ABSTRACT
OBJECTIVE: The purpose of this multicentre retrospective study was to investigate the characteristics and role of ethnicity and socioeconomic status amongst patients with idiopathic macular holes (IMH) and the surgical outcome. SUBJECTS AND METHOD: Consecutive patients undergoing primary IMH surgery at three vitreoretinal units in the UK (King's College Hospital, London, UK, Western Eye Hospital, London, UK, Sunderland Eye Infirmary, Sunderland, UK) between January 2007 and May 2017 were included. The main outcome measure was anatomical closure of IMH. RESULTS: Two hundred and thirty three primary IMH surgeries were included. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. 69.10% of patients were European Caucasian, 6.44% were Asian, and 24.46% were Afro-Caribbean. The mean base macular hole diameter (BD) was 475.5mcm. Mean BD was 432.2mcm in European Caucasian patients, 481.3mcm in Asians (P=0.005), and 505.61mcm in Afro-Caribbeans (P=0.006). Regression analysis demonstrated that BD and Afro-Caribbean ethnicity were independent significant risk factors for surgical failure. Those who have longer duration of symptoms (Afro-Caribbeans) and leave in more deprived places (Afro-Caribbeans) in England where found to have lower success rate on macular hole closure. CONCLUSION: Asian and Afro-Caribbean patients present with larger IMH than European Caucasians. In addition to IMH base diameter, black origin and lower socioeconomic status are independent risk factors for surgical failure. This study presents a large population-based data analysis on ethnic variation in macular holes and may assist in the management and predicting the surgical outcome.
Subject(s)
Ethnicity/statistics & numerical data , Retinal Perforations/surgery , Vitrectomy , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Social Class , Treatment Outcome , United KingdomABSTRACT
PURPOSE: To describe the design and implementation of a nurse-led clinic in a tertiary adult ocular oncology service and to assess its feasibility and patient satisfaction. METHODS: Patients with a melanocytic uveal tumour attending for review during an initial 6-month trial period were assessed in a dedicated ocular oncology clinic by an ophthalmic nurse practitioner. These were: (1) patients who would have been discharged back to the referring hospital but whose ophthalmologist refused to continue their follow-up; (2) patients who preferred to be reviewed in our clinic; and (3) patients with a risk of metastatic disease that was increased but not enough for them to be referred to our medical oncologist. Quality assurance mechanisms were established to ensure safe practice. Patient satisfaction was assessed by means of anonymised questionnaires. RESULTS: A total of 65 patients were seen between 1 November 2011 and 31 May 2011. The mean age was 58 years (range 16-82 years). Most lesions seen were choroidal suspicious naevi (54%) and treated choroidal malignant melanomas (20%). Nine (14%) patients with an increased risk of metastatic disease attended the clinic. Nine patients (14%) were referred back to the ophthalmologist's ocular oncology clinic, because of tumour growth in two patients, macular oedema in one, cataract in five, and conjunctival melanosis at the plaque site in one. Questionnaires showed high levels of satisfaction with the service. CONCLUSION: A nurse-led adult ocular oncology clinic is feasible, thanks to developments in ocular photography. It is well accepted by patients.
Subject(s)
Melanoma/nursing , Outpatient Clinics, Hospital/organization & administration , Patient Satisfaction , Practice Patterns, Nurses'/organization & administration , Uveal Neoplasms/nursing , Adolescent , Adult , Aged , Aged, 80 and over , England , Feasibility Studies , Female , Humans , Male , Melanoma/diagnosis , Middle Aged , Outpatient Clinics, Hospital/standards , Quality Assurance, Health Care/methods , Surveys and Questionnaires , Uveal Neoplasms/diagnosis , Young AdultABSTRACT
This is a report of a middle-aged male with blepharochalasis, who was successfully treated with oral acetazolamide. To our knowledge, this is the first case in the literature reporting the benefits of the use of acetazolamide in the treatment of blepharochalasis.
ABSTRACT
OBJECTIVE/AIM: Corneal perforations can result from a wide variety of disorders and can lead to devastating visual sequelae. Various surgical procedures have been described to manage nontraumatic corneal perforation. Conjunctival flaps offer an important technique in dealing with such corneal emergencies. We report a modified conjunctival flap procedure referred to as superior forniceal conjunctival advancement pedicle (SFCAP) in the successful management of corneal perforation and impending corneal perforation. PATIENTS AND METHODS: Out of 20 patients who underwent SFCAP for non-traumatic corneal perforation and impending perforation, 16 had corneal perforations. Perforations were secondary to acne rosacea (2), advanced bacterial keratitis (6), corneal anaesthesia(2), multiple retinal procedures (2), previous corneal grafts with a compromised ocular surface (3), and advanced Mooren's ulcer (1). RESULTS: The globe was preserved in all patients. In 14 of the 16 eyes with perforated corneas the pedicle stabilised. One patient, who was a chronic alcoholic, rubbed the eye during sleep detaching the pedicle a week after surgery. However, the ulcer healed and the integrity of the globe was restored. None of these patients developed secondary glaucoma or ptosis. CONCLUSION: SFCAP is an appropriate procedure to manage corneal perforations and impending corneal perforations where donor material is not available and transplantation of such tissue is not suitable.
Subject(s)
Conjunctiva , Cornea/surgery , Corneal Ulcer/surgery , Surgical Flaps , Acute Disease , Adult , Aged , Aged, 80 and over , Corneal Ulcer/prevention & control , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome , Wound HealingSubject(s)
Blister/pathology , Corneal Diseases/pathology , Aged , Aged, 80 and over , Corneal Edema/complications , Follow-Up Studies , Humans , Male , RecurrenceSubject(s)
Iridocyclitis/etiology , Retinitis Pigmentosa/complications , Adult , Fundus Oculi , Humans , MaleSubject(s)
Cataract Extraction/adverse effects , Exfoliation Syndrome/etiology , Lenses, Intraocular , Prosthesis Failure , Aged , Humans , Male , Reoperation , Time FactorsABSTRACT
BACKGROUND: This report describes the pathology of an unusual variant of fibroma of the eyelid. The soft ovoid tumour was excised from the centre of the left lower lid in an 84-year-old patient had been growing slowly for several years. METHODS: The tumour was studied by conventional histology, immunohistochemistry and electron microscopy. RESULTS: The tumor was formed by fibroblasts of spindle and multinucleate type, and the collagenous stroma contained mast cells and blood vessels which exhibited minor inflammatory changes. With the immunohistochemical methods the only positive marker was for vimentin. CONCLUSION: On morphological grounds it was possible to distinguish this extremely rare tumour from other mesenchymal tumours. The presence of distinctive multinucleate giant cells makes the term pleomorphic fibroma an appropriate name for this type of lesion.