Predicting macular hole closure with ocriplasmin based on spectral domain optical coherence tomography.

PurposeTo assess the preoperative features of patients with idiopathic macular hole (IMH) and vitreomacular adhesion (VMA) treated with ocriplasmin (OCP) that can predict successful closure.MethodData were prospectively collected on all patients with IMH treated with OCP in three British ophthalmic centres. Several preoperative variables were recorded including the IMH base diameter (BD), minimum linear diameter (MLD), and VMA width measured on spectral domain optical coherence tomography. Several other IMH indices were derived including a 'width factor', defined as the BD minus the MLD in µm. The occurrence of VMA release and hole closure were used as the main outcome measures.ResultsThirty-three patients in total with IMH were treated with OCP. Two patients developed rhegmatogenous retinal detachment and were excluded. The mean age of the remaining 31 patients was 71 years, and 71% were female. VMA release occurred in 19 of the 31 (61%) patients and macular hole closure in 11 (35%). Width factor was the most predictive feature for closure on multivariate analysis. The deviance R(2) was 67% (P<0.001). An IMH with a width factor of <60 µm had a 95% certainty of closure, whereas if >290 µm then there was less than a 5% chance of closure. Neither VMA width nor MLD alone was associated with VMA release or closure.ConclusionsPatients with macular holes where the BD was close in size to the MLD had an improved probability of closure than holes with wider base configurations.

Goldmann tonometer calibration: a national survey.

INTRODUCTION: Recent studies suggest that Goldmann tonometers can rapidly develop calibration errors (CEs) in clinical use and routine checks are necessary to ensure accuracy. PURPOSE: To determine current practice regarding CE checks in the United Kingdom and assess the views of senior nursing staff in charge of running ophthalmology outpatient clinics as to whom they feel to be responsible for CE checks. METHODS: Every ophthalmology unit with training recognition in England, Northern Ireland, Scotland, and Wales was contacted. Senior nurses responded to a structured telephone questionnaire regarding local tonometer calibration practice and their views regarding who is responsible for CE checks. A total of 155 eye units were identified and contacted. The response rate was 100%. RESULTS: CEs were checked for daily in 8 units (5.2%), weekly in 20 units (12.9%), fortnightly in 1 unit (0.6%), monthly in 12 units (7.7%), trimonthly in 5 units (3.2%), biannually in 27 units (17.4%), and annually in 21 units (13.5%). CEs were either never checked or checked in a very random manner (no identifiable pattern) in 61 units (39.4%). Sixty-three (40.6%) of the respondents felt CE checks were a departmental responsibility, 48 (31.0%) felt it to be the doctor's responsibility, and 44 (28.4%) felt CE checks should be performed by the nursing staff. CONCLUSIONS: Our national survey suggests that very few units check their tonometers for CEs at intervals which ensure their accuracy. Our previous survey of doctors suggests that they believe nurses should check for CE, whereas the nursing staff believe CE checks are not their responsibility. This lack of communication between health-care professionals may lead to inaccurate tonometers being used in clinical practice. We suggest that every eye unit should have a protocol, which clearly identifies individuals responsible for checking for CEs at least on a monthly basis.

Tonometer disinfection practice in the United Kingdom: a national survey.

PURPOSE: To assess current tonometer disinfection practice in the UK, and compare with published recommendations. METHODS: Every ophthalmology unit with training recognition in the UK was contacted (n=155). A senior nurse at each institution completed a telephone questionnaire regarding local tonometer disinfection practice. RESULTS: The response rate was 100%. Thirty-five units (23%) reported exclusive use of disposable tonometer heads and were excluded from further analysis. One hundred and twenty units (77%) used either reusable or a combination of reusable and disposable tonometer heads. Where reusable heads were used, 80 units (67%) immersed them in a chlorine-based solution such as sodium hypochlorite or sodium dichloroisocyanurate. Others used isopropyl alcohol (18 units), hydrogen peroxide (12 units), chloramine (5 units), chlorhexidine (4 units) and peracetic acid (1 unit). Where a chlorine-based agent was used, the concentration of available chlorine ranged from 125 to 30 000 p.p.m., with 50 units (63%) using a concentration of less than 5 000 p.p.m. (i.e., inadequate based on published recommendations). Where the tonometer head was immersed in disinfectant between patients (n=101), 29 units (29%) provided just one tonometer head per practitioner, making adequate soak time between patients unlikely. Every unit replenished the disinfectant at least daily, deemed sufficient for most agents. However, hydrogen peroxide solutions should be replenished twice daily, which did not take place in nine units. CONCLUSION: This survey reveals disparity between current tonometer disinfection practice and published international recommendations, with some institutions using practices that may render patients susceptible to transmissible infection.