Differences in the Surgical Outcomes of Glaucoma Surgery in Patients of African Caribbean Descent.

PURPOSE: People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race. METHODS: A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields. RESULTS: A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion. CONCLUSION: In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians.

Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region.

OBJECTIVES: To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. METHODS: A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. RESULTS: Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). CONCLUSION: Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.

Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013.

PURPOSE: The last article on causes of sight impairment (SI) in England and Wales was for April 2007-March 2008. This report updates these figures for April 2012-March 2013. METHODS: In England and Wales, registration for SI is initiated by completion of a certificate of vision impairment (CVI). The main cause of visual impairment was ascertained for certificates completed April 2012-March 2013. A proportional comparison against April 2007-March 2008 was made. RESULTS: We received 24 009 CVIs of which 10 410 were for severe sight impairment (SSI) and 13 129 were for SI. These numbers were slightly higher than those observed in April 2007-March 2008 (9823 SSI; 12 607 SI). The ratio SI:SSI has remained static with 55% of all certifications being SI. The proportion of certificates without a single main cause has fallen slightly (16.6 to 14%). The proportion of certificates with a main cause of degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) decreased from 58.6 to 50% SSI and from 57.2 to 52.5% SI. Glaucoma remains the second most common cause (11% SSI; 7.6% SI) but hereditary retinal disorders overtook diabetes as third leading cause of SSI. CONCLUSION: AMD is still by far the leading cause of certifications for sight impairment in England and Wales (both SI and SSI). Proportionate changes have been observed since 2008, but it is important to note that a proportionate increase in one condition will impact on others.

Congenital nasal pyriform aperture stenosis 5.7 mm or less is associated with surgical intervention: A pooled case series.

OBJECTIVES: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in the newborn. CNPAS is diagnosed clinically and confirmed with CT scanning. Early diagnosis and management is essential for this potentially life-threatening condition. Patients can be managed conservatively or surgically. Surgical treatment is usually reserved for those patients that fail conservative treatment. Our objective was to provide a radiologically-measured pyriform aperture (PA) width that predicts the need for surgical intervention. METHODS: This study was a retrospective chart review of patients treated in a tertiary paediatric hospital as well as a review of the literature. Outcome measures were defined as surgical or conservative intervention for the management of congenital pyriform aperture stenosis. RESULTS: Data from 26 individual patients (7 patients from our own case series and 19 patients from previously published reports) was analysed to calculate those patients requiring surgical intervention. CONCLUSIONS: A PA width of less than 5.7 mm in a neonate is 88% sensitive and specific in predicting that a patient will require surgical intervention.

Causes of certifications for severe sight impairment (blind) and sight impairment (partial sight) in children in England and Wales.

AIM: To explore and describe trends in the principal disorders/conditions ('cause') for severe sight impairment (SSI) (blind) and sight impairment (SI) (partial sight) certification in children in England and Wales since 1999. METHODS: We obtained certification data for SI and SSI from a national database for all individuals aged 16 years or less at the time of certification in England and Wales for the years 1999/2000 and for the years 2007/2008-2009/2010. RESULTS: In total, there were 861 certifications in the year 1999/2000, rising to 1040 certifications in 2009/2010. The commonest single causes of SSI certification in 1999/2000 were cerebral visual impairment (23.2%) and optic nerve disorders (23.2%). The commonest single causes of SI certification in the same year comprised nystagmus (16.7%) and optic nerve disorders (15.5%). Cerebral visual impairment was the commonest single cause of SSI in children in England and Wales annually between 2007/2008 and 2009/2010 accounting for 21%-31% of certifications. The commonest causes of SI certification in 2009/2010 were congenital globe anomalies (18.4%) and retinal dystrophy (16.6%). The proportion of SI and SSI due to optic nerve disorders has decreased since 1999/2000. CONCLUSIONS: Our findings suggest that in England and Wales, cerebral visual impairment is now the commonest cause of paediatric SSI certification and hereditary retinal dystrophy and congenital globe anomalies are the commonest causes of SI certification.

Cochrane Eyes and Vision Group (CEVG).

This is a new column for reviews from the Cochrane Eyes and Vision Group (CEVG). Its main aim is to promote access to systematic reviews of all the interventions used to prevent or treat eye diseases. It is based at the London School of Hygiene & Tropical Medicine in London, UK, and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA.

Ectopic olfactory neuroblastoma: report of four cases and a review of the literature.

Our objective is to present a short series of four rare cases of ectopic olfactory neuroblastoma. Our methods present four case reports of ectopic olfactory neuroblastoma and a review of the literature for management and treatment of this disease. The results indicate short case series reports of ectopic olfactory neuroblastoma arising from the anterior ethmoidal sinuses, the nasopharynx, the lateral nasal wall and the floor of the nose. The discussion focuses on likely origins of ectopic olfactory neuroblastoma, its clinical features and management. We conclude that ectopic olfactory neuroblastoma is a rare disease. Treatment principles are the same for non-ectopic disease and guided by extension into adjacent structures such as the orbit or anterior cranial fossa and usually involves surgery with or without adjuvant radiotherapy.

Causes of blind and partial sight certifications in England and Wales: April 2007-March 2008.

PURPOSE: The last complete report on causes of blindness in England and Wales was for the data collected during April 1999-March 2000. This study updates these figures, with data collected during April 2007-March 2008. METHODS: In England and Wales, registration for blindness and partial sight is initiated with certification by a consultant ophthalmologist with the consent of the patient. The main cause of visual impairment was ascertained where possible for all certificates completed during April 2007-March 2008 and a proportional comparison with 1999-2000 figures was made. RESULTS: We received 23,185 Certificates of Vision Impairment (CVIs), of which 9823 were for severe sight impairment (blindness) (SSI) and 12,607 were for sight impairment (partial sight) (SI). These totals were considerably lower than the numbers certified in the year ending 31 March 2000. In 16.6% of CVIs, there were multiple causes of visual impairment as compared with 3% of BD8s in 2000. Degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) contributed to vision impairment in 12,746 newly certified blind or partially sighted. CONCLUSIONS: AMD is still by far the leading cause of certified visual loss in England and Wales. Proportional comparisons are hampered by the increasing use of multiple pathology as a main cause of visual impairment, which is believed to have arisen owing to the change in certificate used for data collection. These figures are not estimates of the total numbers newly blind in the UK because not all those entitled to certification are offered and or accept it, but they do nevertheless document the number of people who are deemed to be sufficiently sight impaired to warrant support and have been both offered and accepted it. This is usually the case when no further ophthalmic intervention is thought likely to be of benefit in terms of restoring or improving vision.

Sensorineural hearing loss in children.

The objective of the study was to examine the aetiology of sensorineural hearing loss (SNHL) in a paediatric population presenting to the National Centre of Medical Genetics. A retrospective chart review from 1998 to 2006. One hundred and twenty nine children were investigated for SNHL. The average age of diagnosis of hearing loss was 36 months. The degree of hearing loss was mild in 8 children, moderate in 33 children, severe in 31 children and profound in 57 children. Eighty-five children (66%) were diagnosed with a hereditary hearing loss, 11 (8%) children had an acquired hearing loss and no cause found in 33 (26%) children. This is the first report of the causes of hearing loss in Irish children. The mean age of diagnosis in our cohort is high and emphasises the need for a neonatal screening programme. There remains a number of children for whom the cause of hearing loss remains unknown.

The Peterborough scheme for community specialist optometrists in glaucoma: a feasibility study.

PURPOSE: This study assessed the role of specialist optometrists who were working in the community and sharing the care for glaucoma patients with, and under close supervision of, a consultant ophthalmologist working in the Hospital Eye Services (HES) to ensure high-quality standards, safety, and care. METHODS: From February 2005 onwards, the majority of all new glaucoma referrals to our eye department were diverted to our specialist optometrists in glaucoma (SOGs) in their own community practices. Selected patients in the HES setting who were already diagnosed with stable glaucoma were also transferred to the SOGs. The completed clinical finding details of the SOGs, including fundus photographs and Humphrey visual field tests, were scrutinised by the project lead. RESULTS: This study included 1184 new patients seen by specialist optometrists between February 2005 and March 2007. A total of 32% of patients were referred on to the hospital, leaving the remaining 68% patients to be seen for at least their next consultation in the community by the SOGs. The following levels of disagreement were observed between SOGs and the project lead: on cup:disc ratio (11%), visual field interpretation (7%), diagnosis (12%), treatment plan (10%), and outcome (follow-up interval and location) (17%). CONCLUSION: This study indicates that there is potential for a significant increase in the role of primary care optometry in glaucoma management. The study also confirms a need for a significant element of supervision and advice from a glaucoma specialist. The important issue of cost effectiveness is yet to be confirmed.

Non-invasive ventilation in children with upper airway obstruction.

OBJECTIVE: The aim of this paper is to highlight our experience with the use of non-invasive positive pressure ventilation (NIPPV) in children, neonates and pre-term infants with upper airway obstruction. METHODS: This was a retrospective review of our recent experience in using NIPPV for the management of upper airway obstruction in paediatric patients. RESULTS: NIPPV was successful in preventing tracheostomy in patients with significant laryngo-tracheomalacia as well as being used to optimise the timing of surgery in subglottic stenosis. Furthermore, it proved beneficial in stabilising the airway after aryepiglottoplasty and also had a role in the management of obstructive sleep apnoea. CONCLUSION: The use of NIPPV in children with upper airway obstruction can be a safe and effective alternative to invasive mechanical ventilation. NIPPV can potentially be beneficial in avoiding prolonged invasive ventilation, avoiding tracheostomy, stabilizing the airway after extubation or decannulation, and management of obstructive sleep apnoea.

Persistency with medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994-2005.

PURPOSE: To examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy. METHODS: Computerised patient records from 94 general practices across the United Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993-2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature. RESULTS: Percentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994-1996 to 70% in 2002-2004. Persistence with any treatment did not differ between those initiated on beta-blockers compared to prostaglandins (1.05, 95% CI 0.93-1.17). However, 20% of subjects initiated on beta-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a beta-blocker. When failure with initial therapy was considered, beta-blockers appeared worse (1.35, 95% CI 1.21-1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34-1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35-64 years) were significantly more likely to fail as were those over 85 years. CONCLUSIONS: Introduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated.