The lack of harmony in outcome reporting for studies of surgery for IXT is counterproductive. We suggest 4 core outcomes for all future studies, which have already been incorporated into two current randomized trials: alignment, near stereoacuity, control score, and quality of life score.

ObjectivesConventional and quantitative MRI was performed in patients with chronic progressive external ophthalmoplegia (CPEO), a common manifestation of mitochondrial disease, to characterise MRI findings in the extra-ocular muscles (EOMs) and investigate whether quantitative MRI provides clinically relevant measures of disease.MethodsPatients with CPEO due to single mitochondrial DNA deletions were compared with controls. Range of eye movement (ROEM) measurements, peri-orbital 3 T MRI T1-weighted (T1w) and short-tau-inversion-recovery (STIR) images, and T2 relaxation time maps were obtained. Blinded observers graded muscle atrophy and T1w/STIR hyperintensity. Cross-sectional areas and EOM mean T2s were recorded and correlated with clinical parameters.ResultsNine patients and nine healthy controls were examined. Patients had reduced ROEM (patients 13.3°, controls 49.3°, p < 0.001), greater mean atrophy score and increased T1w hyperintensities. EOM mean cross-sectional area was 43 % of controls and mean T2s were prolonged (patients 75.6 ± 7.0 ms, controls 55.2 ± 4.1 ms, p < 0.001). ROEM correlated negatively with EOM T2 (rho = −0.89, p < 0.01), whilst cross-sectional area failed to correlate with any clinical measures.ConclusionsMRI demonstrates EOM atrophy, characteristic signal changes and prolonged T2 in CPEO. Correlation between elevated EOM T2 and ROEM impairment represents a potential measure of disease severity that warrants further evaluation.Key Points• Chronic progressive external ophthalmoplegia is a common clinical manifestation of mitochondrial disease.• Existing extra-ocular muscle MRI data in CPEO reports variable radiological findings.• MRI confirmed EOM atrophy and characteristic signal changes in CPEO.• EOM T2 was significantly elevated in CPEO and correlated negatively with ocular movements.• EOM T2 represents a potential quantitative measure of disease severity in CPEO.

Aims:To analyse the causes of malpractice claims related specifically to cataract surgery in the National Health Service in England from 1995-2008.Methods: All the malpractice claims related to cataract surgery from 1995-2008 from the National Health Service Litigation Authority were analysed. Claims were classified according to causative problem. Total numbers of claims, total value of damages, mean level damages and paid:closed ratio (a measure of the likelihood of a claim resulting in payment of damages) were determined for each cause. Results:Over the 14 year period there were 324 cataract surgery claims with total damages of £1.97 million and mean damages for a paid claim of £19,900. Negligent surgery (including posterior capsule tear and dropped nucleus) was the most frequent cause for claims, while reduced vision accounted for the highest total and mean damages. Claims relating to biometry errors/ wrong intra-ocular lens power were the second most frequent cause of claims and result in payment of damages in 62% of closed cases. The claims with the highest paid:closed ratio were inadequate anaesthetic (75%) and complications of anaesthetic injections including globe perforation (67%). Conclusions:Claims from cataract surgery in the NHS are extremely infrequent. Consent, though essential, may not prevent a claim arising or resulting in damages. Refractive accuracy has significant medicolegal impact. Endophthalmitis can lead to successful claims if there is delay in diagnosis. Claims relating to inadequate anaesthesia or anaesthetic injection complications are particularly hard to defend.