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2.
Invest Ophthalmol Vis Sci ; 60(13): 4388-4396, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634396

RESUMO

Purpose: To explore the impact of childhood lensectomy on posterior segment development. Methods: Cross-sectional observational study at children's eye clinics at a tertiary referral center in London, UK. We included 45 children age 4 to 16 years with healthy eyes and 38 who had undergone lensectomy. We acquired posterior segment optical coherence tomography scans of both eyes. We used parametric and nonparametric tests in SPSS24 for the comparison of parameters between groups and within individuals; a P value less than 0.05 was considered significant. The main outcome measures were foveal pit depth and subfoveal choroidal thickness (CT). Secondary outcomes were inner and outer ring CT and photoreceptor layer parameters, macular and peripapillary retinal nerve fiber layer thickness. Results: Foveal pit depth and subfoveal CT are significantly reduced in eyes that have undergone lensectomy compared with nonoperated eyes. Inner ring CT and outer ring CT are reduced. Foveal inner retinal layer thickness is increased. Mean inner retinal and outer nuclear layer thickness are not affected. Conclusions: Childhood lensectomy is associated with a reduction in developmental foveal pit deepening and lack of developmental thickening of the posterior choroid. Mechanical and optical disruption of foveal and subfoveal choroidal development may affect structural foveal development after childhood lensectomy.


Assuntos
Extração de Catarata , Catarata/congênito , Corioide/crescimento & desenvolvimento , Fóvea Central/crescimento & desenvolvimento , Segmento Posterior do Olho/crescimento & desenvolvimento , Adolescente , Criança , Pré-Escolar , Corioide/diagnóstico por imagem , Corioide/patologia , Estudos Transversais , Feminino , Fóvea Central/diagnóstico por imagem , Fóvea Central/patologia , Humanos , Masculino , Fibras Nervosas/patologia , Células Fotorreceptoras de Vertebrados/patologia , Segmento Posterior do Olho/diagnóstico por imagem , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31636397

RESUMO

In many healthcare settings, benchmarking for complex procedures has become a mandatory requirement by competent authorities, regulators, payers and patients to assure clinical performance, cost-effectiveness and safe care of patients. In several countries inside and outside Europe, benchmarking systems have been established for haematopoietic stem cell transplantation (HSCT), but access is not universal. As benchmarking is now integrated into the FACT-JACIE standards, the EBMT and JACIE established a Clinical Outcomes Group (COG) to develop and introduce a universal system accessible across EBMT members. Established systems from seven European countries (United Kingdom, Italy, Belgium, France, Germany, Spain, Switzerland), USA and Australia were appraised, revealing similarities in process, but wide variations in selection criteria and statistical methods. In tandem, the COG developed the first phase of a bespoke risk-adapted international benchmarking model for one-year survival following allogeneic and autologous HSCT based on current capabilities within the EBMT registry core dataset. Data completeness, which has a critical impact on validity of centre comparisons, is also assessed. Ongoing development will include further scientific validation of the model, incorporation of further variables (when appropriate) alongside implementation of systems for clinically meaningful interpretation and governance aiming to maximise acceptance to centres, clinicians, payers and patients across EBMT.

4.
J AAPOS ; 23(5): 252.e1-252.e4, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31344455

RESUMO

PURPOSE: To determine the extent of superior oblique enlargement in thyroid eye disease (TED) by comparing the cross-sectional superior oblique areas of TED patients with those of unaffected control subjects. METHODS: The medical records of TED patients treated for strabismus from January 2005 to January 2016 were reviewed retrospectively for demographic and surgical data. The cross-sectional superior oblique area was compared to age-matched controls on high-resolution orbital computed tomography (CT) using a standardized protocol. RESULTS: A total of 46 TED patients and 18 controls were included. The mean superior oblique cross-sectional area in TED subjects was 250% larger than in controls (22.88 ± 6.64 mm2 vs 9.32 ± 1.85 mm2. The mean cross-sectional area was >3 standard deviations from the mean of the control group in 96% of TED patients. CONCLUSIONS: Superior oblique enlargement in TED may occur more frequently than generally recognized, challenging the notion that TED is primarily a disease of the rectus muscles.

5.
Bone Marrow Transplant ; 54(7): 933-942, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30705338

RESUMO

Over the last 20 years, haematopoietic stem cell transplantation (HSCT) has been used to treat patients with severe autoimmune and inflammatory diseases whose response to standard treatment options has been limited, resulting in a poor long-term prognosis in terms of survival or disability. The vast majority of patients have received autologous HSCT where an increasing evidence-base supports its use in a wide range of autoimmune diseases, particularly relapsing remitting MS, systemic sclerosis and Crohn's disease. Compared with standard treatments for autoimmune diseases, HSCT is associated with greater short-term risks, including a risk of treatment-related mortality and long-term complications. There is a need for a careful appraisal of potential benefits and risks by disease and transplant specialists working closely together with patients and carers to determine individual suitability for HSCT. HSCT should be conducted in accredited transplant centres with robust arrangements for long-term follow-up with both disease and transplant specialists. The aim of this open-access position statement is to provide plainly worded guidance for patients and non-specialist clinicians considering HSCT for an autoimmune disease, especially when treatment abroad is being considered. Recent technical publications in the field have been referenced to support the statement and provide more detail for clinicians advising patients.

6.
J Pediatr Ophthalmol Strabismus ; 56(1): 43-49, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30371912

RESUMO

PURPOSE: To report the surgical outcomes of children with cataract associated with microphthalmia, microcornea, or persistent fetal vasculature (MMP) and children with isolated cataract. METHODS: The study included 111 children (cataract associated with MMP: n = 25) who underwent cataract surgery at younger than 16 years. Exclusion criteria were duration of follow-up less than 5 years, intraindividual differences in age at surgery, eye disorders other than MMP, secondary cataract, and syndromal diseases. Main outcome measures were proportion of eyes with glaucoma and best corrected visual acuity (BCVA). Both groups were dichotomized by age at surgery (early intervention group: ≤ 48 days). Descriptive analysis was performed throughout. RESULTS: Median age at surgery was 3.9 months for cataract associated with MMP and 23.3 months for isolated cataract. The median (interquartile range [IQR]) duration of follow-up was 95.9 months (range: 76.0 to 154.5 months). In children with bilateral cataract associated with MMP, the proportion of eyes with final BCVA worse than 0.3 logMAR was similar regardless of age at surgery (early intervention: 80%, later intervention: 78%). In bilateral isolated cataract, the proportions were 56% and 33%, respectively. Children with cataract associated with MMP had a high prevalence of glaucoma (28%). Glaucoma prevalence was lower in the later intervention group. CONCLUSIONS: In the presence of MMP, early cataract surgery is associated with a high risk of post-lensectomy glaucoma, but does not offer the benefit of better visual outcomes. [J Pediatr Ophthalmol Strabismus. 2019;56(1):43-49.].


Assuntos
Doenças da Córnea/cirurgia , Gerenciamento Clínico , Microftalmia/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Síndrome da Persistência do Padrão de Circulação Fetal/cirurgia , Catarata/diagnóstico , Criança , Pré-Escolar , Doenças da Córnea/diagnóstico , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Masculino , Microftalmia/diagnóstico , Estudos Retrospectivos , Fatores de Tempo
7.
Ophthalmology ; 126(2): 233-241, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30172708

RESUMO

PURPOSE: To compare Schlemm canal (SC) and trabecular meshwork (TM) in children with healthy eyes and those with and without glaucoma after lensectomy. DESIGN: Cross-sectional observational study. PARTICIPANTS: Fifty children 4 to 16 years of age with healthy eyes and 48 children who underwent lensectomy (124 healthy and 72 postlensectomy eyes). METHODS: Anterior segment (AS) OCT (Tomey SS-1000 CASIA; Tomey, Nagoya, Japan) of the nasal iridocorneal angle at 2 levels of accommodative effort (2.5 diopters [D] and 15 D). For each parameter and state of accommodation, a random effects model was fitted to estimate differences between healthy eyes and eyes with history of lensectomy. MAIN OUTCOME MEASURES: Dimensions of SC and TM and conventional AS OCT iridocorneal angle measurements. RESULTS: The horizontal diameter of SC and its cross-sectional area (CSA) are significantly smaller in eyes that have undergone lensectomy versus healthy eyes. Accommodative effort increases SC size in healthy eyes, but not in eyes that have undergone lensectomy. CONCLUSIONS: Lensectomy is associated with a reduction in SC size and a loss of physiologic SC dilatation during accommodative effort, which may reflect a reduction in outflow facility and may contribute to the development of glaucoma after lensectomy.


Assuntos
Extração de Catarata/efeitos adversos , Glaucoma/etiologia , Limbo da Córnea/fisiopatologia , Malha Trabecular/fisiopatologia , Acomodação Ocular/fisiologia , Adolescente , Segmento Anterior do Olho/diagnóstico por imagem , Fenômenos Biomecânicos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Humanos , Implante de Lente Intraocular , Masculino , Pseudofacia/fisiopatologia , Tomografia de Coerência Óptica/métodos
8.
Strabismus ; 26(4): 203-209, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30325248

RESUMO

PURPOSE: IINS is associated with mild/moderate visual impairment, strabismus and compensatory head postures (CHP), which can negatively impact quality of life. Standard visual acuity assessments tend to underestimate the effect of IINS on visual functioning. Published evidence on the effect of INS on quality of life is slowly emerging. Our study examines visual functioning of adults with IINS using the National Eye Institute Visual Function Questionairre-25 (VFQ-25). METHODS: 38 participants were recruited to participate in the study. All participants underwent detailed clinical examination, as well as appropriate investigations and were asked to complete the self administered VFQ-25. RESULTS: 35/38 participants completed the questionnaire. The mean age of the population was 35.1 years (range 17-64). Mean overall VFQ-25 score at baseline was 65 (SD 13, range 34-91). Participants specifically demonstrated lowest scores for the impact of IINS on mental health, role limitations and dependency. 26/35 of participants were not driving, either due to sub-normal vision, lack of confidence or difficulties with contrast sensitivity. CONCLUSIONS: IINS can have a greater than expected impact on an individual's quality of life, without necessarily causing markedly reduced visual acuity. Our study showed lowest scores in the domains of mental health and wellbeing. Patients also reported reduced visual functioning in driving, which can impact adversely on employability and independence. Visual functioning questionnaires such as the VFQ-25 may provide more functional information on the impact of nystagmus on an individual's quality of life than objective measures such as high contrast Snellen and/or LogMAR visual acuity.


Assuntos
Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Nistagmo Congênito/fisiopatologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Sensibilidades de Contraste/fisiologia , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Congênito/psicologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Inquéritos e Questionários , Síndrome , Visão Ocular/fisiologia , Adulto Jovem
9.
Eye (Lond) ; 32(11): 1752-1759, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30013158

RESUMO

AIMS: To evaluate retreatment rates, visual and anatomical outcomes at 1-year postnatal age in infants treated for retinopathy of prematurity (ROP) METHODS: Longitudinal national surveillance study of infants treated for ROP in the United Kingdom between December 2013 and December 2014, supported by the British Ophthalmic Surveillance Unit. Here we report retreatment rates, anatomical, visual and refractive outcomes at 1-year follow-up. RESULTS: One-year follow-up forms were completed for 168 children of the original cohort of 327 (51.4%). Twenty-two had at least one retreatment: 17/153 right eyes (REs, 11.1%) after initial diode laser, and 5/14 REs (35.7%) after initial injection of anti-vascular endothelial growth factor (VEGF) antibody. Median (interquartile range) RE best-corrected visual acuity was 0.6 (0.4-1.0) (n = 46 REs), and median acuity both eyes open 0.4 (0.3-0.7) logMAR (n = 89). Median spherical equivalent (RE) was 0.44 (-1.3 to 1.3) dioptre (D) (n = 116). Median astigmatism (RE) was 0.5 (0-1.0) D (n = 111), and median anisometropia 0.125 (0-0.75) D (n = 116). Twenty-four children (20.5%) had been prescribed glasses. Sight impairment certification eligibility information was available for 131 children: 11 (8.4%) were eligible to be certified as sight impaired, and 5 (3.8%) as severely sight impaired. CONCLUSIONS: Retreatment rates are in line with previous reports, and appear higher after initial anti-VEGF antibody than after initial diode laser. Refractive outcomes are in line with previous studies, with a trend towards early emmetropia and myopia following diode laser, particularly in more severe ROP.


Assuntos
Retinopatia da Prematuridade/terapia , Retratamento/estatística & dados numéricos , Inibidores da Angiogênese/uso terapêutico , Astigmatismo/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Fotocoagulação a Laser , Masculino , Refração Ocular/fisiologia , Retina/patologia , Retinopatia da Prematuridade/patologia , Retinopatia da Prematuridade/fisiopatologia , Reino Unido , Acuidade Visual/fisiologia
10.
PLoS One ; 13(6): e0199074, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29902283

RESUMO

BACKGROUND: Botulinum toxin injection chemodenervation is a well-established intervention for adult strabismus, and has also been recognised as an effective alternative to routine incisional surgery for paediatric disease. We aimed to investigate the temporal patterns of practice, indications and outcomes of chemodenervation for paediatric strabismus at national and tertiary centre level. METHODS: Retrospective study using routinely collected patient data: Hospital Episode Statistics (HES) data were used to identify children undergoing non-incisional strabismus procedures in England from 2007 to 2016. Single-centre retrospective data on children undergoing botulinum toxin injections (Dysport® 2.5 units/ 0.1ml) as an isolated intervention (not involving incisional procedures) was undertaken to identify indications and outcomes. Successful outcome was defined as deviation <11 prism dioptres (PD). RESULTS: Between 2007 and 2016, there was no increase in the proportion of childhood strabismus involving non-incisional procedures. Amongst 150 children undergoing chemodenervation for strabismus within the tertiary centre, the most common diagnoses were acute onset esotropia (n = 34), infantile esotropia (n = 16) and consecutive exotropia (n = 15). Median age at injection was 8.5 years (range 0.9-15 years), and median follow up 12 months (6 months-11 years). Success rates differed by diagnosis, from 66% (non or partially accommodative esotropia) to 0% (congenital cranial disorders). Adverse events were seen in 62/150, 41%, most commonly transient ptosis (39%, n = 58). Overcorrection was seen in 14/119, 13%. Mild subconjunctival haemorrhage (n = 2) was the only other adverse event. CONCLUSIONS: Botulinum toxin for childhood strabismus has an acceptable safety profile, and considerable potential therapeutic benefit. However, nationally there has been no increased uptake of chemodenervation non-incisional procedures. Further prospective studies are necessary to understand the predictors of outcome within the separate clinical subgroups, to guide clinical decision making.


Assuntos
Toxinas Botulínicas/farmacologia , Bloqueio Nervoso , Estrabismo/tratamento farmacológico , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/uso terapêutico , Criança , Inglaterra , Humanos , Bloqueio Nervoso/efeitos adversos , Estudos Retrospectivos , Segurança , Resultado do Tratamento
11.
J AAPOS ; 22(4): 281-285.e1, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29730053

RESUMO

PURPOSE: To determine the child's and parental perception of functional visual ability (FVA), vision-related and health-related quality of life (VR-QoL, HR-QoL) in children with microphthalmia/anophthalmia/coloboma (MAC). METHODS: Between June 25, 2014, and June 3, 2015, we carried out a cross-sectional observational study at Moorfields Eye Hospital, London, UK, enrolling 45 children 2-16 years of age with MAC attending our clinics, and their parents. To assess FVA, VR-QoL, and HR-QoL we asked participants to complete three validated tools, the Cardiff Visual Ability Questionnaire for Children (CVAQC), the Impact of Vision Impairment for Children (IVI-C) instrument, and the PedsQL V 4.0. The main outcome measures were the FVA, VR-QoL, and HR-QoL scores, reported by children and parents. RESULTS: In children with MAC, FVA is moderately reduced, with a median CVAQC score of -1.4 (IQR, -2.4 to 0.4; range, -3.0 [higher FVA] to +2.8 [lower FVA]). VR-QoL and HR-QoL are greatly reduced, with an IVI-C median score of 63 (IQR, 52-66; normal VR-QoL, 96), a median self-reported PedsQL score of 77 (IQR, 71-90; normal HR-QoL, 100) and parental score of 79 (IQR, 61-93), and a family impact score of 81 (67-93). Psychosocial well-being scores are lower than physical well-being scores. Parents and children have a different perception of the impact of the condition on the child's HR-QoL. CONCLUSIONS: MAC has a significant impact on a child's FVA and QoL, similar to that described by children with acute lymphoblastic leukaemia and chronic systemic conditions. Children and families may benefit from psychosocial support.


Assuntos
Anoftalmia , Coloboma , Microftalmia , Qualidade de Vida , Transtornos da Visão/psicologia , Adolescente , Anoftalmia/fisiopatologia , Anoftalmia/psicologia , Criança , Pré-Escolar , Coloboma/fisiopatologia , Coloboma/psicologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Microftalmia/fisiopatologia , Microftalmia/psicologia , Perfil de Impacto da Doença , Acuidade Visual
12.
Strabismus ; 26(1): 11-21, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29333910

RESUMO

PURPOSE: The optimal management of infantile nystagmus syndrome (INS) is still unclear. Contact lenses (CL) may be superior to glasses in improving visual function in INS but it is not known whether their beneficial effects are due to optical correction alone, or to an additional proprioceptive effect, and whether soft CLs would be as effective as rigid CLs. There is little data on feasibility and and the present study aimed to provide this information. METHODS: We completed a pilot Randomized Control Trial (RCT) at a single tertiary referral centre in London, UK. We enrolled 38 adults with idiopathic INS and randomised them to either plano CL (with corrective spectacles if required) or to corrective CL. CL wear was required for a minimum of 2 weeks. Primary outcome measures were feasibility and safety of CL wear in INS; secondary outcome measures were visual acuity and nystagmus waveform parameters. RESULTS: 27 completed the study (27/38,71%). 4 partcipants withdrew due to difficulty with CL insertion/removal and 7 were lost to follow up. CL tolerability was high (24/27,89%) - 2 found the CLs irritant, and 1 had an exacerbation of allergic eye disease. At two weeks, mean improvement in binocular visual acuity from baseline with plano CLs was 0.07 logMAR (95% confidence interval (CI: 0.03-0.11) and 0.06 logMAR with fully corrective CLs (95% CI:0.02-0.1). Mean improvement in the eXpanded Nystagmus Acuity Function (NAFX, a nystagmus acuity function based on eye movement recording) with plano CLs was -0.04(95% CI: -0.08-0.005) and -0.05 with fully corrective CLs(95% CI: -0.09-0.003). CONCLUSIONS: CLs are well tolerated, with a low risk profile. Whilst our study was not powered to detect significant changes in BCVA and waveform parameters between treatment arms, we observed a trend towards an improvement in visual function at two weeks from baseline with CLs.


Assuntos
Lentes de Contato Hidrofílicas , Doenças Genéticas Ligadas ao Cromossomo X/terapia , Nistagmo Congênito/terapia , Adolescente , Adulto , Movimentos Oculares/fisiologia , Óculos , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Congênito/fisiopatologia , Projetos Piloto , Acuidade Visual/fisiologia , Adulto Jovem
13.
Br J Ophthalmol ; 102(3): 318-322, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28637781

RESUMO

BACKGROUND: Following high-profile cases, referrals for evaluation of 'suspicious optic discs' to eye clinics in the UK have sharply increased, asking ophthalmologists to reliably distinguish between true and pseudopapilloedema. Optic nerve sheath dilatation (ONSD) on ocular ultrasound (US) is considered a reliable sign of true papilloedema, but this test is not widely available. Recently, anterior bowing of Bruch's membrane (BM) and increased retinal nerve fibre layer thickness on optical coherence tomography (OCT) have emerged as indicators of intracranial hypertension, and OCT is widely available. We aimed to evaluate safety and efficacy of the diagnostic workup in our service, with particular emphasis of diagnostic reliability of US and OCT. METHODS: Retrospective service evaluation/cohort study of children and young people younger than 16 years investigated for 'suspicious discs' over a 7-month period in 2016 at a single eye care provider in London, UK. 61 children and young people underwent clinical assessment, US scan and OCT. RESULTS: Of 61 cases, 3 had intracranial pathology. At presentation, only one had ONSD on US and anterior bowing of BM on OCT. Increased nerve fibre layer thickness in at least one of three relevant sectors was observed in two cases. All three cases of intracranial pathology, however, had significant points in their presenting or medical history. CONCLUSION: Ophthalmologists and optometrists must not rely on funduscopy and ocular imaging when assessing a child for possible intracranial disease; history and basic neurological assessment are critical in the diagnostic workup.


Assuntos
Hipotensão Intracraniana/diagnóstico por imagem , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Papiledema/diagnóstico por imagem , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Ultrassonografia/métodos , Adolescente , Criança , Oftalmopatias Hereditárias/diagnóstico por imagem , Feminino , Humanos , Masculino , Doenças do Nervo Óptico/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Eur J Ophthalmol ; 28(2): 246-250, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29077177

RESUMO

PURPOSE: To describe the use of a mobile femtosecond laser platform in assisting paediatric cataract surgery. METHODS: A mobile femtosecond laser was brought into the operating room and calibrated on the day of the surgery. After general anesthesia is induced, the femtosecond laser was docked onto the eyes with a liquid-filled interface, without any perioperative adaptations or additional surgical procedures. An anterior capsulotomy was created with the femtosecond laser, followed by conventional cataract extraction and intraocular lens implantation. RESULTS: Five eyes of 3 children with congenital cataracts were treated with this technique. Docking and capsulorhexis were successful in all cases. No perioperative or intraoperative complications were noted in any of the cases. At median follow-up of 15 months (range 6-18 months), all patients had improved best-corrected visual acuity. CONCLUSIONS: Using the mobile femtosecond laser platform, a perfectly sized anterior capsulotomy could be created with high precision and accuracy in paediatric cataract cases, while ensuring that perioperative care for the children undergoing the procedure was not compromised.


Assuntos
Cápsula Anterior do Cristalino/cirurgia , Extração de Catarata/métodos , Catarata/congênito , Terapia a Laser/métodos , Implante de Lente Intraocular , Capsulorrexe/métodos , Criança , Pré-Escolar , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Resultado do Tratamento , Acuidade Visual
16.
Ophthalmology ; 124(7): 1048-1055, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28385300

RESUMO

PURPOSE: To evaluate the effect of glaucoma on functional vision and on vision-related (VR) and health-related (HR) quality of life (QoL) in children up to 16 years of age. DESIGN: Cross-sectional observational study. PARTICIPANTS: One hundred nineteen children 2 to 16 years of age (mean age, 9.4 years; standard deviation [SD], 4.56 years) with glaucoma and their parents. METHODS: Completion of 3 validated instruments for children to assess (1) functional visual ability (FVA) with the Cardiff Visual Ability Questionnaire for Children (CVAQC), (2) VR QoL with the Impact of Vision Impairment for Children (IVI-C), and (3) HR QoL with the Pediatric Quality of Life Inventory (PedsQL) version 4.0. MAIN OUTCOME MEASURES: Cardiff Visual Ability Questionnaire for Children, IVI-C, and PedsQL scores. RESULTS: Scores for FVA, VR QoL, and HR QoL were reduced in children with glaucoma: median CVAQC score, -1.24 (interquartile range [IQR], -2.2 to -0.11; range, -3.00 higher visual ability to +2.80 lower visual ability); mean IVI-C score, 67.3 (SD, 14.4; normal VR QoL, 96); median PedsQL self-report, 78.8 (IQR, 67.4-90.2); parent report, 71.2 (IQR, 55.7-85.8); and family impact score, 74.3 (IQR, 56.9-88.5; normal HR QoL, 100). Psychosocial subscores were lower than physical subscores on the PedsQL. Older children reported less impairment on CVAQC, IVI-C, and PedsQL than younger children. Parents reported greater impact on their child's HR QoL than children reported themselves. CONCLUSIONS: Glaucoma and its management have a marked impact on a child's FVA and QoL. Children with glaucoma report HR QoL scores similar to those described by children with severe congenital cardiac defects, who have undergone liver transplants, or who have acute lymphoblastic leukemia.


Assuntos
Atividades Cotidianas , Glaucoma/psicologia , Qualidade de Vida , Autorrelato , Inquéritos e Questionários , Acuidade Visual/fisiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino
17.
BMJ Open ; 7(3): e013366, 2017 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-28325857

RESUMO

OBJECTIVES: To estimate the incidence of severe retinopathy of prematurity (ROP) requiring treatment and describe current treatment patterns in the UK. DESIGN: Nationwide population-based case ascertainment study via the British Ophthalmic Surveillance Unit and a national collaborative ROP special interest group. Practitioners completed a standardised case report form (CRF). SETTING: All paediatric ophthalmologists providing screening and/or treatment for retinopathy in the UK were invited to take part. PARTICIPANTS: Any baby with ROP treated or referred for treatment between 1 December 2013 and 30 November 2014, treated with laser, cryotherapy, vascular endothelial growth factor (VEGF) inhibitor or vitrectomy/scleral buckling, or a combination. MAIN OUTCOME MEASURE: Incidence of ROP requiring treatment. RESULTS: We received 370 CRFs; 327 were included. Denominator from epidemiological data: 8112 infants with birth weight of <1500 g. The incidence of ROP requiring treatment was 4% (327/8112, 95% CI 3.6% to 4.5%). Median gestational age was 25 weeks (IQR 24.3-26.1), and median birth weight 706 g (IQR 620-821). Median age at first treatment was 80 days (IQR 71-96). 204 right eyes (62.39%) had type 1 ROP, and 27 (8.26%) had aggressive posterior ROP. Infants were also treated for milder disease: 9 (2.75%) right eyes were treated for type 2 ROP, and 74 (22.63%) for disease milder than type 1 with plus or preplus, which we defined here as 'type 2 plus' disease. First-line treatment was diode laser photoablation of the avascular retina in 90.5% and injection of VEGF inhibitor in 8%. CONCLUSIONS: ROP treatment incidence in the UK is 2.5 times higher than previously estimated. 8% of treated infants receive intravitreal VEGF inhibitor, currently unlicensed. Research is needed urgently to establish safety and efficacy of this approach. Earlier treatment and increasing numbers of surviving premature infants require an increase in appropriate eye care facilities and staff. TRIAL REGISTRATION NUMBER: NCT02484989.


Assuntos
Recém-Nascido Prematuro , Seleção de Pacientes , Padrões de Prática Médica , Retina/patologia , Retinopatia da Prematuridade/terapia , Índice de Gravidade de Doença , Técnicas de Ablação , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Injeções Intravítreas , Lasers , Masculino , Oftalmologia , Reino Unido , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
19.
J AAPOS ; 20(5): 383-386, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27651232

RESUMO

BACKGROUND: Strabismus, which has been estimated to occur in 4% of the adult population, can have a negative psychosocial effect on an individual's quality of life. While correction of strabismus may improve quality of life, this is not always the case, even if realignment surgery is clinically successful. Surgeons need to understand patients' expectations of postsurgical outcomes and the impact surgery has on their psychosocial well-being. METHODS: This was a prospective cross-sectional study of 220 adult patients undergoing strabismus surgery at Moorfields Eye Hospital NHS Foundation Trust. Clinical assessments were performed before surgery and again 2 weeks and 3 months after surgery. Standardized psychological questionnaires were completed preoperatively and 3 and 6 months postoperatively. RESULTS: Of 220 patients included in the study (mean age, 45 years), 54% were female, 81% were white, and 58.6% had a concomitant deviation. Prior to surgery, 24% of study participants were experiencing clinical levels of anxiety; 11% were suffering clinical levels of depression. Quality of life improved and anxiety and depression were reduced after surgery. Approximately 6% of the sample regretted having undergone surgery either at 3 or 6 months after treatment. CONCLUSIONS: It is important to identify patients who are experiencing significant psychosocial distress and to assess their postsurgical expectations in order to improve the outcomes of strabismus surgery. Presurgical psychosocial support should be considered for these patients.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos do Humor/psicologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/psicologia , Estrabismo/psicologia , Estrabismo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Estresse Fisiológico/fisiologia , Inquéritos e Questionários , Adulto Jovem
20.
Br J Ophthalmol ; 100(3): 415-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26198281

RESUMO

AIMS: To develop and validate a short questionnaire to assess patients' expectations about outcomes post strabismus surgery. METHODS: Questionnaire items were extracted from previous literature and reviewed by a multidisciplinary team. A cross-sectional study was then undertaken with 220 adult patients due to undergo strabismus surgery. Participants completed the 17-item questionnaire. Scale structure was explored using principal component analysis (PCA), and the subscales analysed in relation to demographic and clinical characteristics and psychosocial well-being in order to establish validity. RESULTS: PCA revealed a 3-factor solution for the Expectations of Strabismus Surgery Questionnaire (ESSQ): (a) intimacy and appearance-related issues, (b) visual functioning, (c) social relationships. This 3-factor solution explained 59.30% of the overall variance in the ESSQ. Internal consistency, content and nomological and concurrent validity were considered acceptable. CONCLUSIONS: Patients with strabismus have high expectations about their postsurgical outcomes. This questionnaire provides a useful tool to assess the expectations patients have about their surgery, whether these expectations change over time and how they impact on postsurgical outcomes.


Assuntos
Procedimentos Cirúrgicos Oftalmológicos , Satisfação do Paciente , Qualidade de Vida/psicologia , Estrabismo/psicologia , Estrabismo/cirurgia , Inquéritos e Questionários , Adulto , Idoso , Transtornos de Ansiedade , Estudos Transversais , Transtorno Depressivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Perfil de Impacto da Doença
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