Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes.

PURPOSE: To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom. METHODS: Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors. RESULTS: Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05). DISCUSSION: The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.

Awareness of smoking risks and attitudes towards graphic health warning labels on cigarette packs: a cross-cultural study of two populations in Singapore and Scotland.

BACKGROUND: Little is known about the level of awareness of blindness as a smoking-related condition, although the relationship has been well established. AIM: To compare the awareness of smoking risks and the impact of graphic health warning labels on cigarette packs in discouraging smoking among adults in Singapore and Scotland. METHODS: A cross-sectional survey using a structured interview of adults in ophthalmic, general medical, and general surgical outpatient clinics in Singapore and Scotland. RESULTS: One hundred and fifteen out of 163 (70.6%) outpatients in Singapore and 105 out of 112 (93.8%) outpatients in Scotland responded to the study. In both samples, awareness levels for smoking-related diseases such as lung cancer, mouth and throat cancer, heart disease, and stroke were all greater than 85%. These were found to be significantly higher than the level of awareness of blindness as a smoking-related condition (chi (2)-test, P<0.001). Although the awareness of blindness as a smoking-related condition was greater in Singapore (36.5%) than in Scotland (30.5%), this difference was not statistically significant. More than half of the respondents indicated that graphic health warning labels would be effective in discouraging them from smoking. CONCLUSION: Graphic health warning labels reading 'Smoking causes blindness' printed on cigarette packs may be useful in raising public awareness of blindness as a smoking-related condition and discouraging the habit of smoking in Singapore and Scotland.

Blindness in patients with diabetes who have been screened for eye disease.

PURPOSE: Detection of diabetic retinopathy by screening is a major public health concern. Fundus photography has been shown to be a useful screening tool for the detection of diabetic retinopathy. In this paper the authors assess the incidence of blind and partially sighted registration due to diabetic eye disease in patients screened by a mobile fundus photography unit and identify the factors that contributed to loss of vision in the registered group. METHODS: A retrospective review of blind and partially sighted registrations between 1990 and 1995 was performed in a diabetic population screened by a mobile fundus photography unit in a region with a population of 390,000. The incidence of blind and partially sighted registration in the screened diabetic population was calculated. In the registered group, cause of visual loss, accuracy of photograph reporting, delay in laser treatment, adequacy of laser treatment and non-attendance rates at ophthalmic clinics were assessed. RESULTS: Of the 5390 patients screened by the mobile unit over 6 years, 68 (210 per 10(5) patient-years) were registered blind or partially sighted, but in only 17 patients (53 per 10(5) patient-years) was this as a result of diabetes. The factors contributing to loss of vision were found to be failure of laser treatment, rapidly progressive disease and poor patient attendance. CONCLUSIONS: As the majority of visual impairment in patients with diabetes is not due to diabetic retinopathy, this has important implications for screening programmes and may make the St Vincent Declaration targets difficult to achieve. The rate of new blind and partially sighted registration due to diabetes in the screened population was low at 53 per 10(5) patient-years (95% confidence interval, 29-76).

A new method of image analysis of fluorescein angiography applied to age-related macular degeneration.

Quantitative analysis of retinal and choroidal abnormalities using current photographic techniques is complex and laborious. Digital image analysis techniques using the scanning laser ophthalmoscope overcome many of the problems with present techniques and allow reliable quantitation. A prerequisite of quantitation is accurate image acquisition and registration. The authors describe a reliable method of image analysis and apply it to the quantitation of hyperfluorescence in scanning laser fluorescein angiograms of different forms of age-related macular degeneration. Retrospective analysis of scanning laser fluorescein angiograms obtained using a standardised technique was undertaken. Eighty-six angiograms from patients with age-related macular degeneration were analysed and categorised as dry maculopathy, geographic atrophy of the retinal pigment epithelium, retinal pigment epithelial detachment (PED) or subretinal neovascularisation (SRNV). Fluorescein characteristics of both SRNV and PED showed a characteristic pattern of fluorescence. The advantages and disadvantages of the technique are discussed.

The role of white light interferometry in predicting visual acuity following posterior capsulotomy.

White light interferometry was performed on 21 eyes of 19 patients presenting for posterior capsulotomy following uncomplicated extracapsular cataract surgery. The white light interferometer was able to predict post-operative visual acuity to within one Snellen line in 56 per cent of eyes and to within two Snellen lines in 76 per cent of eyes.

Vitrectomy for diabetic eye disease.

Thirty four eyes which underwent vitrectomy because of diabetic proliferative retinopathy were reviewed. The overall success rate of the operation was 62%. Excluding table top retinal detachments, which all did badly, the success rate was 72%. Grading by ultrasound was found to be helpful in; (a) planning surgical approach, (b) assessing visual outcome. The most common late complication was cataract. Extracapsular cataract extraction with implantation was found to be successful in these cases.

Retinal break formation following contrecoup trauma: case report.

A previously healthy 38-year-old woman was involved in a road traffic accident resulting in severe commotio retinae. Subsequently extramacular retinal dissolution was noted (not previously described). The patient was treated by closed intraocular microsurgery with a successful anatomical and functional result.

Videofluoroscopy in macular disease.

Fluorescein Angiography has contributed immensely to our understanding and management of macular disease. Ridley first introduced the concept of television ophthalmoscopy and in 1973 Van Heuven and Schaffer reported the value of videofluoroscopy using a low light level system and an image intensifier. Major advances in electronic imaging technology since then have permitted high quality videofluoroscopy to be developed in particular the integral silicone intensified tube (SIT) allowed ultra low light levels to be recorded. A videofluorography system has been in routine use in our department for the last six years and we have found it to have certain advantages over conventional photography in macular disease. In this presentation we demonstrate some of these.

Atypical retinitis pigmentosa with hypophosphatasia.

Hypophosphatasia is a rare inborn error of metabolism. Ocular signs of hypophosphatasia previously described are blue sclera, band keratopathy, conjunctival calcification, cataract, optic atrophy and the complications of craniostenosis. This paper reports the association of a pigmentary dystrophy similar to rod/cone dystrophy with hypophosphatasia.