A safety audit of the first 10 000 intravitreal ranibizumab injections performed by nurse practitioners.

PURPOSE: To evaluate the safety of a nurse practitioner (NP)-delivered injection service for the treatment of wet age-related macular degeneration (wAMD) with ranibizumab. METHODS: An evaluation of medical staffing resources for providing an injection service for wAMD highlighted difficulties covering lists. An alternative strategy of an NP-delivered injection service was evaluated. Two suitable NPs with previous extensive experience in minor surgical procedures were identified. The department's senior vitreo-retinal consultant supervised the NP's training programme. A prospective safety audit was conducted for the first 5.5 years of the service. RESULTS: The NPs administered 10 006 injections in the first 5.5 years of the service (1 May 2008 to 8 October 2013). This represented 84.1% of the total injections performed during this period. Four patients developed presumed infectious endophthalmitis (1 was culture positive and 3 were culture negative). The incidence of post-injection endophthalmitis was 0.04%. There was no evidence of lens touch, retinal detachment, or systemic thrombo-embolic events. CONCLUSIONS: Carefully selected and well-trained NPs are capable of delivering a safe and effective wAMD injection treatment service. This work demonstrates how such a service can be established and provides safety data that other units can use as a benchmark when evaluating their own practice.

A case of Erysipelothrix rhusiopathiae causing bilateral endogenous endophthalmitis.

This report describes a case of bilateral endogenous endophthalmitis caused by Erysipelothrix rhusiopathiae, an occupational zoonotic pathogen, which was successfully treated with intravenous penicillin G followed by oral linezolid. This is believed to be the first report of E rhusiopathiae causing endogenous endophthalmitis.

TN/TN glottic carcinoma: a comparison of two fractionation schedules.

The aim of this paper is the retrospective comparison of accelerated/hypofractionated radiotherapy regimen (AHFX) with standard fractionation regimen (SFX) for patients with early glottic carcinoma. One hundred and forty-five patients with T(1)-T(2) glottic cancer between 1986 and 1998 were eligible. Before 1992, patients received 60-66 Gy in 30-33 fractions over 6-6.5 weeks (SFX) with (60)Co and 6-MV beams. After 1992, patients received 52.5-55 Gy in 20 fractions over 4 weeks (AHFX) using 6-MV beams. The end-points were overall survival, laryngectomy-free survival (LFS), loco-regional control and toxicity. One hundred and two were stage T(1)N(0); 43 were stage T(2)N(0). Median follow up was 4.9 years. The 5-year overall survival was 78%. Five-year loco-regional control in T(1)N(0) patients was higher in AHFX than in SFX group (95 vs 75%, P = 0.002). Loco-regional control in T(2)N(0) patients was similar for AHFX and SFX (81 vs 80%, P = 0.813). Overall LFS was 88%. T(1)N(0) AHFX patients had 5-year LFS of 95% compared with 75% for SFX (P = 0.003). For T(2)N(0) AHFX patients, overall LFS was 92% compared with 80% for the SFX group (P = 0.291). No grade 4 or 5 late toxicity occurred. One AHFX patient developed grade 3 toxicity; two of 51 SFX patients developed grade 2 toxicity versus five of 94 AHFX patients. AHFX using 6-MV beams for treatment of early glottic cancer resulted in equivalent LFS and toxicity when compared with SFX.

Visual outcomes following ICG assisted ILM peel for Macular Hole.

PURPOSE: To evaluate the anatomical and visual outcome of indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling for macular hole surgery. A literature search identified potential factors that may affect the functional success of the procedure. METHODS: Retrospective case note review of 14 consecutive patients undergoing phaco-vitrectomy, gas and ICG-assisted ILM peeling for macular hole from July 2001 to July 2002. A 0.5% ICG solution (osmolarity 270 mOsm) was left in contact with the retina for 1-3 min. The outcome measures were hole closure, change in visual acuity, and macular pigmentary changes. RESULTS: Anatomical hole closure was achieved in 13 of 14 eyes (92.8%). The mean logMAR Snellen acuities were 0.80 (range 0.60-1.30) preoperatively and 0.77 (0.48-1.30) postoperatively. Seven eyes (50%) developed retinal pigmentary changes in the macular area. CONCLUSIONS: ICG-assisted ILM peeling for macular hole surgery achieves high rates of anatomical hole closure, but functional results are less encouraging. Previous studies suggest toxicity of the ICG to the retina, at the level of the RPE or inner retina. The results may be optimized by using a lower concentration, iso-osmolar, viscous solution, and by minimizing contact time of the solution and intensity, and duration of illumination.

Presbyopic phacovitrectomy.

AIM: To review the results and complications of combined phacoemulsification and vitrectomy in presbyopic patients. METHODS: Retrospective review of 90 consecutive presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment (RRD) (21), redo-RRD (seven), stages 2 and 3 full thickness macular holes (FTMH) (38), stage 4 FTMH (six), idiopathic epiretinal membrane (ERM) (11), proliferative diabetic retinopathy (PDR) (three) and vitreous haemorrhage secondary to branch retinal vein occlusion (BVO) (four). RESULTS: Lens opacity was absent or mild in 84.5% of patients. Reattachment rates for primary RRD and redo-RRD after one procedure were 90.5% and 71.4% and final reattachment rates were 95.2% and 100%, respectively. Macular hole closure rate was 89.5% for stage 2 and 3 FTMH and 83.3% for stage 4 FTMH. There was significant improvement in the median logMAR visual acuity from 1.00 preoperatively to 0.48 postoperatively for the whole cohort (p<0.001, Wilcoxon test). Postoperative complications included fibrinous uveitis (13.3%), iris bombe (2.2%), IOL/iris capture secondary to gas overfill (1.1%), and posterior capsule opacification (51.1%). CONCLUSION: Combined phacoemulsification and vitrectomy is a safe and desirable option in the management of phakic, presbyopic patients with vitreoretinal pathologies that warrant vitreous surgery, even in the absence of significant lens opacity.