IMPORTANCE It is unclear if the risk of intraocular bleeding with novel oral anticoagulants differs compared with warfarin.OBJECTIVE To characterize the risk of intraocular bleeding with novel oral anticoagulants compared with warfarin.DATA SOURCES A systematic review and meta-analysis was undertaken in an academic medical setting. MEDLINE and ClinicalTrials.gov were searched for randomized clinical trials published up until August 2016. This search was supplemented by manual bibliography searches of identified trials and other review articles.STUDY SELECTION Studies were eligible for inclusion if they were phase 3 randomized clinical trials, enrolled patients with atrial fibrillation or venous thromboembolism, compared a novel oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban) with warfarin, and recorded event data on intraocular bleeding. Data on intraocular bleeding were pooled using inverse-variance, weighted, fixed-effects meta-analysis. DATA EXTRACTION AND SYNTHESISThe PRISMA guidelines were used for abstracting data and assessing quality. Independent extraction was performed by 2 investigators. MAIN OUTCOMES AND MEASURESIntraocular bleeding events and associated risk ratio for novel oral anticoagulants compared with warfarin.RESULTS Twelve trials investigating 102 627 patients were included. Randomization to novel oral anticoagulants was associated with a 22% relative reduction in intraocular bleeding compared with warfarin (risk ratio, 0.78; 95% CI, 0.61-0.99). There was no significant heterogeneity observed (I 2 = 4.8%, P = .40). Comparably lower risks of intraocular bleeding with novel oral anticoagulants were seen in subgroup analyses, with no significant difference according to the indication for anticoagulation (P for heterogeneity = .49) or the novel oral anticoagulant type (P for heterogeneity = .15). Summary estimates did not differ materially when random-effects meta-analytic techniques were used. CONCLUSIONS AND RELEVANCEThese results suggest that novel oral anticoagulants reduce the risk of intraocular bleeding by approximately one-fifth compared with warfarin. Similar benefits were seen in both patients with atrial fibrillation and venous thromboembolism. Our data have particular relevance for patients at higher risk of spontaneous retinal and subretinal bleeding. These findings may also have important implications in the perioperative period, in which the use of novel oral anticoagulants may be superior. Future studies are required to better characterize the optimal management of patients with both ophthalmic disease and cardiovascular comorbidities requiring anticoagulation.

Objective: The COVID-19 pandemic has led to significant service loss across the NHS, and ophthalmology is one of the greatest affected specialties. We attempt to quantify the impact of the first peak of the COVID-19 pandemic on a paediatric ophthalmology unit in a children's hospital in the United Kingdom (UK) and report lessons learnt to aid in the recovery of the service. Methods and Analysis:Two eight-week periods of clinical activity were compared; one during the first UK peak of the COVID-19 pandemic and the other during a similar period the previous year. Four areas of clinical activity were included in the study: outpatient clinic appointments, theatre activity, outpatient referrals to ophthalmology and ward reviews. Appointment data was collected from departmental databases.Results: During the first peak of the pandemic, outpatient clinic appointments were reduced by 87.2%, ophthalmic surgery by 90.9%, outpatient referrals to ophthalmology by 50.2% and ward reviews by 50%. The number of actual cancelled appointments was 1377, of which 6.8% were triaged as suitable for teleophthalmology. Conclusion:The COVID-19 pandemic has dramatically restricted clinical activity in the ophthalmology service. Paediatric ophthalmology is vulnerable to capacity issues and the consequences of delayed or cancelled appointments. Departments must adapt quickly and maximise capacity to help reduce the backlog and treat patients effectively and safely. Solutions such as teleophthalmology have potential although can be difficult in the paediatric population.

SUMMARYWe present a case of endogenous fungal endophthalmitis arising as a complication of fungal septicaemia following gastrointestinal surgery, and subsequent treatment with endoluminal vacuum therapy (Endo-SPONGE, B Braun Medical Ltd). Our patient developed a pre-sacral collection due to an anastomotic leak post ileoanal pouch formation. Despite treatment with Endo-sponges and antibiotics, the patient suffered recurrent sepsis and the cavity failed to reduce in size. He developed red eyes and blurred vision, leading to the diagnosis of fungal endophthalmitis. Extended fungal cultures of the Endo-sponges and pouch effluent revealed Candida spp. This case is the first report of fungal endophthalmitis associated with Endo-sponge use and highlights the importance of fungal cultures in patients with ongoing sepsis. BACKGROUND

The known Personality type influences choice when buying luxury goods.The new Compared with their non-surgical colleagues, surgeons and junior doctors interested in pursuing a career in surgery more often purchased their cars new, owned vehicles with a higher median value, and replaced their cars earlier. These differences were apparent at all levels of seniority. The implicationsThe "surgical personality" or personality type attracted to a career in surgery may influence automobile buying choices.

No abstract

ObjectiveTo report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications.Methods and analysisPatients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil.Results134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0–2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes).ConclusionThis is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies.

Lifetime and stability of lipid bilayer membranes are essential parameters in ion channel reconstitution experiments. Reports on nano-BLMs across porous silicon nitride and alumina membranes with nanometer-sized apertures show a dramatically enhanced bilayer lifetime. In addition, the particular porous structure of the membranes enables the formation of a nano-BLM array, where failure of one membrane will not affect the membranes suspended across the other nanopores. However, a tradeoff between membrane thickness and mechanical stability is necessary when manufacturing these devices, with a three-dimensional multi-layer structure, substantially raising the cost of top-down device fabrication. In our study, the use of biogenic nanopores as substrates to host nano-BLMs was explored. Diatoms are unicellular marine algae in porous silica shells, called frustules. These shells have a tiered structure, with pores of minimum diameter 40 nm. The hierarchical porous structure of these shells makes them exceptionally mechanically stable. Frustules obtained from the marine algae Coscinodiscus wailesii were supported on a silicon platform with a micron-sized through-wafer aperture that allows fluidic access to either side of the frustule. Nano-BLMs were formed across the frustule pores using bubble-collapse method and were monitored by measuring the seal resistance and capacitance. Untreated frustules are hydrophilic, preventing the organic solvent from wetting the surface, resulting in a low BLM formation probability. Our studies indicate a formation probability of 1 out of 10 attempts. To render the surface hydrophobic, frustules were functionalized usingsilane chemistry, significantly improving bilayer formation probability. To study the effect of pore size on the incorporation probability and functionality of membrane proteins, the self-insertion of outer membrane protein OmpF of E.Coli in the nano-BLMs was investigated using single channel recordings. Blocking of the channel in the presence of the antibiotic ampicillin indicates the full functionality of the channel protein.

No abstract