ABSTRACT
BACKGROUND: To determine the success of repeat trabeculectomy augmented with mitomycin C in a cohort of patients who had undergone previously failed trabeculectomy surgery. DESIGN: A consecutive cohort series of patients. PARTICIPANTS: Fifty patients undergoing augmented trabeculectomy surgery following a previously failed trabeculectomy and at least 12 months' follow up. METHODS: All patients had demographic and clinical data collected at the time of surgery and at all subsequent follow-up visits. MAIN OUTCOME MEASURES: Visual field progression, loss of visual acuity, intraocular pressure (IOP) control. RESULTS: The mean follow up was 36.7 months. Forty-one patients (82%) achieved an IOP ≤21 mmHg (with ≥20% reduction of preoperative IOP) and ≥6 mmHg on no additional glaucoma treatment at 12 months' follow up. Forty-four patients (88%) achieved a qualified success with the same criteria at 1 year. The median logMAR acuity preoperative was unchanged after surgery; however, 11 patients (22%) lost ≥2 Snellen lines during follow up. There was no significant change in mean deviation during the follow-up period. CONCLUSIONS: Repeating trabeculectomy augmented with mitomycin C is an effective method of controlling IOP and preventing further visual deterioration in the majority of patients treated. However, visual loss was seen in a significant proportion of patients.
Subject(s)
Glaucoma/surgery , Trabeculectomy , Adolescent , Adult , Aged , Aged, 80 and over , Alkylating Agents/administration & dosage , Child , Female , Glaucoma/physiopathology , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Mitomycin/administration & dosage , Postoperative Complications , Reoperation , Treatment Outcome , Visual Acuity/physiology , Visual Fields/physiologyABSTRACT
PURPOSE: A postal questionnaire study to evaluate the current practice of cataract surgery delivery in the United Kingdom including strategies for postoperative review was performed. METHODS: A cataract questionnaire was sent to all hospital departments delivering ophthalmic services in the United Kingdom based on a list from the Royal College of Ophthalmologists. It included questions about the staffing level, number of cases operated on per list, and the different strategies employed postoperatively. The results were statistically analyzed. RESULTS: A total of 248 questionnaires were sent and 106 (43%) replies were received. The mean number of consultant teams was 11 (2-20). The average number of cases per list was 6-7 (range 4-9). In 65 hospitals, all patients are reviewed postoperatively in the hospital and some consultant teams review patients postoperatively in 18 hospitals. In 15 hospitals, patients were seen by the community optician. Most hospitals review their patients postoperatively within the first 3 weeks with more hospitals seeing them at 2-3 weeks. A wide variety of health professionals review the postoperative cases and they include doctors, nurses, and opticians (in house and community). CONCLUSIONS: There are varied practices for cataract surgery in the United Kingdom including the number of cases on the list and postoperative review protocols. There is room for better service organization in some hospitals in terms of patient flow and better use of medical staff time to improve output.
Subject(s)
Cataract Extraction/statistics & numerical data , Postal Service , Surveys and Questionnaires , Humans , United KingdomABSTRACT
We present a case of a patient who had pupilloplasty for an atonic pupil following phacoemulsification cataract surgery. Postoperatively, the patient experienced glare that was not relieved by a neodymium:YAG laser capsulotomy. A cosmetic contact lens helped to resolve the symptoms. In cases of glare due to a large pupil, a painted cosmetic contact lens should be considered an option.
