SUMMARY Fifty-two patients with systemic lupus erythematosus (SLE) were examined by fluorescein angiography, and retinopathy was detected in 15.
outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes AbstractPurpose This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents success and complication rates, and examines variations in outcome. Methods Sampling and recruitment details of this nationwide cross-sectional survey of 768 patients of 167 consultant ophthalmologists having their first operation for rhegmatogenous retinal detachment have been described. The main clinical outcomes detailed here are anatomical reattachment at 3 months after surgery and complications related to surgery. Consultants with a declared special interest in retinal surgery and able to perform pars plana vitrectomy were designated specialists for the analyses. Results Overall reattachment rate with a single procedure was 77% (95% CI 73.9-80.2). There were significant differences in reattachment rates between specialists and non-specialists. Without allowing for casemix, specialists had a reattachment rate of 82% (95% CI 77.9-85.7) with a single procedure and non-specialists 71% (95% CI 65.9-76.0). Allowing for case-mix, there was a significant difference between specialists and non-specialists for grade 2 detachments of 87% and 70% respectively (P Ͻ 0.0001). Analysing detachments by break type, the largest difference between specialists and non-specialists was observed for retinal detachments secondary to horseshoe tears, 80% and 68% respectively (P Ͻ 0.003). Specialists met the standards set for primary reattachment rates, while non-specialists did not. Over a third of patients had at least one complication reported at some point during the audit period. Conclusions Significant differences were seen in reattachment rates between specialists and non-specialists, overall and for specific subgroups of patients. This study provides relevant, robust and valid standards to enable all surgeons to audit their own surgical outcomes for primary retinal detachment repair in rhegmatogenous retinal detachments, identify common categories of failure and aim to improve results.
Diabetes is a common cause of blindness in the UK. The survey by Sorsby' showed it to be the fifth commonest cause of blindness in England and Wales, while in a recent study2 confined to the west of Scotland diabetes ranked as the fourth commonest cause.
n emmetropic otherwise well 67 year old man, with no history of eye disease, presents with a rhegmatogenous retinal detachment. The patient needs surgery to repair the detachment. There are three major techniques available to repair the detachmentscleral buckling without drainage, primary vitrectomy, and pneumatic retinopexy. In determining which surgical technique to choose, there are a number of clinical features to consider
Aim To examine residual debris within sterilised instruments prior to cataract surgery. Methods (i) Flushings from 32 sets of phacoemulsification instruments, sterilised according to hospital routine protocols, were taken preoperatively and analysed by scanning electron microscopy (SEM).(ii) A total of 16 sets of flushings from a different institute were collectedFwith separation of samples collected from phacoemulsification and those from irrigation-aspiration (IA) instrumentsFand analysed in the same way.(iii) A total of 15 sets of flushings were collected from instruments where an automated flushing system was used prior to sterilisation. Results(i) In the first study, 62% were clean, 16% were moderately contaminated and 22% were severely contaminated. Various contaminants were identified including lens capsule and cells, man-made fibres, squamous cells, bacteria, fungal elements, diatoms, red blood cells and proteinaceous material.(ii) In the second study, the results were similar and contamination of both phacoemulsification and IA instruments was shown.(iii) The third study showed that although a decrease in contamination followed automated flushing, contamination was not completely eliminated. Conclusions Although all equipment had been sterilised, pyrogenic material was still present. These findings emphasise the importance of meticulous cleaning of all surgical equipment in which biological debris can remain.
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