ABSTRACT
AIMS: The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia. METHODS: Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary's Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance. RESULTS: Seven hundred and four patients had appointments booked at St Mary's and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary's and 9% at Hillingdon; P=0.75). Of the 704 patients, 533 (St Mary's, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related. CONCLUSIONS: Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits.
Subject(s)
Amblyopia/diagnosis , Amblyopia/therapy , Child Health Services/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Workload/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Prospective Studies , Young AdultSubject(s)
Frameshift Mutation/genetics , Pantothenate Kinase-Associated Neurodegeneration/genetics , Phosphotransferases (Alcohol Group Acceptor)/genetics , Retinal Telangiectasis/genetics , Adolescent , Child , Female , Genetic Predisposition to Disease/genetics , Genotype , Homozygote , Humans , MaleABSTRACT
PURPOSE: To analyze the results over a 10-year period with a different type of strabismus surgery performed with topical anesthesia, to describe the differences in technique compared with surgery performed with general anesthesia, and to detail current indications and technical changes made according to the experience accrued during these years. METHODS: A total of 101 patients undergoing strabismus surgery with topical anesthesia in a single hospital were analyzed. These patients were randomly selected from a total of 567 patients who had undergone extra-ocular muscle surgery in the past 10 years. RESULTS: A good result was obtained (squint angle < 10 prism diopters and absence of diplopia) in 95% of patients immediately after surgery and in 85% at final follow-up (mean follow-up: 3.1 years). The mean operating time for each muscle was 29 minutes. Surgery was well tolerated in every patient. Conversion to general anesthesia was not necessary in any case. Atropine was used in three patients (3%) because of induction of the vagal reflex. CONCLUSION: Topical anesthesia in strabismus surgery is a useful technique in the treatment of extraocular muscle pathology, with few limitations. Appropriate monitoring by an anesthetist is vital to ensure adequate control of pain and possible side effects and to enable conversion to general anesthesia. The oculocardiac reflex is infrequent. For experienced strabismus surgeons, the total surgical time is comparable with topical and general anesthesia.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Oculomotor Muscles/surgery , Procaine/analogs & derivatives , Strabismus/surgery , Tetracaine/administration & dosage , Administration, Topical , Adolescent , Adult , Aged , Aged, 80 and over , Drug Combinations , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Patient Satisfaction , Procaine/administration & dosage , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To analyze the response of normal emmetropic subjects to different ocular dominance tests and to analyze the influence of this response in surgically induced monovision. DESIGN: A prospective study of diagnostic accuracy was carried out to analyze the different tests to determine ocular dominance, without a gold standard test. METHODS: Nine different tests were carried out in a group of 51 emmetropic subjects to determine both motor and sensory ocular dominance. For analysis, patients were divided into two groups according to age. Normal ophthalmologic examination results were the inclusion requirement, with normal binocular vision and good stereoacuity. RESULTS: A significant percentage of uncertain or ambiguous results in all tests performed was found, except in the hole-in-card and kaleidoscope tests. When the tests were compared, two by two, the correlation or equivalence found was low and was much lower if tests were compared three by three. CONCLUSIONS: No clear ocular dominance was found in most studied subjects; instead, there must be a constant alternating balance between both eyes in most emmetropic persons, but not in those with pathologic features. This fact would explain the great variability both between and within different kinds of tests. Also, it would establish that the monovision technique is well tolerated in most patients, with unsuccessful results only in those patients with strong or clear dominance. Consequently, it seems appropriate to evaluate patient's dominance before monovision surgery to exclude those individuals with clear dominance.
