Cambridgeshire cataract shared care model: community optometrist-delivered postoperative discharge scheme.

BACKGROUND/AIMS: To evaluate a community optometrist-delivered postoperative discharge scheme in patients who underwent same day discharge from the hospital eye service (HES) following cataract surgery. METHODS: A service-level agreement (SLA) was agreed between the HES, primary care trust and community optometrists in Cambridgeshire regarding community follow-up after cataract surgery. Patients undergoing uncomplicated surgery with no significant ocular comorbidity were eligible for same day discharge to community optometrists. Feedback return rate and unintended medical interventions were assessed using an electronic medical record system. RESULTS: Over a 23-month period, a total of 1492 of 2461 (60.6%) Cambridgeshire patients were discharged to the community on the day of cataract surgery. Complete postoperative feedback was available in 96.85% of these patients. Uneventful postoperative recovery was recorded in 93.77% of patients with 2.95% of patients re-referred. Rates of cystoid macular oedema, uveitis and raised intraocular pressure were 0.6%, 1% and 0.1%, respectively. No patients had sight-threatening complications in this study. CONCLUSIONS: Postcataract surgery follow-up by community optometrists provides the advantages of care closer to home and avoids unnecessary hospital visits for patients undergoing uncomplicated cataract surgery.

Is there an association between Vogt-Koyonagi-Harada syndrome and intracranial meningioma?

The authors report a case of Vogt-Koyonagi-Harada syndrome associated with intracranial meningioma. The authors discuss the HLA-DR4 gene as a common and causative factor in both conditions. This case report draws attention to the possibility of a causative association between intracranial meningioma and Vogt-Koyonagi-Harada syndrome, a rare but potentially blinding condition if not detected and treated early.

Congenital unilateral corneal anaesthesia with microphthalmos: a case report.

Congenital corneal anaesthesia (CCA) is an uncommon condition difficult to diagnose. We report the case of a 20-month-old boy who presented with unilateral congenital corneal anaesthesia. The child was referred with a persistent corneal epithelial defect, unresponsive to symptomatic local treatment for over 10 months. Intensive topical treatment and strict corneal protection led to quick corneal healing. Congenital corneal anaesthesia occurs either alone or in association with neurological diseases or systemic congenital abnormalities. It is important to search for corneal anaesthesia in children with chronic ulcerations of the cornea and self-inflicted injuries. Early diagnosis and treatment are important due to the risk of poor visual prognosis. Management of CCA should aim for the prevention of epithelial defects and is a life-long process.

The Importance of Clinicians Reviewing CT Scans in Suspected Lacrimal Gland Disease Causing Eyelid Swelling, Even if Radiologists Previously Interpreted them as Normal.

PURPOSE: To highlight the importance of deliberate evaluation of the lacrimal gland during routine orbital imaging by both radiologists and clinicians, which may avoid delays in diagnosis of eyelid swelling related to lacrimal gland disease. METHODS: We present four cases referred to a tertiary ophthalmic plastic and orbital centre for assessment of chronic upper eyelid swelling of unknown aetiology. All four cases had been investigated with orbital CT imaging, reported to be normal by consultant radiologists. RESULTS: Careful review of existing imaging provided valuable information concerning the lacrimal gland and helped identify a pathological cause in all four cases. CONCLUSIONS: Lacrimal gland disease can be missed radiologically without evaluation of coronal as well as standard axial orbital imaging. Clear communication with the radiologist as well as personally reviewing scans can avoid such pitfalls.

Bilateral Acanthamoeba keratitis in an experienced two-weekly disposable contact lens wearer.

PURPOSE: To present a case of bilateral Acanthamoeba keratitis in a patient who stored both contact lenses in the same storage case. METHODS: The case report of a 44-year-old female contact lens wearer who developed bilateral culture-positive Acanthamoeba keratitis. Although an experienced contact lens user for many years, she admitted to occasionally rinsing her dual contact lens case in tap water and leaving it to air dry. She was successfully treated with intensive topical polyhexamethyl biguanide and propamide isethionate in conjunction with a mydriatic agent, topical ofloxacin, and oral flurbiprofen. RESULTS: The Acanthamoeba keratitis resolved without sequelae. After 6 months, the patient had a visual acuity of 20/20 in each eye. CONCLUSIONS: Although bilateral Acanthamoeba keratitis is rare, it is essential that the patient is properly educated in contact lens hygiene and disinfection. Regular contact lens follow-up of patients is essential, and lens storage and disinfection techniques must be reviewed with the patient. The use of single-use contact lens storage cases may be advantageous in reducing the incidence of bilateral disease after case contamination.

Evaluating surgical dexterity during corneal suturing.

OBJECTIVE: To evaluate motion tracking as an aid to a more objective assessment of ophthalmic microsurgical skill. METHODS: In a cohort study, 3 groups of differing levels of surgical experience were assessed. The groups included novice surgeons (n = 10) with fewer than 5 previously performed corneal sutures, trainee surgeons (n = 10) with 5 to 100 previously performed corneal sutures, and expert surgeons (n = 10) with more than 100 previously performed corneal sutures. The Imperial College Surgical Assessment Device was used for the objective assessment of surgical dexterity during corneal suturing. Each of the subjects used a 10-0 nylon suture in a 3-1-1 pattern on an artificial eye (Royal College of Ophthalmologists, London, England). The Imperial College Surgical Assessment Device measures 3-dimensional spatial vectors via electromagnetic sensors attached to the surgeon's fingers. The number of movements, path length for the respective movements, and time taken to complete the given task were recorded. RESULTS: Highly statistically significant differences were found between the 3 grades of surgeon experience for time taken (P<.001), number of hand movements (P<.001), and path length of the hand movements (P = .002) to complete the given task. CONCLUSIONS: Motion analysis measured by this technology may be useful in the formal surgical training of residents and as an objective quantitative measure of dexterity.