Sodium-glucose co-transporter-2 inhibitors in type 2 diabetes: Are clinical trial benefits for heart failure reflected in real-world clinical practice? A systematic review and meta-analysis of observational studies.

AIM: To determine the absolute risk reduction (ARR) of heart failure events in people treated with sodium-glucose co-transporter-2 (SGLT2) inhibitors. MATERIALS AND METHODS: We searched PubMed, EMBASE, CINAHL and ISI Web of Science for observational studies published to 9 May 2022 that explored the association between SGLT2 inhibitors and any indication for heart failure (including new diagnosis or hospitalization for heart failure) in type 2 diabetes. Identified studies were independently screened by two reviewers and assessed for bias using the Newcastle-Ottawa scale. Eligible studies with comparable outcome data were pooled for meta-analysis using random-effects models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). The ARR per 100 person-years was determined overall, and in subgroups with and without baseline cardiovascular disease (CVD). RESULTS: From 43 eligible studies, with a total of 4 818 242 participants from 17 countries, 21 were included for meta-analysis. SGLT2 inhibitors were associated with a reduced risk of hospitalization for heart failure (HR 0.65, 95% CI 0.59-0.72) overall and both in those with CVD (HR 0.78, 95% CI 0.68-0.89) and without CVD (HR 0.53, 95% CI 0.39-0.71). Risk reduction for hospitalization for heart failure in people with a history of CVD (ARR 1.17, 95% CI 0.78-1.55) was significantly greater than for those without CVD (ARR 0.39, 95% CI 0.32-0.47). The number-needed-to-treat to prevent one event of hospitalization for heart failure was 86 (95% CI 65-128) person-years of treatment for the CVD group and 256 (95% CI 215-316) person-years for those without CVD. CONCLUSIONS: Real-world SGLT2 inhibitor use supports randomized trial data for the size effect of reduced hospitalization for heart failure in type 2 diabetes, although with a much lower ARR in people without CVD.

A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice.

PURPOSE: Neovascular glaucoma (NVG) is characterised by neovascularisation of the angle and therefore elevated intraocular pressure (IOP). This results in progressive optic neuropathy and loss of visual acuity. Treatment aims to reduce IOP in order to prevent optic nerve damage. A systematic review was completed synthesising results from randomised control trials (RCTs) comparing interventions for the management of NVG and their efficacy and safety. METHODS: Data was sourced from Web of Science, Embase and Medline after 1st January 2000. The primary outcome measures were mean IOP at follow-up and success rate. The secondary outcomes included mean IOP lowering medications and total complications. A meta-analysis was completed on comparative studies using Revman (version 5.4). RESULTS: For the two studies comparing Ahmed glaucoma valve (AGV) + pan-retinal photocoagulation (PRP) vs AGV + PRP + intra-vitreal bevacizumab (IVB), there was no difference in mean IOP or odds of success from the meta-analysis. From the 4 studies examining the utilisation of anti-vascular endothelial growth factor (anti-VEGF), one study showed lower mean IOP at 1 (p = 0.002) and 3 months (p = 0.033) for IVB vs sham injection. In the 2 studies studying transcleral diode laser (TDL), there were no significant findings. From the 4 studies looking at trabeculectomy (trab), lower mean IOP at 6 (p = 0.001), 9 (p = 0.01), 12 (p = 0.02) and 18 months (p = 0.004) was shown for intra-vitreal ranibizumab (IVR) + PRP + visco-trabeculectomy vs IVR + PRP + trab, and a significantly lower mean IOP was present in the Baerveldt group vs trab at 6 months (p = 0.03). In the 2 studies investigating the AGV, there was a lower mean IOP at 1 month (p = 0.01) in the AGV + triamcinolone (TCA) group. The risk of bias was low for 4 studies, high for 4 studies and 6 studies had some concerns. CONCLUSION: This is the first meta-analysis of RCTs in the management of neovascular glaucoma. The lack of high-quality evidence contributes to the lack of consensus in managing NVG. Our results highlight modern treatment strategies and the need for better powered RCTs with long-term follow-up in order to establish optimal treatment modalities and true patient outcomes.

Association between dietary niacin and retinal nerve fibre layer thickness in healthy eyes of different ages.

BACKGROUND: To investigate the relationship between dietary intake of niacin (water-soluble form of vitamin B3 ) and retinal nerve fibre layer (RNFL) thickness in healthy eyes. METHODS: This cross-sectional study examined the association between daily niacin intake and RNFL thickness in three large population-based cohorts with varied age differences. RNFL thickness was extracted from optical coherence tomography data; energy-adjusted niacin intake was estimated from food frequency questionnaires. Linear mixed-effects models were utilised to examine the association between RNFL thickness and energy-adjusted niacin intake. Three separate analyses were conducted, with niacin treated as a continuous, a categorical (quartiles) or a dichotomous (above/below Australian recommended daily intake) variable. RESULTS: In total, 4937 subjects were included in the study [Raine Study Gen2, n = 1204, median age 20; Busselton Healthy Ageing Study (BHAS), n = 1791, median age 64; TwinsUK, n = 1942, median age 64). When analysed as a continuous variable, there was no association between RNFL thickness and niacin intake in any of the three cohorts (95% CI ß: Raine Study Gen 2, -0.174 to 0.074; BHAS, -0.066 to 0.078; TwinsUK -0.435 to 0.350). Similar findings were observed with quartiles of niacin intake and for niacin intakes above or below Australian recommended daily intake levels in all three cohorts. CONCLUSIONS: Dietary intake of niacin from a standard diet does not appear to be associated with age-related RNFL thinning in healthy eyes. Supraphysiological doses of niacin may be required for therapeutic effect in the retina.

Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data.

BACKGROUND: Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). METHODS: Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure. RESULTS: A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. CONCLUSION: There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

Influence of Graft Source on Postoperative Activity and Joint Laxity in Posterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To compare the clinical and functional outcomes of allograft and autograft reconstruction in patients with posterior cruciate ligament (PCL) deficiency. METHODS: The MEDLINE, Embase, and Cochrane Library databases were used to identify all relevant articles. Clinical outcomes including International Knee Documentation Committee, Tegner, and Lysholm scores; joint laxity; and posterior tibial displacement were evaluated. RESULTS: Among the 145 unique articles identified during the title screening, 25 studies published between 2002 and 2016 with a combined population of 900 patients were deemed eligible for inclusion in the review. Of the 900 patients, 603 were treated with autograft and 297 were treated with allograft PCL reconstruction. Five of the included studies directly compared autograft and allograft PCL reconstruction. Most studies found postoperative functional outcomes and joint laxity to improve postoperatively regardless of graft source. With only 1 exception, the included comparative studies found no significant postoperative difference in any of the functional outcome scores between patients treated with allograft and those treated with autograft. Two comparative studies found autograft reconstruction to result in significantly less posterior laxity than in the allograft group, whereas 2 comparative studies found no significant difference in posterior laxity between the 2 groups. CONCLUSIONS: PCL reconstruction results in improved functional outcome scores and joint laxity regardless of graft source. Current studies suggest there is no significant difference in postoperative functional outcomes between patients treated with autograft and those treated with allograft. Patients treated with autograft have donor-site morbidity that is not associated with allograft reconstruction. Some evidence suggests that autograft reconstruction may result in reduced posterior laxity relative to allograft reconstruction. The magnitude of this finding, however, may not be clinically significant. Our review found that decision making based on the current literature is at high risk of potential bias. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.

An unusual case of infective pneumocephalus: case report of pneumocephalus exacerbated by continuous positive airway pressure.

BACKGROUND: Pneumocephalus, illustrated by air in the cranial vault is relatively infrequent and generally associated with neurosurgery, trauma, meningitis and barotrauma. However cases of spontaneous non-traumatic pneumocephalus remain rare. While the relationship between continuous positive airway pressure (CPAP) and atraumatic pneumocephalus has been previously reported, to our knowledge the rare presentation associated with sinus wall osteomyelitis has never been described. We summarize here the case of a 67-year-old woman's acute presentation of Streptococcus salvarius infection after a sudden drop in her consciousness. CASE PRESENTATION: The patient was brought to hospital by family reporting a one week history of sudden deterioration, cognitive decline, and lethargy. The patient presented with reduced arousal, cognitive function (Glasgow Coma Scale: 10, Abbreviated Mental Test Score:CS, 0 AMTS), and no history of trauma. Computed Tomography (CT) imaging was ordered and identified a significant pneumocephalus with no cranial defect. Further investigations acknowledged possible sinus or middle ear disease, which was highlighted by the discovery of S. salivarius by polymerase chain reaction (PCR) and potentially exacerbated by the use of nocturnal continuous positive airway pressure (CPAP). The patient made a complete recovery by eliminating likely causative factors and long term regimental antibiotics administration. CONCLUSION: This case highlights a rare neurological presentation of S. salivarius infection with a mixed aetiology of spontaneous pneumocephalus. This case features an atypical complication associated with CPAP use, and to our knowledge is the first case to be associated with sinus wall osteomyelitis. Recognition of the clinical features and risk factors for spontaneous pneumocephalus -while rare-serve to broaden our clinical index of suspicion when presented with patients experiencing neurological deficit. Information from this case may also aid in improving prevention, early diagnosis, and future management.

Stress and cataract surgery: A nationwide study evaluating surgeon burnout.

BACKGROUND: We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem. METHODS: A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains. RESULTS: A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity. CONCLUSION: The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.

Prevalence, Concordance, and Heritability of Vitreomacular Interface Abnormalities in a Twin Study.

Purpose: The relative importance of genetic factors in common vitreomacular interface (VMI) abnormalities is unknown. The aim of this classical twin study is to determine the prevalence case wise concordance between monozygotic and dizygotic twin pairs, and heritability of common VMI abnormalities, including epiretinal membrane (ERM), posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), lamellar macular holes (LMHs), and full-thickness macular holes (FTMHs). Methods: This is a single-center, cross-sectional classical twin study of 3406 TwinsUK participants over the age of 40 years who underwent spectral domain macular optical coherence tomography (SD-OCT) scans which were graded for signs of VMI abnormalities. Case wise concordance was calculated and the heritability of each VMI abnormality was estimated using OpenMx structural equation modeling. Results: In this population (mean age = 62.0 years [SD = 10.4 years], range = 40-89 years) the overall prevalence of ERM was 15.6% (95% confidence interval [CI] = 14.4-16.9) and increased with age, posterior vitreous detachment affected 21.3% (20.0-22.7), and VMA was diagnosed in 11.8% (10.8-13.0). Monozygotic twins were more concordant for all traits than dizygotic twins, and age, spherical equivalent refraction (SER), and lens status-adjusted heritability was estimated at 38.9% (95% CI = 33.6-52.8) for ERM, 53.2% (95% CI = 41.8-63.2) for PVD, and 48.1% (95% CI = 33.6-58) for VMA. Conclusions: Common VMI abnormalities are heritable and therefore have an underlying genetic component. Given the sight-threatening potential of VMI abnormalities, further genetic studies, such as genomewide association studies, would be useful to identify genes and pathways implicated in their pathogenesis.

The incidence and prevalence of recurrent corneal erosion syndrome in London, UK.

BACKGROUND: Recurrent corneal erosion syndrome (RCES) is caused by repeated episodes of corneal epithelial breakdown due to improper adherence of the corneal epithelium to the underlying basement membrane. The most common aetiologies are corneal dystrophy or previous superficial ocular trauma. The incidence and prevalence of the condition is currently unknown. This study aimed to determine the incidence and prevalence of RCES within the London population over a 5-year period in order to better inform clinicians and evaluate how this condition affects ophthalmic service provision. METHODS: A retrospective cohort study over a 5-year period reviewed 487,690 emergency room patient attendances at Moorfields Eye Hospital (MEH) London between 1 January 2015 and 31 December 2019. MEH caters for a local population comprising of around ten regional clinical commissioning groups (CCGs). The data for this study were collected using OpenEyesTM electronic medical records including demographics and comorbidities. The CCGs encompass 41% (3,689,000) of London's total 8,980,000 inhabitants. Using these data the crude incidence and prevalence rates of disease were estimated with results reported per 100,000 population. RESULTS: Out of 330,684 patients, 3623 patients were given a new diagnosis of RCES by the emergency ophthalmology services, and from these, 1056 patients attended outpatient follow-up. The crude annual incidence of RCES was estimated at 25.4 per 100,000, with a crude prevalence rate of 0.96%. There was no statistical difference in annual incidence across the 5-year period. CONCLUSIONS: The period prevalence of 0.96% shows that RCES is not uncommon. There was also a stable annual incidence over the 5-year period, showing no changing trend over the study period. However, identifying the true incidence and period prevalence is a challenging task, as minor cases may heal prior to examination by an ophthalmologist. It is highly likely that RCES is underdiagnosed and therefore underreported.

Case series of staged lamellar corneal grafting with thin manual Descemet's stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty.

The purpose of this report is to present the outcomes of Descemet's stripping endothelial keratoplasty (DSEK), followed by deep anterior lamellar keratoplasty (DALK), as an alternative to penetrating keratoplasty (PKP) for different indications. Patients in this retrospective case series underwent manual DSEK, followed by manual DALK, for tectonic and/or visual reasons. It includes three cases that underwent DSEK followed by DALK as an alternative to PKP for the following conditions: failed PKP and stromal scarring, aphakic bullous keratopathy and herpetic stromal scarring, and herpetic corneal perforation. All cases had successful anatomical repair with visual improvement. Many corneal conditions involving endothelium and stroma have been traditionally managed with PKP. However, in certain settings with high risk of complications, this might not be an appropriate option. Therefore, for these cases, we propose management with DSEK followed by DALK as an alternative approach in a 'closed anterior chamber' fashion, which can reduce the risk of significant, sometimes irreversible, complications.

Bilateral 0.19 mg Fluocinolone Acetonide Intravitreal Implant in the Successful Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis and Secondary Macular Oedema: A Case Report and Review of Intravitreal Therapies.

INTRODUCTION: Treatment of juvenile idiopathic arthritis (JIA)-associated uveitis necessitates the use of long-term corticosteroids or immunosuppressive agents, each of which poses their own significant side effect profile. Initial treatment requires intensive topical glucocorticoids, with a step-up approach employing immunosuppressive agents for those cases with poor response or high-risk complications such as macular oedema. To date, there is minimal evidence to support a specific approach to such complicated subgroups. We present the first case to successfully employ the 0.19 mg fluocinolone acetonide implant (ILUVIEN®, Alimera Sciences, Hampshire, UK) as a novel device for prolonged intravitreal administration of disease-modifying agents for patients with JIA complicated by uveitis. METHODS: This retrospective case report describes a 20-year old woman diagnosed with oligoarticular JIA complicated by chronic uveitis and associated cystoid macular oedema (CMO). Considering factors including the patient's non-compliance, age, lens status, non-steroid response, and good response to short-term intravitreal steroid therapy, the 0.19 mg fluocinolone acetonide intravitreal implant was deemed an appropriate step-up treatment option. RESULTS: At 12-month follow-up, the left eye (OS) showed an improvement in visual acuity to 6/15 - 1 from 6/60 + 1 (0.42 from 0.98 logMAR) (pre-insertion) and a reduction in central retinal thickness (CRT) of 199 µm from 471 µm. The right eye (OD), treated 10 months later, showed an improvement in visual acuity to 6/7.5 from 6/24 - 1 (0.10 from 0.56 LogMAR) and a reduction in CRT of 327 µm 6 months after treatment. CONCLUSION: In this case, the 0.19 mg fluocinolone acetonide implant provided safe and effective long-term treatment of JIA-associated uveitis and secondary CMO. This potentially offers an alternative approach to complex cases that show good response to short-term corticosteroid use.

Evidence That Pupil Size and Reactivity Are Determined More by Your Parents Than by Your Environment.

Purpose: A classic twin study to evaluate the relative contributions of genetic and environmental factors to resting pupil size and reactivity. Methods: Pupillometry was performed on 326 female twins (mean age 64 years) from the TwinsUK Adult Twin Registry, assessing resting pupil diameter in darkness and increasing levels of ambient light, alongside dynamic pupillary characteristics. Maximum-likelihood structural equation models estimated the proportion of trait variance attributable to genetic factors. Results: Mean (SD) pupil diameter in darkness was 5.29 mm (0.81), decreasing to 3.24 mm (0.57) in bright light. Pupil light reaction (PLR) had a mean (SD) amplitude of 1.38 mm (0.27) and latency of 250.34 milliseconds (28.58). Pupil size and PLR were not associated with iris colour, intraocular pressure or refractive error, but were associated with age (diameter ß = -0.02, p = 0.016, constriction amplitude ß = -0.01, p < 0.001, velocity ß = 0.03, p < 0.001, and latency ß = 0.98, p < 0.001). In darkness the resting pupil size showed a MZ intraclass correlation coefficient of 0.85, almost double that of DZ (0.44), suggesting strong additive genetic effects, with the most parsimonious model estimating a heritability of 86% [95% confidence interval (CI) 79-90%] with 14% (95% CI 10-21%) explained by unique environmental factors. PLR amplitude, latency and constriction velocity had estimated heritabilities of 69% (95% CI 54-79%), 40% (95% CI 21-56%), and 64% (95% CI 48-75%), respectively. Conclusion: Genetic effects are key determinants of resting pupil size and reactivity. Future studies to identify these genetic factors could improve our understanding of variation in pupil size and pupillary reactions in health and disease.

Tectonic Descemet Stripping Endothelial Keratoplasty for the Management of Corneal Perforation: A Case Series.

PURPOSE: Corneal perforations pose a considerable challenge for ophthalmic surgeons. The aim remains restoring the anatomical integrity of eye while attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of 4 successful tectonic Descemet stripping endothelial keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, restoration of globe integrity was achieved. In cases where visual potential remained, deep anterior lamellar keratoplasty over DSEK was offered. METHODS: Four patients presenting to Royal Gwent Hospital (Newport, Wales) with corneal perforation were included. Etiological origins included exposure keratopathy, corneal hydrops secondary to pellucid marginal degeneration with fistulization-associated aqueous leak, and herpetic keratitis. Patients were treated with initial temporary therapies, including glue patch, the use of bandage contact lenses, amniotic membrane transplant, and antibiotic cover, depending on the size and location of the perforation. Subsequent DSEK was subsequently performed under local anesthesia. RESULTS: All patients had successful tectonic grafts (3 DSEKs and 1 hemi-DSEK) up to 4 months postoperatively. In the case involving a hemi-DSEK, the patient underwent 2 refloating attempts of the graft before anchoring suture placement because of repeated graft detachment. Successful graft placement and tectonic globe restoration was confirmed by anterior segment imaging. CONCLUSIONS: Tectonic DSEK provides corneal surgeons with a new modality of treating corneal perforations. It provides clinicians an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated or deemed high risk of complications.

An unexpected case of iatrogenic Escherichia coli endogenous pan-endopthalmitis after ERCP-associated biliary sepsis: A case report.

INTRODUCTION: Endogenous endopthalmitis is a diagnostically challenging ophthalmic and medical emergency. It has the ability to manifest at any age and is associated with a number of predisposing factors. The rapid progression of disease poses catastrophic risk for adverse outcomes both localised and systemic. To our knowledge, we describe the first reported iatrogenic case of endogenous Escherichia coli-induced endopthalmitis progressing to pan-endopthalmitis as a consequence of endoscopic retrograde cholangiopancreatography. DIAGNOSIS, INTERVENTIONS AND OUTCOMES: The patient presented with reduced visual acuity and painless red eye; however, apart from biochemistry results suggesting biliary sepsis, no other clinical features of acute disease were noted. Despite rigorous systemic and intravitreal treatment, the rapid progression of disease led to irreversible damage to the eye. CONCLUSION: Clinicians must maintain a very high index of suspicion when encountering patients after interventional procedures, as misdiagnosis by trained ophthalmologists for endogenous endopthalmitis remains a common occurrence. Prompt identification and diagnosis ensured our patient avoided evisceration and early ophthalmic biopsies guaranteed the correct systemic intervention was started to address the severe subsequent septicaemia.

Evaluation of the Northern Ireland National Artificial Eye Service: A Regional Audit of Patient and Prosthetic Characteristics.

PURPOSE: The purpose of this study is to establish an up-to-date baseline of the profile of patients using the National Artificial Eye Service in Northern Ireland and to understand key areas of service provision, to contribute to patient and health-care provider education, and thus to improve patient outcomes for future researchers. METHODS: A prospective audit of artificial eye wearers attending the Northern Ireland National Artificial Eye Service between May 18, 2015 and June 26, 2015 was conducted. RESULTS: A total of 131 patients, who attended consecutively for appointments over the 6-week period, were included: males 68%; females 32%. The majority of eyes were lost secondary to trauma (54%). In recent decades, medical causes have now taken over as the primary referral cause for prosthetic eyes. Approximately, one-third of patients attending the service required further education on how to maintain the hygiene of their ocular prosthesis. CONCLUSION: Patients attending artificial eye services should be further educated about using lubricants to maintain the hygiene of their prosthesis. Primary care health professionals (General Medical Practitioners and Primary Care Optometrists) should be informed about artificial eye services and of how to contact the service for advice if required. Trauma remains the most common cause for referral; however, in recent decades more patients are attending secondary to a medical cause of eye loss. Health service providers should be aware of the changing profile of patients attending artificial eye services and of the medical and traumatic causes of eye loss.

Glycemic control is an important modifiable risk factor for uveitis in patients with diabetes: A retrospective cohort study establishing clinical risk and ophthalmic disease burden.

AIM: To characterize the risk uveitis, scleritis or episcleritis in relation to diabetes, glycaemic control, and co-existence of retinopathy. METHODS: Using the Royal College of General Practitioners Research and Surveillance Centre database, we established the prevalence of acute uveitis and scleritis or episcleritis over a six-year period among populations without(n = 889,856) and with diabetes(n = 48,584). We evaluated the impact of glycaemic control on disease risk. Regression modeling was used to identify associations, adjusting for clinical and demographic confounders. RESULTS: Incidence of acute uveitis was higher among patients with diabetes; Type 1 OR:2.01 (95% CI 1.18-3.41; p = 0.009), and Type 2 OR:1.23 (1.05-1.44; p = 0.01). Glycaemic control was established as an important effect modifier for uveitis risk, whereby those with poorer control suffered higher disease burden. Results confirmed a dose-response relationship such that very poor glycaemic control OR:4.72 (2.58-8.65; p < 0.001), poor control OR:1.57 (1.05-2.33; p = 0.03) and moderate control OR:1.20 (0.86-1.68; p = 0.29) were predictive of uveitis. Similar results were observed when evaluating retinopathy staging: proliferative retinopathy OR:2.42 (1.25-4.69; p = 0.01). These results were not maintained for scleritis or episcleritis. CONCLUSION: Acute uveitis is more common in patients with diabetes; at highest risk are those with type 1 disease with poor glycaemic control. Glycaemic improvements may prevent recurrence.

The association between diabetes, level of glycaemic control and eye infection: Cohort database study.

AIM: To examine whether diabetes and the degree of glycaemic control is associated with an increased risk of acute eye infection, and prescribing of ocular antimicrobial agents. DESIGN AND SETTING: A retrospective cohort study was carried out using the Royal College of General Practitioners Research and Surveillance Centre database (RCGP RSC), a large primary care database in the United Kingdom. We compared ocular infection rates in people aged ≥15 years without diabetes to those with diabetes, both type 1 and type 2. We developed logistic regression models to assess the excess risk in diabetes of: conjunctivitis, blepharitis, stye/chalzion, periorbital cellulitis, keratitis/keratoconjunctivitis, lacrimal gland infection, endopthalmitis, and ocular antimicrobial prescriptions over a six-year period (2010-2015). We also analysed the impact of glycaemic control on infection rates in those with diabetes. All models were adjusted for potential confounders. RESULTS: We analysed infection risk in 889,856 people without diabetes and 48,584 people with diabetes (3273 type 1, and 45,311 type 2). After adjustment for confounders both type 1 and type 2 were associated with increased incidence of conjunctivitis (OR 1.61; 95% CI 1.38-1.88; p<0.0001 and OR 1.11; 95% CI 1.06-1.16; p<0.0001 respectively). No association was found with blepharitis, stye/chalzion, periorbital cellulitis, keratitis/keratoconjunctivitis, lacrimal gland infection, and endopthalmitis in the whole population. In subgroup analyses blepharitis was more common in those with type 1 diabetes under 50 years old and endopthalmitis in those under 50 with type 2 diabetes. Glycaemic control was not found to be associated with any infection. Diabetes was also associated with an increased incidence of antimicrobial prescriptions (Type 1 OR 1.69; 95% CI 1.51-1.88; p<0.0001 and type 2 OR 1.17; 95% CI 1.13-1.20; p<0.0001). CONCLUSIONS: Conjunctivitis is recorded more frequently in people with diabetes. However, no substantial increase in recording of other ocular infections was noted. Infection risk was not found to be associated with the degree of glycaemic control.