Improving the operative rate for cataract surgery.

PURPOSE: To establish a cataract referral patient pathway that is of high quality and of greater efficiency and to compare the operative rates (conversion to surgery from referral) for patients referred via the new refined direct optometrist (RDO) pathway and for those referred by general practitioners (GPs). SETTING: Bristol Eye Hospital, Bristol, United Kingdom. DESIGN: Cohort study. METHODS: A retrospective cohort of patients referred to the "1-stop cataract clinic" at Bristol Hospital Eye Service between November 1, 2008, and May 31, 2010, were identified. The operative rates between the 2 pathways were compared. RESULTS: Of the patients, 4657 were referred; 4222 were referred via the traditional GP route and 435 via the RDO route. Operative rates (conversion to surgery from referral) were higher for the RDO pathway than for the GP pathway (91.9% versus 82.4%) (P=.0043). CONCLUSIONS: By combining referral information from optometrists and GPs, a high-quality and efficient cataract surgery patient pathway can be established. This has major economic advantages, and this scheme could be adopted at a national level.

Bacterial susceptibility to topical antimicrobials and clinical outcome in bacterial keratitis.

PURPOSE: To investigate the relationship between the susceptibility of bacteria to topical antimicrobials and clinical outcome in microbial keratitis. METHODS: Clinical outcome data were collected from patients with microbial keratitis from whom a bacterium had been isolated during the period 2003 to 2006. The minimum inhibitory concentration (MIC) was determined for the isolates against 10 antimicrobials. The determinants of the primary clinical outcome, the ratio of healing time (closure of epithelial defect) to ulcer size (HT/UA), was analyzed in a general linear model. RESULTS: Complete clinical outcome and MIC data were available for 421 patients. Sixteen (4%) patients required enucleation and 23 (5%) surgical treatment; in 382 (91%) the ulcer healed with intensive topical antimicrobial therapy. There were significant correlations between HT/UA and organism type (P = 0.001), nearest distance of the ulcer to the limbus (0.02), and MIC of the first antimicrobial used or lowest MIC of combined therapy (P = 0.006). In a model including patients who received monotherapy with a fluoroquinolone who had no subsequent change in their treatment and whose ulcers healed without surgical intervention, there were significant linear associations between clinical outcome and MIC for Pseudomonas spp. (P = 0.047), Staphylococcus aureus (P = 0.04), and Enterobacteriaceae (P = 0.045), but not for Streptococcus spp. (P = 0.85) and coagulase-negative staphylococci (CNS) (P = 0.88). CONCLUSION: With fluoroquinolone monotherapy, there was significant association between the MIC of the antimicrobial prescribed and the clinical outcome with all bacteria except CNS and Streptococcus spp. The approach used in this study, if used prospectively, could allow topical breakpoint susceptibility concentrations to be determined for individual antimicrobial and bacterial combinations.

Ultrastructural evaluation of explanted opacified Hydroview (H60M) intraocular lenses.

AIM: To describe the ultrastructural appearance of explanted opacified Hydroview H60M intraocular lenses. METHODS: 14 explanted lenses were examined by scanning electron microscopy, and their appearance compared with a non-implanted H60M lens from the same time period. Wavelength-dispersive x ray spectroscopy (WDX) was performed on two opacified lenses. RESULTS: Subsurface deposits were seen in all explanted opacified lenses. These deposits broke only onto the surface of more densely opacified lenses. WDX confirmed that the deposits contained both calcium and phosphorous, consistent with their being calcium apatite. CONCLUSION: These findings challenge the widely accepted opinion that H60M intraocular lens opacification begins on the surface of the optic.