Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
76,884
result(s) for
"Eye surgery"
Sort by:
Economic evaluation of an adjunctive intraocular and peri-ocular steroid vitreoretinal surgery for open globe trauma: Cost-effectiveness of the ASCOT randomised controlled trial
In the United Kingdom, it is estimated that 5,000 patients sustain eye injuries or ocular trauma requiring hospital admission annually, of which 250 patients will be permanently blinded. This study explores the cost-effectiveness of Adjunctive Steroid Combination in Ocular Trauma (ASCOT) given during surgery versus standard treatment in vitreoretinal surgery in patients with open globe trauma.
This economic evaluation was embedded alongside the ASCOT RCT (ClinicalTrials.gov Identifier: NCT02873026). We conducted a primary cost-effectiveness analysis from a National Health Service perspective using the proportion of patients who achieved a visual acuity of 10 or more letter improvement on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale as the measure of effect, in developing incremental cost-effectiveness ratios (ICERs). Secondary cost-utility analysis using the EuroQol 5 Dimension 5 Level (EQ-5D-5L) to generate a cost per quality-adjusted life-year (QALY), and a cost-effectiveness analysis using vision-specific quality of life (QoL) was conducted. Sensitivity analyses were also applied to investigate parameter uncertainties.
The sample size of the ASCOT intervention arm and standard care arm of this study was 130 and 129, respectively. The intervention cost per patient was estimated at £132. The proportion of participants with an ETDRS of 10 or more letter improvement was 0.47 for the ASCOT group with a mean cost of £5,526 per patient, while the standard care group had an effect of 0.43 with a mean cost of £5,099 per patient. The ICER value of the primary outcome was £12,178 per 10 or more letter improvement on the ETDRS score. The secondary result in terms of cost per QALYs gained had a probability of 44% being cost-effective at a willingness-to-pay threshold of £30,000/QALY gained.
Though there is no formally accepted cost-effectiveness willingness-to-pay threshold for 10-letter or more improvement, the ASCOT intervention for open globe trauma is a low-cost intervention. The ASCOT intervention is not cost-effective when compared to the standard care in this group and setting. The proportion of patients in the ASCOT intervention arm with 10 or more letter improvement produced some positive results but this is outweighed by the costs.
Journal Article
The barefoot surgeon : the inspirational story of Dr Sanduk Ruit, the eye surgeon giving sight and hope to the world's poor
Inspiring and uplifting, this is the extraordinary story of Dr Sanduk Ruit who, like his mentor Fred Hollows, took on the world's medical establishment to give the life-changing gift of sight to hundreds and thousands of the world's poorest and most isolated people. It is the story of a boy from the lowest tiers of a rigid caste system who grew up in a tiny, remote Himalayan village with no school to become one of the most respected ophthalmologists in the world and a medical giant of Asia. Compelling and compassionate, it is also the story of a young doctor who became Fred Hollows' medical soul mate and who chose to defy the world's medical establishment and the lure of riches to make the world a better place.
Comparison of two swept-source optical coherence tomography biometers and a partial coherence interferometer
To compare biometry and prediction of postoperative refractive outcomes obtained by two swept-source optical coherence tomography (SS-OCT) biometers (IOLMaster 700 and Argos), and a partial coherence interferometry (IOLMaster ver 5.4).
Biometric values were measured using two SS-OCT and PCI device and evaluated against one another. Predictive errors were compared at one month after cataract surgery.
One hundred forty six eyes were considered. Axial length (AXL) measurements were not successful in 3 eyes measured by IOLMaster 700 and Argos devices, and in 17 eyes measured by IOLMaster ver. 5.4 devices. AXL as measured by Argos showed a tendency to be shorter in long eyes with AXL more than 26.0 mm (p < .001) and to be longer in short eyes with AXL less than 22.5 mm (p = .005). Anterior chamber depth as measured by IOLMaster ver. 5.4 was longer than that measured by the other two SS-OCT devices (vs. IOLMaster 700: p = .003; vs. Argos: p = .006). White-to-white diameter measured using Argos was significantly different measurements obtained using two IOLMaster (p < .001, respectively). The mean absolute postoperative prediction errors were 0.41 ± 0.31 diopters (D), 0.42 ± 0.32 D, and 0.35 ± 0.30 D for IOLMaster ver. 5.4, IOLMaster 700, and Argos, respectively.
The ocular biometric measurements using three devices showed high agreement. AXL measured by Argos showed a significant difference compared with the measurements from two IOLMaster. ACD was highly correlated between two SS-OCT devices except IOLMaster ver 5.4. LT and CCT values between IOLMaster 700 and Argos were different significantly. SS-OCT devices demonstrated a superior ability to successfully perform measurements compared with PCI device.
Journal Article
Single‑pass four‑throw versus traditional knotting pupilloplasty for traumatic mydriasis combined with lens dislocation
Purpose
To compare the use of single‑pass four‑throw (SFT) and traditional double-pass two-throw knotting (DTT) techniques in pupilloplasty for traumatic mydriasis combined with lens dislocation, and to evaluate the learning curve between the two knotting techniques by wet lab.
Method
The eyes of 45 patients (45 eyes) were divided into two groups according to the knotting technique used: single‑pass four‑throw (22 eyes) or traditional double-pass-two-throw knotting (23 eyes). Combined phacoemulsification and pupilloplasty with pars plana vitrectomy were performed in traumatic mydriasis patients with lens dislocation. Preoperative and postoperative corrected distance visual acuity (CDVA), pupil diameter, intraocular pressure (IOP), pupilloplasty time, and complications were compared. Twenty ophthalmology residents were randomized to perform a pupilloplasty suturing exam with or without SFT knotting techniques in porcine eyes.
Result
All cases had a minimum follow‑up period of 6 months (range 6–12 months). There was no significant difference in the CDVA (
P
= 0.55), postoperative pupil diameter (
P
= 0.79), IOP (
P
> 0.05), anterior chamber exudate degree, and loosening or shedding of the line knot between the two groups. The duration of the pupilloplasty was 22.32 ± 4.58 min in the SFT group and 30.35 ± 5.55 min in the traditional group, which was a significant difference
(P
< 0.01). The residents in the SFT group had higher test scores and fewer surgical mistakes (
P
< 0.05).
Conclusion
The SFT knotting technique has a similar treatment effect and safety as the traditional technique but requires a shorter time and is easier to perform in pupilloplasty surgery.
Journal Article
Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study
Purpose To evaluate and compare the results of bipedicle conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the treatment of non-viral infectious keratitis resistant to medical treatment. Methods This prospective randomised interventional study included 40 eyes of 40 patients with resistant non-viral infectious keratitis. Twenty eyes received CF and 20 eyes received AMG. In the CF group, there were 12 eyes with fungal keratitis, 7 eyes with bacterial keratitis and 1 eye with Acanthamoeba keratitis. In the AMG group there were 13 eyes with fungal keratitis, 5 eyes with bacterial keratitis and 2 eyes with Acanthamoeba keratitis. In the CF group, three ulcers had descemetocele and four ulcers were perforated. In the AMG group, four ulcers had descemetocele and two ulcers were perforated. In CF, 360° peritomy was done and a bipedicle CF from the upper conjunctiva was dissected from Tenon's capsule, mobilised to cover the cornea and sutured to episclera. In AMG, one or two layers of AM were trimmed to fit the ulcer and sutured to the cornea. The follow-up period was 6 months. Results Successful results were observed in 18/20 eyes (90%) in each group. Postoperatively, no significant differences between the two groups were found regarding success rate (p=1.0), epithelialisation time (p=0.75) or visual acuity improvement (p=0.84). Conclusions CF and AMG are effective in treatment-resistant infectious keratitis. They could restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. For large corneal perforation, it may be better to use another procedure such as penetrating keratoplasty to restore ocular integrity.
Journal Article
Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial
AimsTo evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).MethodsA single-centre, participant-masked, prospective, randomised controlled clinical trial. A total of 68 globe rupture patients with zone III were randomised to the control group (n=34) or the TA group (n=34) in 1:1 allocation ratio. Patients were treated with 0.1 mL TA in the TA group and 0.1 mL balanced salt solution in the control group at the end of emergency surgery. The primary outcome was the assessment of TPVR during vitrectomy 10±3 days later. Secondary outcomes included visual acuity (VA), retinal attachment rate, macular attachment rate, proliferative vitreoretinopathy (PVR) recurrent rate, side effects 6 months after vitrectomy.ResultsDuring vitrectomy, the TPVR grade of the control group was significantly more severe than the TA group (p=0.028). The TPVR score was significantly better in the TA group (9.30±0.82) than in the control group (6.44±1.06) (p=0.036). The final VA improved in 23 eyes (92%) in the TA group and in 14 eyes (63.64%) in the control group (p=0.008). The retinal attachment rates were 88% and 63.64% in the TA and control group, respectively (p=0.049). The two groups showed no significant difference in macular repositioning and PVR recurrent rate (p=0.215, 0.191). Temporary intraocular pressure elevation occurred in one eye in the TA group after emergency surgery.ConclusionsEarly intravitreal TA injection for OGI effectively reduces TPVR, increases surgical success and improves visual prognosis.
Journal Article
P264 Modified sub-tenon’s block (STB) in anterior segment eye surgery: retrospective analysis of a ropivacaine-dexmedetomidine LA-mixture
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and AimsEye surgery is increasingly taking place without anaesthesiologists. Providing safe and cost-effective analgesia, avoiding the risks of traditional sharp-needle blocks is important. This study explores a safe tangential sharp-needle approach for STB, screening for complications and inadequate analgesia through VAS/PROM screeningMethodsIn 2023, a representative demographic cohort (>18 y) of consenting ASA 1–2 patients (n=907) (median-age 75.5 y) scheduled for anterior chamber eye surgery (refractive, glaucoma and iris surgery) received STB-injection of 1–1.5 ml ropivacaine 2% containing 50 μg dexmedetomidine. STB injected at 8 mm lateral limbus, lateral M rectus inf. insertion (see figure 1)Results- STB-onset averaged 4 min, -STB-duration > 3 h, - small sub-conjunctival hemorrhage 42%, - conjunctival chemosis 19.4% -18% of the patients demanded additional analgesia iv (2 γ/kg fentanyl + 1 mg midazolam), reporting VAS scores >/= 3 during surgeryAbstract P264 Figure 1Schematic depiction of short sharp-needle STB injected lateral to musc-rect. inf., remainiung parallel to anetrior scleral plane-compare to photographic depiction[Image Omitted. See PDF.]ConclusionsAnterior sharp-needle STB is a valid alternative to blunt-cannula post-aequator STB or epi-caruncular sharp-needle STB in anterior segment eye surgery. 82% of the 907 patients were able to undergo interventions on lens, capsula, cornea, iris and trabeculae without additional systemic analgesia. No grave sharp-needle complications (bulbar perforation, intraorbital bleeding, brainstem anaesthesia, strabism) occurred due to the needle-trajectory running parallel to the scleral surface. Conjunctival hemorrhage and negligible chemosis were comparable to other STB-techniques.
Journal Article
Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments
AimsTo report 15 cases of intraocular lens (IOL) calcification following intraocular surgery and to identify common risk factors.MethodsA retrospective case review of patients with IOL calcification reported from the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland.Results15 cases of IOL calcification were identified. Eight cases were in hydrophilic acrylic IOLs and seven in hydrophilic acrylic IOLs with hydrophobic surface properties. Five cases occurred following intraocular injection of gas during endothelial keratoplasties. Two cases occurred following pars plana vitrectomy where gas was used. The remaining eight cases did not involve the injection of any intraocular gas; six cases were following trabeculectomy surgery, and two cases were after insertion of a ‘piggyback’ sulcus IOL. In each case, the calcification had a characteristic pattern, being centrally placed in the pupillary zone, mainly affecting the anterior lens surface.ConclusionThe aetiology of IOL calcification is not fully understood, although there are known risk factors such as using hydrophilic acrylic materials and the use of intraocular gas. Surgical consideration of a patient’s ocular comorbidities before IOL implantation is an important tool to mitigate some of this risk.
Journal Article