The psychosocial effects of strabismus: effect of patient demographics on the AS-20 score.

PURPOSE: The introduction of the AS-20 strabismus-specific quality-of-life questionnaire allows clinicians to quantify the effects of strabismus on adults for the first time. We correlated strabismic patients' demographic and clinical findings to their AS-20 scores. METHODS: A consecutive cohort of patients from an ongoing prospective study of adults with manifest strabismus was recruited. The patients' age, sex, socioeconomic status (SES), magnitude, and direction of deviation were correlated to their AS-20 scores. Patients' zip codes were used to derive a score for their SES based on the English 2007 Index of Multiple Deprivation score (IMD2007). RESULTS: A total of 61 questionnaires with all demographic and clinical data were available. The median magnitude of deviation was 20.4(Δ) in this group. The mean AS-20 score was 49.5 (SD 21.6). Women had significantly lower AS-20 scores than men (p = 0.02). There was no difference in AS-20 scores between individuals with eso- and exodeviations (p = 0.7). Multiple linear regression analysis shows female sex and lower SES to be significantly associated with lower AS-20 scores (p = 0.03 and p = 0.006, respectively). CONCLUSIONS: Strabismic patients who are female or live in a more deprived area have a significantly lower AS-20 score.

A review of allograft ophthalmic tissue in eye surgery.

Transplanting human tissue to the front of the eye has been practiced for over 100 years. Contiguous corneal layers may be transplanted separately (lamellar keratoplasty) or together (full thickness or penetrating keratoplasty). The former methods are gaining in popularity, replacing full thickness transplants. Reasons for transplantation and current practice and techniques are described with respect to their impact on vision, and associated adverse events.

A UK scheme for reporting serious adverse events and reactions associated with ocular tissue transplantation.

Reporting and investigation of serious adverse events and reactions associated with tissue and cell transplantation is a fundamental aspect of ensuring adequate levels of safety and quality and is a requirement of the European Union Directives on tissues and cells. In the UK, a system for the reporting and analysis of events and reactions associated with ocular tissue transplantation is well established. It is operated by a network of individuals and organisations, each with clearly defined roles and responsibilities, following written procedures for reporting and investigation. Analysis of reports indicates that the most important adverse reactions associated with this type of tissue transplantation are endophthalmitis (0.58%) and primary graft failure (0.3%). This system allows the analysis of all types of events and reactions by the professionals involved so that trends can be identified and services improved. Tools to evaluate the severity and imputability of individual events or reactions, such as those developed by the EUSTITE project, can be utilised to facilitate the selection of those cases meeting the criteria for reporting to the Competent Authority. This vigilance model has been shown to be effective and could be applied in other fields of tissue or cell transplantation.

Concentration and bioavailability of ciprofloxacin and teicoplanin in the cornea.

PURPOSE: To investigate the concentration and bioavailability of ciprofloxacin and teicoplanin in the cornea. METHODS: A biological assay was developed with corneal tissue used as a carrier for the antimicrobial. Concentration and biological activity were determined with a chemical assay and zone of inhibition (ZOI) around corneal samples with epithelial and endothelial surfaces in contact with the indicator organism. Patients undergoing penetrating keratoplasty received ciprofloxacin 0.3% or teicoplanin 1%. RESULTS: There were good correlations between antimicrobial concentration and ZOI, when either filter paper or corneal discs were used (R(2) > 92%). Of 33 patients, the mean (median) concentration of ciprofloxacin in the cornea was 1.37 mg/L (0.46 mg/L) and 1.89 mg/L (1.44 mg/L; bioassay) in the epithelial and endothelial orientations, respectively, and 14.87 mg/L (7.41) in the cornea and 0.51 mg/L (0.42) in the aqueous (chemical assay). For teicoplanin, the mean (median) concentration in the cornea was 9.58 mg/L (0 mg/L) in the epithelial and 4.78 mg/L (0 mg/L) in the endothelial orientations (bioassay). In the chemical assay, teicoplanin could not be detected in the cornea or aqueous at the lower limit of detection of 3.6 mg/L. CONCLUSIONS: The ZOI produced by corneal tissue provides a potential bioassay of antimicrobial activity and concentration. Although in contrast to teicoplanin ciprofloxacin shows good corneal penetration, with high endothelial-to-epithelial levels, only approximately 10% of measured levels in a chemical assay are available, according to a bioassay. Teicoplanin shows relatively poor corneal penetration through intact epithelium. These methods may be useful in evaluating the biological activity across the cornea of antimicrobials introduced into ophthalmic practice to deal with changing bacterial resistance.