Aims-A national survey of over 100 hospitals in the UK was carried out to collect routine clinical information on the outcomes of cataract surgery. The clinical outcomes of interest were: visual acuity at time of discharge from postoperative hospital follow up, visual acuity at time of final refraction; complications related to surgery occurring during the operation, within 48 hours of surgery, and within 3 months of surgery. In addition, information on age and comorbidity was obtained. This article reports on the findings of the experience of approximately 18 000 patients who had cataract surgery in the hospital eye service of the NHS. Results-Of those with no ocular comorbidity, 85% achieved a visual acuity of 6/12 or better on discharge from postoperative hospital follow up, while 65% of patients with a serious co-existing eye disease achieved this level of acuity at this time. At final refraction, 92% of patients without ocular comorbidity and 77% of patients with ocular comorbidity achieved 6/12 or better visual acuity. The following main risk indicators were associated with visual outcomes and complications related to surgery: age, other eye diseases, diabetes and stroke, type of surgical procedure, and grade of surgeon. Conclusions-The acceptability of these findings could fruitfully be the subject of discussion within the ophthalmic community and hopefully issues arising out of the study can lead to research, especially in-depth studies of the outcomes of cataract surgery in those patients with coexisting serious eye conditions. (Br J Ophthalmol 1999;83:1336-1340
SUMMARY A double-blind stratified treatment trial was carried out on 108 patients with moderate to severe trachoma in a village in Southern Iran to assess the efficacy of topical therapy of I % rifampicin eye ointment or 1 % spiramycin eye ointment in comparison with 1 % oxytetracycline eye ointment. A 6-week course of treatment with the antibiotics used twice daily produced a cure rate of 67 % for rifampicin, 56% for oxytetracycline, and 64% for spiramycin when the upper tarsal conjunctiva was examined 1 week after completion of treatment. Seven months later the number of patients still free from active trachoma was reduced considerably. When the whole conjunctiva was examined, the cure rate for all 3 antibiotics was considerably lower than that obtained by examining the upper tarsus alone. The marked difference in response to treatment between the upper tarsus and the whole conjunctiva was due mainly to the presence of residual mild trachomatous inflammation in the upper fornix and the lower lid conjunctiva. The follow-up investigations revealed that this residual inflammation in the upper fornix and the lower lid is related to an increased risk of recurrence of inflammation in the whole conjunctiva, including the upper tarsal area. Microbiologically, after treatment with the antibiotics the isolation rate fell from 18-19% to 2-4%. Seven months later the isolation rate in the group treated with rifampicin or oxytetracycline remained low, whereas in the group treated with spiramycin this was raised to a level of 27 %.The result of this study indicates that under field conditions topical chemotherapy with rifampicin or oxytetracycline eye ointment twice daily for 6 weeks, though suboptimal, is beneficial in reducing the intensity of trachomatous inflammation and suppressing its transmission.Hyperendemic trachoma continues to be a major cause of blindness in the rural populations of developing countries, especially those in Africa and Asia. Improvement in the standard of living and the level of rural public health would appear to be the ideal way to reduce and ultimately eradicate communicable ophthalmia, namely, trachoma and associated bacterial conjunctivitis (Jones, 1975).
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