Our study showed that femtosecond-assisted SBK and PRK with mitomycin C have comparable safety and efficacy for correction of high myopia. However, better predictability of postoperative refraction was noted after PRK compared with SBK.
Purpose: Diabetes is a known risk factor of cataracts1. Diabetic patients are at an increased risk of macular oedema post‐cataract surgery, which can lead to poorer visual outcomes1. 9 months ago, an audit was conducted on the management of diabetic patients undergoing cataract surgery at Rochdale Eye Unit, United Kingdom. Recommendations following this included fundus examination with optical coherence tomography (OCT) scan to be part of preoperative assessment for this set of patients. Intraoperative steroid injections and postoperative topical non‐steroidal anti‐inflammatory drugs (NSAID) should be given as a standard, to reduce the incidence of diabetic macular oedema (DMO). A re‐audit aimed to assess implementation of changes in this subgroup of patients to standardize care and minimize risk of complications. Methods: A retrospective analysis of 45 cataract surgeries performed in diabetic patients between January to April 2022 was conducted. Electronic records and Heidelberg OCT macula scans were accessed. Results: 23 out of 45 patients (51.1%) had preoperative OCT, compared to 34.8% in cycle 1. No useful information could be obtained on pre‐ and postoperative OCT as few patients (13.3%) had both, which was the case in cycle 1 (17.4%). Out of 45 patients, 4 (8.9%) had intraoperative steroids given, reduced from 22% in cycle 1, and 35 (77.9%) received postoperative NSAID eyedrops, which was comparable to cycle 1 (78%). Eight patients (17.8%) had postoperative OCT, compared to 22% in cycle 1. Conclusions: This 2nd cycle of the audit demonstrated an improvement in preoperative assessment of the macula and consistency in prescription of postoperative NSAID to diabetic patients undergoing cataract surgery. There has been a reduction in both use of intraoperative steroids and postoperative assessment of the macula. In order to implement the recommendations more effectively for the use of periocular steroid injections, stricter and more robust protocols will be discussed within the department and a short re‐audit planned within the next 3 months. Reference 1. Zhang R, Dong L, Yang Q, Liu Y, Li H, Zhou W et al. Prophylactic interventions for preventing macular edema after cataract surgery in patients with diabetes: A Bayesian network meta‐analysis of randomized controlled trials. eClinicalMedicine. 2022;49:101463.
Purpose: Both the National Institute for Health and Care Excellence (NICE)1, United Kingdom (UK), and the Royal College of Ophthalmologists2 guidelines for neovascular age‐related macular degeneration (nAMD) recommend that all patients referred with suspected nAMD should be reviewed and offered treatment within 14 days of referral. Therefore, the aim of our study was to evaluate the current percentage of patients with nAMD being referred to the Rochdale Eye Unit, UK, who are reviewed and offered therapy within 14 days and to establish any causes of delays. Methods: A retrospective study of all patients newly referred for assessment and treatment of nAMD between 1st September 2021 – 30th April 2022 was performed. For each patient, data were collected (OpenEyes™) on dates of referral, review in medical retina clinic, 1st, 2nd, 3rd intravitreal injection (IVI), follow‐up, visual acuity at presentation and follow‐up, and any causes of delay in receiving injections or follow‐up. A total of 74 eyes were identified. Results: Of the 74 eyes, 17 (23%) received the 1st IVI within 14 of days of referral. 42 eyes (56%) received the first IVI within 1 month of referral. The number of days between referral to 1st IVI varied considerably, with an average of 74 days, and mode of 25 days. The causes for delay included patients being lost to follow up (25%), awaiting fundus fluorescein angiography (5%), being re‐booked due to other health concerns (7%), and incapacity to meet demands (63%). Conclusions: A growing aging population has increased the demands on Ophthalmology departments, such as Rochdale Eye Unit, to provide a robust nAMD service. We recommend establishment of an independent referral system for patients with suspected/known nAMD and higher training of senior registrars and advanced nurse practitioners, using college approved courses, to meet the demands of such service in order to avoid delaying treatment for these patients. References 1. National Institute for Health and Care Excellence. (2018). Age‐related macular degeneration [NG82]. 2. The Royal College of Ophthalmologists. (2021) Commissioning Guidance: Age Related Macular Degeneration Services.
Purpose: Posterior capsule rupture (PCR) is a serious complication of cataract surgery, which can lead to other complications such as cystoid macular oedema, retinal detachment and endophthalmitis1,2. The aim of our study was to firstly, ascertain the rate of PCR in patients undergoing phacoemulsification and intraocular lens implant (IOL) surgery at Rochdale Eye Unit, UK. Secondly, to identify the factors contributing to increased risk of PCR. Thirdly, to establish whether patients are being appropriately screened for risk factors for PCR. Methods: A retrospective study of patients that underwent phacoemulsification and IOL surgery between 1st September 2021 and 1st April 2022 was performed. A total of 1179 patients were obtained using electronic records (OpenEyes™https://openeyes.apperta.org/). Results: Of the 1179 patients, 18 patients (1.52%) experienced PCR with or without vitreous loss. Pre‐procedure PCR risk was not calculated for any of them. 11 (61%) cases were carried out by consultants, 6 (33%) by registrars, and 1 (6%) by an associate specialist. Increasing age (above 70 years), excess movement, and co‐morbidities were associated with an increased risk of PCR. Only 7 (0.6%) of the 1179 patients had the PCR risk estimated (using OpenEyes™ calculator) prior to booking of procedure. The calculator considers presence of glaucoma, diabetes, the density of the cataract, and experience of the surgeon, among other factors. The risk was not calculated in 1109 (94%) patients. Conclusions: The risk of PCR during phacoemulsification and IOL surgery rises with increasing patient age, presence of co‐morbidities, and procedure undertaken by junior surgeons. Through greater utilization of PCR risk calculation, encouraged with electronic prompts and educational posters, this risk can be further reduced. The method may also be adapted by other National Health Service (NHS) Trusts in their cataract listing proforma. References 1. Thevi T, Sahoo S, Kyaw Soe HH. Posterior Capsule Rupture during Phacoemulsification among Patients with Pseudoexfoliation – Is There A correlation? The Malaysian Journal of Medical Sciences. 2014;21(4):51–53. 2. Chakrabarti A, Nazm N. Posterior Capsular Rent: Prevention and Management. Indian Journal of Ophthalmology. 2017;65(12):1359–1369.
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