The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis.

TOPIC: Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial. CLINICAL RELEVANCE: This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat. METHODS: Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR). RESULTS: Eight studies reporting SO as an outcome were included in total. The included studies contained 7500 patients and 7635 OGIs. In total, 7620 OGIs met the criteria for inclusion in this analysis; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%-0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a pooled SO estimate of 0.05% (95% CI, 0.00%-0.21%). For primary repair, the pooled estimate of SO rate was 0.15% (95% CI, 0.00%-0.33%). The ARR using a random effects model was -0.0010 (in favour of eye removal; 95% CI, -0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data. DISCUSSION: Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The Use of Preoperative Prophylactic Systemic Antibiotics for the Prevention of Endopthalmitis in Open Globe Injuries: A Meta-Analysis.

TOPIC: This study reports the effect of systemic prophylactic antibiotics (and their route) on the risk of endophthalmitis after open globe injury (OGI). CLINICAL RELEVANCE: Endophthalmitis is a major complication of OGI; it can lead to rapid sight loss in the affected eye. The administration of systemic antibiotic prophylaxis is common practice in some health care systems, although there is no consensus on their use. METHODS: PubMed, CENTRAL, Web of Science, CINAHL, and Embase were searched. This was completed July 6, 2021 and updated December 10, 2022. We included randomized and nonrandomized prospective studies which reported the rate of post-OGI endophthalmitis when systemic preoperative antibiotic prophylaxis (via the oral or IV route) was given. The Cochrane Risk of Bias tool and ROBINS-I tool were used for assessing the risk of bias. Where meta-analysis was performed, results were reported as an odds ratio. PROSPERO registration: CRD42021271271. RESULTS: Three studies were included. One prospective observational study compared outcomes of patients who had received systemic or no systemic preoperative antibiotics. The endophthalmitis rates reported were 3.75% and 4.91% in the systemic and no systemic preoperative antibiotics groups, a nonsignificant difference (P = 0.68). Two randomized controlled trials were included (1555 patients). The rates of endophthalmitis were 17 events in 751 patients (2.26%) and 17 events in 804 patients (2.11%) in the oral antibiotics and IV (± oral) antibiotics groups, respectively. Meta-analysis demonstrated no significant differences between groups (odds ratio, 1.07; 95% confidence interval, 0.54-2.12). CONCLUSIONS: The incidences of endophthalmitis after OGI were low with and without systemic antibiotic prophylaxis, although high-risk cases were excluded in the included studies. When antibiotic prophylaxis is considered, there is moderate evidence that oral antibiotic administration is noninferior to IV. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study.

BACKGROUND/AIM: Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis. METHODS: A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders. RESULTS: One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis. CONCLUSIONS: The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.

Evaluation and management of a spontaneous corneal rupture secondary to pellucid marginal degeneration, using swept-source anterior segment optical coherence tomography.

We describe a case of bilateral spontaneous corneal perforation secondary to pellucid marginal degeneration and present the associated swept-source anterior segment optical coherence tomography (SS-ASOCT) findings and management principles used. A 47-year-old woman presented with ocular pain, redness, foreign body sensation and clear discharge in the right eye in 2017 and with very similar symptoms in 2019 in the left eye. Clinically she had a corneal perforation at the inferior cornea with associated loss of anterior chamber volume. Corneal topography demonstrated peripheral thinning and steepening in the contralateral eye. ASOCT images revealed full-thickness perforation, iridocorneal touch and iris stranding. The patient was managed with a combination of contact bandaging and corneal gluing. SS-ASOCT is a useful adjunctive tool in the clinical assessment and evaluation of spontaneous corneal perforation. Alongside the clinical evaluation, it can be used to monitor the clinical response.

East London deliberate corrosive fluid injuries.

OBJECTIVES: The aims of this case series are to (1) highlight the incidence of deliberate corrosive fluid injuries (DCFI) in East London; (2) ascertain the types of substances used; and (3) grade the resulting ocular surface burns using two validated grading systems. METHODS: The Metropolitan Police 2017 Freedom of Information (FOI) requests were reviewed for DCFI. We retrospectively reviewed patient records between October 2016 and 2017 from local A&E departments for DCFI. Roper-Hall and Dua Classifications were used to classify prognoses in patients with deliberate ocular corrosive fluid injuries (DOCFI). RESULTS: The FOIs demonstrated an increasing trend with the highest number of DCFI surrounding our centre. We identified 57 patients with DCFI. Based on pre-irrigation pH measurement, 54.4% (n = 31) sustained acidic; 21.1% (n = 12) alkaline and 24.6% (n = 14) unknown injuries. More than half, 66.7% (n = 38), sustained DOCFI with median presentation visual acuity (VA) 0.25 LogMAR (n = 26, IQR: 0.10-0.39) and 1 month VA 0.20 LogMAR (n = 16, IQR: 0.02-0.20). Prognosis of the worse eye using (1) Roper-Hall Classification was 55% good (Grade I-II); 23% guarded (Grade III); 23% guarded (Grade IV); and (2) Dua Classification was 23% very good (Grade I); 35% good (Grade II-III); 19% good to guarded (Grade IV); 23% guarded to poor (Grade V); and 0% very poor (Grade VI). CONCLUSIONS: DCFI mostly affected young men in this cohort. Our clinical experience suggested an alarming increase in DCFI and is supported by police data. Although this patient group appears to show relatively good outcomes, legislation to prevent these attacks should be prioritised.

Pterygium: prevalence and severity in an Amazonian ophthalmic setting, Brazil / Pterígio: prevalência e gravidade em um cenário oftálmico na Amazônia, Brasil

OBJECTIVE: This is a cross sectional ophthalmic clinic-based study to estimate the prevalence and severity of pterygium in a selected population in the Amazon Basin, Brazil. METHODS: The study included 225 subjects above 20 years age from three different places of residence of Manaus city (group 1, n=89), river based communities (group 2, n= 116) and indigenous rainforest inhabitants (group 3, n=20). Pterygia was graded 1-4 by torch examination and gender, age and occupation determined. RESULTS: were assessed to have pterygia (grades 2-4) 117 people; 52% against 108 control subjects with bilateral disease in 43% of subjects. Prevalence of grades 2-4 increased from 36% in group 1 to 62.5 % in group 2 and 75% in group 3. Of these subjects the percentage with outdoor professions increased across the groups from 31.2% to 67.1 % and 70% respectively. Also subjects of group 2 who worked largely outdoors, showed increasing pterygia severity, from grades 2 at 57% (p=0.0002), grade 3 at 93.3% (p,0.0001) to grade 4 at 100% (p=0.0004 CONCLUSION: Amazonian communities have a high prevalence of pterygia, which correlates to greater outdoor occupation and sun exposure. This study agrees with previous worldwide reports and it is the first study to compare the prevalence of pterygium in rural and urban living in Amazonian in Brazil. This study highlights the public health significance and gross need for intervention studies.

OBJETIVO: Este é um estudo clínico oftálmico transversal para estimar a prevalência e gravidade de pterígios em uma população específica na bacia Amazônica, Brasil. MÉTODOS: O estudo incluiu 225 indivíduos acima de 20 anos de idade, oriundos de três diferentes residências na cidade de Manaus (grupo 1, n = 89), comunidades ribeirinhas (grupo 2, n = 116) e indígenas que habitam nas florestas (grupo 3, n = 20). Pterígios foram classificados de 1-4 pelo exame com tocha e determinando-se sexo, idade e ocupação. RESULTADOS: Foram diagnosticadas 117 pessoas com pterígio (graus 2-4); 52% contra 108 indivíduos com doença bilateral em 43% dos indivíduos. Prevalência de graus 2-4 aumentou de 36% no grupo 1 para 62,5% no grupo 2 e 75% no grupo 3. Dentre estes indivíduos, o percentual com profissões ao ar livre aumentou entre os grupos para 31,2%, 67,1% e 70%, respectivamente. Além disso, indivíduos do grupo 2 que trabalhavam em grande parte ao ar livre, mostrou aumento da gravidade do pterígio, com grau 2 a 57% (p=0.0002), grau 3 a 93.3% (p,0.0001) e grau 4 a 100% (p=0.0004). CONCLUSÃO: Comunidades amazônicas têm uma alta prevalência de pterígios, que se correlaciona com maior ocupação ao ar livre e exposição ao sol. Este estudo concorda com relatórios anteriores em todo o mundo e é o primeiro estudo a comparar a prevalência de pterígio nas zonas rural e urbana da Amazônia no Brasil. Este estudo destaca a importância da saúde pública e a necessidade de estudos de intervenção.

Reduction of Nd:YAG capsulotomy rates after implantation of a single-piece acrylic hydrophilic intraocular lens with 360° squared optic edge: 24-month results.

BACKGROUND AND OBJECTIVE: Posterior capsule opacification remains a significant problem following cataract surgery. The aim of the study was to evaluate the incidence of symptomatic posterior capsule opacification requiring Nd:YAG capsulotomy in patients who underwent cataract extraction and implantation of the Rayner C-flex 570C intraocular lens (IOL) (Rayner Intraocular Lens, Ltd., Sussex, UK). PATIENTS AND METHODS: A retrospective study of 3,461 eyes that underwent cataract extraction and insertion of the Rayner C-flex IOL from January 2004 to December 2005. The cases that received Nd: YAG capsulotomies were evaluated. RESULTS: Over a 24-month period, 3,461 Rayner C-flex IOLs were implanted. Nd:YAG capsulotomy was performed in 58 of these cases. The rate of Nd:YAG capsulotomy was 0.6% at 12 months and 1.7% at 24 months. The mean time to Nd:YAG capsulotomy was 9.3 months (range: 1.3 to 22.7 months). The follow-up period was 5.3 to 29.0 months. CONCLUSION: The incidence of symptomatic posterior capsule opacification with the Rayner C-flex IOL is low.

Retro-orbital oedema and transient blindness following endoscopic oesophagogastroduodenoscopy: a case report.

This case report looks at the association of an endoscopic oesophagogastroduodenoscopy and the onset of retro-orbital oedema in a young female. A literature search was performed in order to find any common factors between an endoscopic investigation and retroorbital oedema. An association between increased vascular permeability secondary to alcohol abuse and retroorbital oedema has been made. The case also describes the clinical signs of retro-orbital oedema and other possible causes. A link has been made between acute reversible retroorbital oedema following endoscopic oesophagogastroduodenoscopy.

Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill.

PURPOSE: To compare the cost and effectiveness of the two most popular forms of eye care in intensive care, ocular lubricant (Lacrilube) and polyacrylamide hydrogel dressings (Geliperm); for the prevention of exposure keratopathy in the critically ill. METHODS: A prospective randomised contralateral eye study was conducted at the Intensive Care Unit (ICU), Royal London Hospital, London, UK. Eighty eyes of 40 patients were recruited. Each patient received both Lacrilube and Geliperm allocated at random to different sides. A daily ophthalmology ward round was conducted. The outcome measures included the greatest palpebral aperture length, conjunctival oedema, and any exposure keratopathy. RESULTS: There was no statistically significant difference in the maximum corneal exposure score between the eyes treated with Lacrilube and Geliperm (P = 0.38). No significant difference in degree of chemosis or palpebral aperture was identified. CONCLUSIONS: Our data suggest that Geliperm is as effective as Lacrilube in the prevention of exposure keratopathy in the critically ill. We also note that nursing staff must be fully trained in its application for eye care.

A standardized digital photography system with computerized eyelid measurement analysis.

BACKGROUND: The authors have developed a slit-lamp mounted digital photography system. This ensures that the patient's head is consistently positioned in the same plane in relation to the camera and generates standardized images of the eyelids, which are then analyzed using commercially available computer measurement software. The aim of this study was to assess the repeatability and reproducibility of this system compared with traditional methods of eyelid measurement. METHODS: Both eyes of 10 patients were photographed and then measured by three clinicians using a handheld ruler for five eyelid parameters (i.e., palpebral aperture, superior marginal reflex distance, inferior scleral show, levator function, and upper eyelid skin crease height). The photographs were then assessed using computer software by the same clinicians (twice by a consultant and once by a clinical fellow and a specialist registrar). At all times, each observer was masked to their colleagues' results. Data were analyzed using Bland-Altman plots. RESULTS: There was a good level of agreement between measurements obtained by computer analysis of digital photographs and measurements obtained by traditional methods. A higher level of reproducibility (interobserver variability) was demonstrated in all digital measurements compared with those obtained by handheld ruler. Repeatability (intraobserver variability) with the digital photograph technique was also high and consistent for each of the five eyelid parameters. CONCLUSIONS: These results suggest that a digital photography system with computer analysis is comparable to, and offers advantages over, traditional methods of measurement. This system offers a simple, standardized, and rapid method of patient assessment with important applications in electronic patient records, audit, and research.

The role of the maxillofacial surgeon in the initial 48 h following a terrorist attack.

On 7 July 2005 there were four explosions in central London, three almost synchronously and a fourth within an hour. The Royal London Hospital received 208 casualties and the Hospital Major Incident Plan was put into action. We report on the events of that day and the role of the maxillofacial surgeons immediately and in the subsequent 48 h.

Unexpected posterior capsule rupture with unfolding silicone plate-haptic lenses.

PURPOSE: To evaluate the incidence, management, and long-term outcomes of unexpected posterior capsule rupture during injection of a C11UB plate-haptic silicone intraocular lens (IOL) with the Passport II system (both Bausch & Lomb Surgical). SETTING: Tertiary referral center and teaching hospital. METHODS: This retrospective analysis comprised 24 cases of posterior capsule rupture during plate-haptic silicone IOL injection. RESULTS: Over 6 months, a C11UB IOL was injected after phacoemulsification in 3446 cases, from which 24 patients were drawn. Thus, the rate of posterior capsule rupture was 0.70%. The median preoperative best corrected visual acuity was 6/48 (range 6/12 to light perception). The median best spectacle-corrected acuity at the time of discharge or the last visit was 6/9 (range 6/4 to 6/24). Twenty patients had improved acuity, 2 lost 1 Snellen line, and 2 had unchanged acuity. There were no postoperative complications in 13 patients (54%). Three patients required further surgery. Twenty-one patients were discharged after a mean of 32 weeks +/- 22 (SD); they required a mean of 5 +/- 4 visits. The remaining 3 continue to be followed because of their preoperative ocular comorbidity. CONCLUSIONS: Although no predisposing factor was identified, we believe the risk for posterior capsule rupture during IOL injection can be minimized by careful injection technique. In particular, if there is doubt about the integrity of the zonules, anterior capsule, or posterior capsule, a plate-haptic silicone IOL should not be injected. With the appropriate management, the final visual outcome was good.