Bilateral Late-Onset Pigment Dispersion Syndrome following Implantable Collamer Lens Surgery: A Case Report.

Introduction: We report a case of bilateral pigment dispersion syndrome after 13 years of uncomplicated implantable collamer lens (ICL) surgery. Case Presentation: A 53-year-old woman was referred from her optometrist to our glaucoma clinic due to early superonasal visual field loss in both eyes. She was asymptomatic with no changes in visual acuity and had undergone bilateral ICL implantation 13 years ago to correct her high myopia. Clinical examination revealed pigment deposition on the corneal endothelium, iris transillumination defects, and iris vaulting at the areas of contact with the ICL. Gonioscopy showed open angles with significant pigmentation of the trabecular meshwork. The diagnosis of pigment dispersion syndrome secondary to ICL implantation was made, and subsequent follow-up visits demonstrated normal intraocular pressure IOP and stable visual fields. Conclusion: Pigmentary dispersion syndrome can occur several years after ICL implantation. This case report emphasizes the need for long-term follow-up and monitoring after ICL surgery.

A proposed redesign of elective cataract services in Scotland - pilot project.

BACKGROUND: The demand for cataract surgery is expected to increase by 25% in the next 10 years as the result of our ageing population. A new pathway is being proposed to improve efficiency by utilising the new General Ophthalmic Services code 2.9 for community optometrists in Scotland for Cataract Referral Refinement and Consenting process. A pilot project has been undertaken at NHS Grampian enabling patients to be assessed and undergo surgery at a single visit to the Eye Outpatient Department. OBJECTIVES: To determine the suitability of community cataract referrals for a one stop cataract surgery service and target areas for referral refinement. METHODS: 300 consecutive cataract referrals were assessed for suitability for one stop cataract surgery, determined by the documentation of pertinent clinical findings. All suitable referrals were offered a telephone consultation to confirm suitability and those patients were subsequently offered on the day cataract surgery. A telephone led patient satisfaction survey was then completed. RESULTS: 71 (24%) suitable patients were identified from vetting 300 referrals. 54 patients from this group were selected for one-stop service following telephone consultation. 51 patients subsequently attended for surgery. There was a 100% conversion rate to same day surgery and no intraoperative complications reported. CONCLUSION: The waiting time was significantly reduced, by 30 weeks, for one-stop patients. Approximately one quarter of referrals were deemed suitable for a one-stop service. Many more patients may have been suitable for same day surgery but there was not sufficient information in their referrals to determine their suitability.

Glaucoma-service provision in Scotland: introduction and need for Scottish Intercollegiate Guidelines Network guidelines.

PURPOSE: To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. MATERIALS AND METHODS: A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. RESULTS: Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. CONCLUSION: With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.

Relationship between socioeconomic deprivation or urban/rural residence and visual acuity before cataract surgery in Northern Scotland.

PURPOSE: To evaluate the influence of socioeconomic factors on visual acuity before cataract surgery. 
 METHODS: The medical case notes of 240 consecutive patients listed for cataract surgery from January 1, 2010, at Grampian University Hospital, Aberdeen, were reviewed retrospectively. Patients with ocular comorbidity were excluded. Demographics, postal codes, and visual acuity were recorded. Scottish Index of Multiple Deprivation was used to determine the deprivation rank. Home location was classified as urban or rural. The effect of these parameters on preoperative visual acuity was investigated using chi-square tests or Fisher exact test as appropriate. 
 RESULTS: A total of 184 patients (mean 75 years) were included. A total of 127 (69%) patients had visual acuity of 6/12 or better. An association was found between affluence and preoperative visual acuity of 6/12 or better (χ2trend = 4.97, p = 0.03), with a significant rising trend across quintile of deprivation. There was no evidence to suggest association between geographical region and preoperative visual acuity (p = 0.63). 
 CONCLUSION: Affluence was associated with good visual acuity (6/12 or better) before cataract surgery. There was no difference in preoperative visual acuity between rural and urban populations.

Lymphomatoid papulosis of the eyelid.

Lymphomatoid papulosis (LyP) is a chronic papulonecrotic or papulonodular skin disease, with histological features suggestive of malignant lymphoma. It was originally described by Macauley (1968) as a "self-healing paradoxical eruption, histologically malignant but clinically benign." Unless accompanied by systemic lymphoma, most patients have no constitutional symptoms, and physical findings are limited to the skin. The distribution of lesions is characteristically on the trunk or extremities, but the face, scalp, or oral mucosa may be involved. We report an unusual case of lymphomatoid papulosis of the eyelid. To the best of our knowledge, this is the first report of eyelid involvement by lymphomatous papulosis.

Accuracy of intraocular lens power estimation in eyes having phacovitrectomy for macular holes.

PURPOSE: To report the accuracy of intraocular lens (IOL) power estimation in eyes having combined phacoemulsification and vitrectomy for macular holes and to compare the axial length (AL) in those eyes with that in the fellow eyes. SETTING: Calderdale Royal Hospital, Halifax, West Yorkshire, United Kingdom. METHOD: The mean and standard deviation of the refractive aim, achieved refraction, and postoperative prediction error (calculated as difference between achieved refraction and refractive aim) were determined in 40 patients who had phacovitrectomy with gas tamponade for the treatment of idiopathic macular holes. The percentage of patients with an achieved refraction within +/-0.50 diopter (D), +/-1.00 D, and more than 2.00 D of the refractive aim was recorded. The mean absolute error (MAE) of the postoperative prediction error was calculated. In addition, the AL in eyes with macular holes was compared with that in fellow eyes. Axial lengths were measured using applanation A-scan ultrasound. RESULTS: Of eyes having phacovitrectomy, 45.0%, 67.5%, and 90.0% achieved a postoperative refraction within +/-0.50 D, +/-1.00 D, and +/-2.00 D, respectively, of the refractive aim; 10.0% of eyes were more than -2.00 D from the refractive aim. The overall postoperative prediction error ranged from +1.64 D to -2.51 D. The mean refractive aim was +0.30 +/- 0.72 D and the mean achieved refraction, -0.09 +/-1.25 D. There was no clinically significant difference between the means. The mean postoperative prediction error was -0.39 +/- 1.01 D, suggesting a myopic overcorrection occurred postoperatively. The MAE of the postoperative prediction error was 0.83 D. The mean AL was 23.40 mm in operated eyes and 23.46 mm in fellow eyes. CONCLUSIONS: The achieved refraction after phacovitrectomy for macular holes was comparable to results after phacoemulsification alone. The myopic overcorrection after phacovitrectomy might be a result of the gas bubble causing forward displacement of the capsular bag and IOL or inaccuracies in AL and keratometry measurements. Aiming for residual hyperopia may counteract the overcorrection. There was no difference in AL between eyes with macular holes and fellow eyes.

Scleral thinning after transcleral diode laser cycloablation.

BACKGROUND AND OBJECTIVE: To highlight the occurrence of scleral thinning after transcleral diode laser cycloablation therapy. PATIENTS AND METHODS: A retrospective chart review was done of consecutive patients from the glaucoma and pediatric ophthalmology clinics of a tertiary eye care center in whom the presence of scleral thinning was noted after transcleral diode laser cycloablation therapy. RESULTS: Eleven eyes of 9 patients with various types of glaucoma (traumatic, congenital, juvenile, steroid induced, uveitic, and secondary angle closure) were found to have scleral thinning after undergoing transcleral diode laser cycloablation therapy for refractory glaucoma. Seven patients had undergone only 1 session before new scleral thinning was noted. Two patients had bilateral transcleral diode laser cycloablation therapy and subsequent bilateral thinning. CONCLUSIONS: Scleral thinning may occur after diode laser cycloablation therapy even with only 1 treatment session and intact sclera, and young patients may be more susceptible to thinning.