Intravitreal injections using a novel conjunctival mould: a comparison with a conventional technique.

AIMS: The aims were to compare a novel conjunctival mould used to assist the delivery of intravitreal drugs to a conventional technique with respect to patient, surgeon and cost benefit. METHODS: A prospective review of 200 intravitreal injections was undertaken, 100 using a 'conventional' freehand technique (group 1) and 100 using a novel conjunctival mould (group 2). Intraoperative visual analogue scale (VAS) pain scores, patient preference, surgeon perception of the ease of insertion of the conjunctival mould were recorded as well as a cost comparison. RESULTS: VAS pain score in the conventional group was 2.58 compared to 1.38 in the conjunctival mould group (p<0.01). The surgeon reported the insertion of the conjunctival mould as easy in 89 cases, moderate in 10 cases, and difficult in one case. The cost saving with a conjunctival mould pack compared to a conventional pack was £7.70; an annual saving of £19,250 for the trust. CONCLUSIONS: The reduction in the VAS pain score with the conjunctival mould was statistically significant (p<0.01). The surgeons found that the device, which was easy to insert, offered excellent globe stability and a safe, reproducible entry site and angle of needle insertion.

Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial.

PURPOSE: To investigate the effect of 180° versus 360° primary selective laser trabeculoplasty (SLT) on tonographic outflow facility and intraocular pressure (IOP). DESIGN: Prospective, single masked randomised clinical trial. PARTICIPANTS: Patients with untreated primary open angle glaucoma or ocular hypertension both with IOP > 21-35 mmHg. METHODS: 40 patients randomly treated with 180° or 360° SLT after baseline tonographic outflow facility (electronic Schiøtz tonography) and IOP measurements were repeated after 1 month. One eye from each patient was randomly selected for analysis. Eight untreated eyes were included as a control group. MAIN OUTCOME MEASURES: Tonographic outflow facility and IOP difference. Responders were defined as having at least a 20% reduction in IOP. RESULTS: Three patients were excluded due to poor tonography. There were 18 eyes in the 180° group and 19 eyes in the 360° group. Tonographic outflow facility increased significantly (180° p = 0.003, 360° p = 0.005) and IOP decreased significantly (180° and 360° p < 0.001) from baseline. There were no significant differences between the two groups as regards the increase in tonographic outflow facility (180° group 37.5%, 360° group 41%, p = 0.23) and decrease in IOP (180° group 24%, 360° group 35%, p = 0.35). There were similar number of responders in 180° group (72%) as compared to 360° group (89.5%, p = 0.23). Tonographic outflow facility and IOP did not change significantly from baseline in the control group (tonographic outflow facility: 8% increase p = 0.48, IOP: 4% decrease p = 0.33). CONCLUSIONS: Primary SLT significantly increased the tonographic outflow facility and decreased IOP in patients with primary open angle glaucoma and ocular hypertension but no statistically significant differences were found between the 360° and 180° groups. The level of IOP reduction due to primary SLT treatment could not be explained by the increase in tonographic outflow facility alone. Clinical trial registration ISRCTN66330584, Current Controlled Trials. 1/11/2006.

Toxoplasma retinochoroiditis in pregnancy: Using current evidence to inform management.

Toxoplasma retinochoroiditis in pregnancy may create considerable patient anxiety and is a dilemma for the treating ophthalmologist. A case report highlighting this clinical issue is presented followed by a review of the literature. Consensus in relation to the management of toxoplasma retinochoroiditis in pregnancy is lacking and is discussed.

Visual function following transpupillary thermotherapy with adjusted laser parameters for the treatment of exudative age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) using adjusted laser parameters for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: TTT was performed on patients with CNV using a diode laser (810 nm) for 60 s in a subthreshold manner. Power settings were varied between 460 and 1200 mW, depending on lesion size, presence of pigment epithelial detachment and the amount of fundal pigmentation and subretinal fluid. LogMAR visual acuity, contrast sensitivity (Pelli-Robson) and metamorphopsia (Amsler chart) were assessed prior to and 6 months following treatment. Subjects also self-administered the National Eye Institute 25-Item Visual Function Questionnaire. RESULTS: Thirty occult/minimally classic and eight predominantly classic membranes were treated with TTT. At 6 months, absence or significant reduction of fluorescein leakage was observed in 20 (53%) patients. Stabilization of vision (loss of less than 15 letters) was observed in 25/30 (83%) eyes with occult/minimally classic CNV and 5/8 (63%) eyes with predominantly classic CNV. Improvement of contrast sensitivity was noted in 15 (35%) eyes, in 10 (26%) eyes it remained unchanged and in 13 (34%) eyes it deteriorated. There was no statistically significant effect of TTT on the National Eye Institute 25-Item Visual Function Questionnaire composite or subscale scores. CONCLUSIONS: TTT using adjusted parameters depending on fundal characteristics appears to be effective in stabilizing subjective and objective visual ability in a considerable number of patients with subfoveal CNV due to age-related macular degeneration. Larger-scale studies are required to confirm the benefit of this technique as opposed to the natural history of occult CNV.