Anterior approach ptosis surgery: comparison of absorbable polyglactin sutures and non-absorbable polyester sutures. Does Vicryl stand the test of time?

PURPOSE: To determine whether the long-term success of ptosis surgery is influenced by the use of absorbable or non-absorbable sutures to advance the levator aponeurosis onto the tarsal plate. METHODS: Multi-centre retrospective comparative study of re-operation rates in primary anterior approach ptosis surgery using absorbable polyglactin sutures (Vicryl) and non-absorbable polyester sutures (Ethibond). The Medisoft audit tool was used to identify all patients who underwent primary ptosis surgery for aponeurotic ptosis, performed by five oculoplastic consultants within a 7-year period, across two NHS Ophthalmology departments. The electronic patient records were reviewed for each patient. Basic demographics, suture material, and post-operative complications were recorded. All patients requiring repeat surgery between the study dates and the present day were recorded, allowing a minimum postoperative period of 3 years and 10 months. Re-operation rates in surgery using absorbable Vicryl sutures and non-absorbable Ethibond sutures were compared using Fisher's exact test. RESULTS: Four hundred and fifty-five operations in 330 patients were performed within the study period that met the inclusion and exclusion criteria. Fifty-seven percent of the patients were female, with an average age of 68.8 years. One hundred and sixty-nine operations in 128 patients were performed using absorbable Vicryl sutures. Of these, 22 (13.0%) required repeat operations. Two hundred and eighty-six operations in 202 patients were performed using non-absorbable Ethibond sutures. Of these, 17 (5.9%) required repeat operations. The two-tailed P-value was 0.0143. CONCLUSION: The use of non-absorbable Ethibond sutures to advance the levator aponeurosis onto the tarsal plate in primary ptosis surgery is associated with improved long-term success and reduced need for secondary surgery.

Pseudophakic negative dysphotopsia and intraocular lens orientation: a prospective double-masked randomized controlled trial.

PURPOSE: To determine whether horizontal orientation of the intraocular lens optic-haptic junctions has an effect on the incidence of pseudophakic negative dysphotopsia. METHODS: Single-centre prospective double-masked randomized controlled trial. 220 eyes of 201 participants undergoing routine cataract surgery were randomized to receive their intraocular lens either orientated with the optic-haptic junctions at 180° ('horizontal') or without manipulation following implantation (control). Patients were excluded according to age (<19 and > 99 years), coexisting eye disease affecting visual function and insufficient cognitive function to complete the study. In the fourth postoperative week, a telephone interview was conducted to determine rates of negative dysphotopsia. The data were analysed to provide the relative risk of negative dysphotopsia with horizontal orientation of the intraocular lens (IOL) optic-haptic junctions compared with standard treatment. RESULTS: Orientating the IOL optic-haptic junctions horizontally halved the incidence of pseudophakic negative dysphotopsia in the fourth postoperative week (9/110 in the intervention group; 18/110 in the control group; RR: 0.50, 95% confidence interval: 0.235-1.064, p = 0.072). The overall incidence of negative dysphotopsia was 12.2% (27/220 participating eyes). No intraoperative adverse effects of intraocular lens rotation were reported. CONCLUSION: The simple intraoperative manoeuvre of rotating the intraocular lens to orientate the optic-haptic junctions at 180° may be a safe and effective measure to reduce the risk of developing postoperative pseudophakic negative dysphotopsia in the first postoperative month. This is the first report that demonstrates the benefit of horizontal optic-haptic junction positioning to be sustained beyond the first postoperative day.

Treatment of diabetic maculopathy.

Diabetic maculopathy is an important cause of severe sight impairment. There has been a significant evolution in its treatment over the past decade and laser treatment is now largely being superseded by intravitreal injections of anti-vascular endothelial growth factor agents or corticosteroids.

Bilateral sequential non-arteritic anterior ischaemic optic neuropathy following repeat influenza vaccination.

A 68-year-old man developed bilateral sequential non-arteritic anterior ischaemic optic neuropathy, each episode occurring with a close temporal relationship to influenza vaccination.

Sensitivity to numerosity is not a unique visuospatial psychophysical predictor of mathematical ability.

Sensitivity to visual numerosity has previously been shown to predict human mathematical performance. However, it is not clear whether it is discrimination of numerosity per se that is predictive of mathematical ability, or whether the association is driven by more general task demands. To test this notion we had over 300 participants (ranging in age from 6 to 73 years) perform a symbolic mathematics test and 4 different visuospatial matching tasks. The visual tasks involved matching 2 clusters of Gabor elements for their numerosity, density, size or orientation by a method of adjustment. Partial correlation and regression analyses showed that sensitivity to visual numerosity, sensitivity to visual orientation and mathematical education level predict a significant proportion of shared as well as unique variance in mathematics scores. These findings suggest that sensitivity to visual numerosity is not a unique visual psychophysical predictor of mathematical ability. Instead, the data are consistent with mathematics representing a multi-factorial process that shares resources with a number of visuospatial tasks.