Does prior endoscopic cyclophotocoagulation (ECP) affect subsequent trabeculectomy outcomes?

PURPOSE: To report long-term outcomes of trabeculectomy following prior endoscopic cyclophotocoagulation (ECP). METHODS: Retrospective case-controlled comparative study reporting 2-year outcomes of eyes undergoing trabeculectomy following failed prior ECP (group 1), using eyes undergoing trabeculectomy as a primary glaucoma procedure as controls (group 2). RESULTS: Filtration surgery was required in only 19.4% (12/62) of eyes undergoing ECP. Of these, nine eyes that underwent trabeculectomies were included in group 1. Nine matched eyes were used as controls and included in group 2. Mean baseline IOPs were 23.7 ± 7.7 and 26.0 ± 6.7 mmHg (p = 0.452) in groups 1 and 2, respectively, on a mean of 3.4 ± 0.9 and 2.8 ± 1.4 medications, respectively (p = 0.274). The mean 2-year IOP was 10.6 ± 5.2 and 12.9 ± 4.0 mmHg (p = 0.285) in groups 1 and 2, respectively, on a mean of 0.1 ± 0.3 and 0.1 ± 0.4 medications (p = 0.931) respectively. Complete success rates were 77.8% and 88.9% in groups 1 and 2, respectively (p = 0.527). Qualified success rates were 11.1% in both groups. Combined success rates were 88.9% and 100.0% in groups 1 and 2, respectively (p = 0.318). There were no failures in group 2, compared to 11.1% in group 1 (p = 0.318). There were no significant between-group differences in hypotony, bleb needling, cystoid macular oedema, persistent uveitis, or repeat filtration surgery rates. CONCLUSIONS: ECP is a safe initial procedure in eyes with progressive glaucomas, and may substantially reduce the need for trabeculectomy without compromising outcomes in the minority that go on to require it.

Teaching pathology via online digital microscopy: positive learning outcomes for rurally based medical students.

INTRODUCTION: Technology has revolutionised teaching. Teaching pathology via digital microscopy (DM) is needed to overcome increasing student numbers, a shortage of pathology academics in regional medical schools, and difficulties with teaching students on rural clinical placement. OBJECTIVE: To identify whether an online DM approach, combining digital pathology software, Web-based slides and classroom management software, delivers effective, practical pathology teaching sessions to medical students located both on campus and on rural placement. METHODS: An online survey collected feedback from fourth and fifth year undergraduate James Cook University medical students on the importance of 16 listed benefits and challenges of using online DM to teach pathology, via a structured five-point Likert survey. RESULTS: Fifty-three students returned the survey (response rate = 33%). Benefits of online DM to teach pathology rated as 'very important' or 'extremely important' by over 50% of students included: higher quality images; faster learning; more convenient; better technology; everyone sees the same image; greater accessibility; helpful annotations on slides; cost savings; and more opportunity for self-paced learning out-of-hours and for collaborative learning in class. Challenges of online DM rated as 'very important' or 'extremely important' by over 50% of students included: Internet availability in more remote locations and potential problems using online technology during class. CONCLUSIONS: Nearly all medical students welcomed learning pathology via online digital technology. DM should improve the quantity, quality, cost and accessibility of pathology teaching by regional medical schools, and has significant implications for the growing emphasis in Australia for decentralised medical education and rural clinical placements.

Migration of the XEN45 Gel Stent into the Anterior Chamber Managed by Trimming the Implant.

We report a case of migration of the XEN45 gel stent into the anterior chamber successfully treated with trimming of the implant. To the best of our knowledge, this management strategy for migration of the implant has not previously been reported.

Lumbar spine teratoma with associated neuroendocrine tumour (NET) in a 37-year-old woman.

Spinal teratoma with associated neuroendocrine tumour (NET) is a rare entity. To date there have been only three such cases reported in the literature. Information available to clinicians regarding clinical presentation, behaviour of this tumour over time, management options and follow-up, are as a consequence very limited. We present a case of a 37-year-old woman who was found to have an incidental lumbar spine teratoma with NET after presenting with a one-week history of acute lower back pain and radiculopathy. Magnetic resonance imaging (MRI) of the lumbosacral spine demonstrated an acute disc prolapse at the L4/5 level as well as incidental lesion at the L1/2 level causing effacement of the conus medullaris. Lumbar laminectomy with gross total resection of the intradural extramedullary lesion at the L1/2 level was performed with histopathology confirming the teratoma with NET. The objective of our case is to report our experience with this unique tumour and potential management implications.

Lessons learnt from implementing blended 'integrated' learning into an undergraduate medical curriculum.

This article was migrated. The article was marked as recommended. Method:This study utilized a mixed-method design involving a cross-sectional survey (n=111, response rate=61%) to compare Year 2 medical student perceptions of content delivered by a Blended Integrated Learning (BIL) approach versus a traditional didactic teaching (TT) approach, plus 2 focus groups to explore learner perceptions of the BIL approach and brainstorm improvements. Results: Most medical students preferred the BIL approach over TT with respect to 'practically applying basic sciences to a patient case' and 'knowledge retention in the subject' (53% versus 30%, and 51% versus 35%, respectively). However, most medical students preferred TT with respect to 'level of interaction with other students and lecturers while reviewing teaching materials' (78% versus 11%), 'overall enjoyment of learning' (54% versus 32%), and 'understanding the lecture content faster' (49% versus 39%). Focus groups identified what did and did not work with the BIL approach and brain-stormed specific improvement strategies. Conclusions: Students preferred BIL over TT for knowledge retention and integrating basic sciences into common clinical cases, but found BIL less preferable for aspects related to learning engagement. However, focus groups identified a variety of strategies to promote student engagement in BIL by improving online content, delivery processes and further innovative use of technology.

Progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate (0.02%).

PURPOSE: To report a case of progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate 0.02%. METHODS: A 45-year-old woman was treated for presumed Acanthamoeba keratitis with chlorhexidine gluconate 0.02% and propamidine 0.1% eyedrops. RESULTS: After using the chlorhexidine and propamidine eyedrops for 8 weeks, the patient developed a near total loss of the corneal epithelium and a progressive ulcerative keratitis, which eventually required penetrating keratoplasty. Histopathologic examination of the corneal button showed ulceration and loss of Bowman's membrane, massive loss of keratocytes with apparent apoptosis, and loss of the endothelial cells with inflammatory cells adherent to the remaining cells. These histopathologic findings are similar to those seen in Hibiclens keratopathy. Hibiclens contains chlorhexidine 4% with a detergent. No organisms were seen in sections stained with modified Ziehl-Neelsen, gram, Grocott, or periodic acid-Schiff, and immunohistochemistry showed no significant findings. CONCLUSION: We think that the topical use of chlorhexidine gluconate 0.02% may have resulted in a progressive ulcerative keratitis in our patient.

A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension.

OBJECTIVE: To determine and compare the effect of 180 and 360 degrees of selective laser trabeculoplasty (SLT) treatment as a primary therapy on the intervisit intraocular pressure (IOP) fluctuation in patients followed up for a period of 2 years without any further medical or surgical intervention. METHODS: Retrospective chart review of patients with ocular hypertension and primary open angle glaucoma who received SLT as primary therapy without any subsequent medical or surgical intervention. IOP before SLT and postlaser IOP at all the visits during the follow-up period of months 6 to 24 was determined. The standard deviation (SD) of the mean IOP was used as a surrogate for IOP fluctuation. RESULTS: Forty-one eyes were treated by SLT, 19 eyes in the 180-degree group and 22 eyes in the 360-degree group. The mean reduction in IOP at 2 years was 28% in 180-degree group and 35% in 360-degree SLT group. After the SLT, the 360-degree SLT group had a lower IOP fluctuation compared with the 180-degree SLT group over the follow-up period of months 6 to 24. The percentage of eyes with intervisit IOP fluctuation (SD)

Terson's syndrome presenting as an ophthalmic emergency.

PURPOSE: To report an unusual case of Terson's syndrome caused by a ruptured intracranial aneurysm presenting as an ophthalmic emergency with visual loss, without any neurological features at the time of presentation. METHODS: Case report. A 38-year-old man was referred to the eye emergency department with sudden loss of vision in both eyes. Vitreous haemorrhage was noted in both eyes. There was no history of loss of consciousness or headaches and no signs of meningeal irritation at presentation. The patient subsequently developed progressive neck stiffness and headache. RESULTS: Neuro-imaging studies revealed a subarachnoid haemorrhage resulting from a ruptured carotid-ophthalmic artery aneurysm. CONCLUSIONS: It is important to consider Terson's syndrome, a potentially life-threatening condition, in any patient presenting with bilateral vitreous haemorrhage. Some patients may not show any headache, neurological deficits or signs of meningeal irritation at presentation but may develop them later on.