcare providers because of financial or staffing rea...Background/aim: Sub-Tenon’s block (STB) or topical anaesthesia alone (TOP) are popular techniques employed during cataract surgery. TOP is often preferred b y healthcare providers because of financial or staffing reasons, despite existing evidence that pain during surgery is better controlled with STB. Pain is not the only consideration that determines patient preference for the anaesthesia tec hnique. The authors decided to investigate the issue of patient satisfaction usi ng the recently developed Iowa Satisfaction with Anesthesia Scale (ISAS). Method : In a randomised controlled pilot trial, 28 patients were enrolled to receive e ither STB with 3 ml of 2%lidocaine and hyaluronidase, or TOP with proxymetacain e 0.5%and amethocaine 1%(Tetracaine) eye drops. Postoperatively patients rated their satisfaction with anaesthesia care by filling in the self administered wr itten questionnaire, the ISAS. Results: One patient in the TOP group dropped out of the study because of intolerable pain. Analysis of the questionnaire results with a two sample Wilcoxon rank sum test showed a significant difference in pat ient satisfaction (p< 0.0085). The median satisfaction score was higher in the S TB group 2.77 (interquartile range IQR 2.45 to 3), than in the TOP group 2.04 (I QR 1.54 to 2.5). Conclusion: In the setting of day case cataract surgery, patien ts report significantly higher satisfaction scores with STB than with TOP alone.展开更多
文摘Background: Primary open-angle glaucoma (POAG) is a leading cause of blindnes s. High intraocular pressure (IOP) has been shown to be a key risk factor for PO AG. Topical application of angiotensin 1-converting enzyme (ACE) inhibitors has been shown to lower IOP, and angiotensin-induced increase in vascular tone has been implicated as a pathogenetic mechanism in glaucomatous cupping and damage to the optic nerve. The objective of this study was to investigate the associati on between the deletion polymorphism in the ACE gene and ocular signs of POAG. M ethods: Baseline data from the Rotterdam Study was used. The ACE genotype was de termined in 6,462 subjects. We used univariate and multiple variable statistical techniques to examine associations between ACE genotype and each of ocular hype rtension, glaucomatous optic neuropathy, glaucomatous visual field defects and P OAG diagnosis. Results: We found no consistent evidence between ACE genotype and ocular signs of POAG.We did, however, find evidence of an association betweenAC E genotype and optic disc area, subjects homozygous for the deletion allele tend ing to have fractionally smaller optic disc areas than those with a single delet ion allele subjects, who in turn tended to have fractionally smaller optic discs than those with no deletion alleles (P=0.01) Conclusions: The data provided lit tle evidence of any association between ocular signs of POAG and the deletion po lymorphism of ACE. Therewas, however, evidence that ACE may be associated with o ptic disc size-this was an unexpected finding.
文摘PURPOSE: To investigate the long-term visual outcome and the complication rate following transscleral suture fixation of posterior chamber intraocular lenses (sutured PC-IOLs). DESIGN: A retrospective case-series descriptive study.METHODS: Records of patients who underwent combined pars plana vitrectomy and sutured PC-IOLs at Moorfields Eye Hospital and who had at least 12 months of follow-up were examined for recorded complications. RESULTS: Sixty-one eyes of 48 patients (33 males and 15 females) were identified and included in the analysis, with mean follow-up of 6 years. The mean final best-corrected visual acuity remained at preoperative levels (P=.211) and was largely determined by the underlying ocular pathology before sutured PC-IOL. Overall 30 of 61 (49%) eyes, two or more procedures were performed to reverse a significant peri-or postoperative complication. Breakage of polypropylene sutures was the main indication accounting for 17 of 30 (57%) of those reoperations. Subgroup analysis showed that younger patients were more likely to suffer the above complication (P=.009). The multivariate analysis also showed that longer follow-up was significantly associated with suture breakage (P=.014), with the mean time to breakage approximately 4 years after surgery. CONCLUSIONS: Long-term follow-up of patients undergoing sutured PC-IOLs appears to be associated with a high rate of postoperative complications and significant need for further surgery,which should be discussed during their informed consent process.
文摘Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). Design: Prospective, interventional, comparative, clinical case series. Participants: Adult patients with involutional entropion. Methods: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. Main Outcome Measures: Patients’symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. Results: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%)-had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P > 0.4). Conclusions: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.
文摘PURPOSE: The Drusen Laser Study evaluated macular laser to prevent choroidal neovascularization (CNV) and vision loss in high-risk age-related maculopathy (ARM). DESIGN: Prospective, interventional, randomized, controlled clinical trial in five hospital centers. METHODS: Patients in the unilateral group had neovascular ARM and drusen in the study eye. Study eyes were randomized to laser-treated or no-laser groups. For patients in the bilateral drusen group, eyes were randomized to right eye, laser or no laser; and left eye, alternative. Laser treatment comprised 12 argon spots. Outcome was best-corrected visual acuity and CNV signs, which were monitored for 3 years. RESULTS: In the unilateral group, vision loss occurred in 21 (28.8%) of 73 patients in laser vs 13 (19.7%) of 66 no-laser patients (P=.214). Incidence of CNV was 27 (29.7%) of 91 in laser vs 15 (17.65%) of 85 no-laser patients (P=.061). CNV onset was approximately 6 months earlier in laser-treated compared with no-laser patients (P=.05). In the bilateral group, vision loss occurred in six (8.3%)-of 72 laser-treated vs 10 (13.9%) of 72 fellow eyes (P=.3877). CNV incidence was 12 (11.6%) of 103 in laser-treated vs seven (6.8%) of 103 fellow eyes (P=.225). There was no difference in onset of CNV. CONCLUSIONS: Results do not support prophylactic laser of the fello weye of patients with neovascular ARM. Its role in patients with bilateral drusen remains unclear.
文摘Background/aim: Sub-Tenon’s block (STB) or topical anaesthesia alone (TOP) are popular techniques employed during cataract surgery. TOP is often preferred b y healthcare providers because of financial or staffing reasons, despite existing evidence that pain during surgery is better controlled with STB. Pain is not the only consideration that determines patient preference for the anaesthesia tec hnique. The authors decided to investigate the issue of patient satisfaction usi ng the recently developed Iowa Satisfaction with Anesthesia Scale (ISAS). Method : In a randomised controlled pilot trial, 28 patients were enrolled to receive e ither STB with 3 ml of 2%lidocaine and hyaluronidase, or TOP with proxymetacain e 0.5%and amethocaine 1%(Tetracaine) eye drops. Postoperatively patients rated their satisfaction with anaesthesia care by filling in the self administered wr itten questionnaire, the ISAS. Results: One patient in the TOP group dropped out of the study because of intolerable pain. Analysis of the questionnaire results with a two sample Wilcoxon rank sum test showed a significant difference in pat ient satisfaction (p< 0.0085). The median satisfaction score was higher in the S TB group 2.77 (interquartile range IQR 2.45 to 3), than in the TOP group 2.04 (I QR 1.54 to 2.5). Conclusion: In the setting of day case cataract surgery, patien ts report significantly higher satisfaction scores with STB than with TOP alone.
