ObjectiveTo develop a best practice guide for managing people with plantar heel pain (PHP).MethodsMixed-methods design including systematic review, expert interviews and patient survey.Data sourcesMedline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey.Eligibility criteriaRandomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online.ResultsFifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to ‘step care’ using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02).ConclusionBest practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.

Purpose: to investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques.Methods: retrospective case-series reviewing 20,175 patients' cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, postoperative complications were recorded and small pupil expansion device outcome.Results: 1,426 patients were identified as having small pupil (SP). Of these, 1,110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p<0.05). SPs had a significantly higher rate of intraocular complications including posterior capsular rupture (PCR) with vitreous loss (OR 2.75, p<.001). There was also a significantly higher rate of post-operative complications such as corneal oedema (OR 2.64, p<.001) and anterior uveitis (OR 2.11, p<.001) in the SP group. However, VA improvement and complications between the different pupil expansion groups showed no significant differences (p>0.05) except for a greater rate of iris tears in the Malyugin group (p<0.05). Conclusion:To date, this is the largest reported case series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.

Objective To develop a Best Practice Guide for managing people with plantar heel pain (PwPHP)Design a mixed methods designData sources Medline, Embase, CINAHL, SportsDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, reference lists, and citation tracking. Semi-structured interviews with world experts and a patient survey.Eligibility criteria RCTs evaluating any intervention for PwPHP in any language were included subject to strict quality criteria. Trials with a sample size greater than 38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and PwPHP surveyed online.Results Forty PwPHP completed the survey and 14 experts were interviewed resulting in 7 themes and 38 sub-themes. Fifty-one eligible trials enrolled 4351 participants, with 10 interventions suitable to determine proof of efficacy. There was good agreement between the interview data and systematic review findings about taping (SMD: -0.47, 95% CI -0.88 to -0.05) and stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term, with clinical reasoning guidance to combine these interventions with education and footwear advice as a core approach. There was good agreement to stepped care with focussed shockwave for first step pain in the short term (OR: 1.72, 95% CI 1.14 to 2.61), medium term (SMD -1.31, 95% CI -2.01 to – 0.61) and long term (SMD -1.67, 95% CI -2.45 to -0.88) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). Good agreement for stepped care was also revealed for custom foot orthoses for pain in the short term (SMD: -0.41, 95% CI -0.74 to – 0.07) and medium term (SMD: -0.55, 95% CI -1.02 to -0.09).ConclusionA best practice guide was formulated based on robust evidence, with application guided by expert reasoning and patients’ perspectives.Systematic review registration Prospero CRD42018102227

Aims: To report spectral domain optical coherence tomography (OCT) findings in cases of impending or occult central retinal artery occlusion (CRAO) in which a diagnosis other than CRAO was made on initial presentation. Methods: Retrospective, observational case series of patients diagnosed with CRAO for whom on initial presentation fundal examination and OCT findings were deemed unremarkable and/or a diagnosis other than CRAO was made. OCT images from the initial presentation were then reviewed for evidence of inner retinal ischaemia.Results: 214 cases of CRAO were identified. 11 patients (5.14%) had been given an alternative initial diagnosis at their first presentation in casualty and were included. The age range was 20-84 years and 81% (9/11) were male. On review of initial OCT imaging performed in casualty, all cases had evidence of inner retinal ischaemia.Conclusions: CRAO is an ophthalmic emergency which leads to vision loss which is often irreversible. Examination of the fundus may be normal early in the course of the disease and therefore a timely diagnosis may be missed. This case series reports the OCT findings of inner retinal ischaemia in patients with occult or impending CRAO which may aid in the early diagnosis and referral to stroke services.