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Ayr, United Kingdom

Awan M.A.,Tennent Institute of Ophthalmology | Lyall D.A.M.,Tennent Institute of Ophthalmology | Koshy Z.R.,Ayr Hospital
British Journal of Ophthalmology | Year: 2012

Aim: To describe a novel technique of sclerotomy construction to facilitate 20-gauge transconjunctical sutureless vitrectomy (TSV) along with the evaluation of the wound integrity. Methods: The surgical technique is described. One hundred consecutive patients who underwent TSV were evaluated for wound leaks, postoperative hypotony, endophthalmitis and any other complication related to surgery. The sclerotomies of eight patients (24 ports) were analysed by imaging with anterior segment optical coherence tomography immediately after surgery, and on the first postoperative day and after the first postoperative month. Results: 104 eyes of 100 patients were evaluated with a mean follow-up of 9.6 months. All cases underwent surgery with standard 20-gauge instrumentation and vitrectomy techniques. Five sclerotomies were found to leak at the end of surgery, requiring a suture. Anterior segment optical coherence tomography images were obtained from eight eyes with good apposition of the tunnel noted in all the cases. Mean intraocular pressure was 18.7 mm Hg on the first postoperative day. One patient had hypotony without leak and this patient had pre-existing hypotony due to chronic panuveitis. There was no instance of postoperative endophthalmitis. Conclusions: This technique of 20-gauge TSV achieves good wound apposition with a low incidence of complications while using standard 20-gauge instrumentation and vitrectomy techniques.

Masterton R.G.,Ayr Hospital
International Journal of Antimicrobial Agents | Year: 2010

In modern sepsis management, long-held concerns about the inexorable rise of antimicrobial resistance have led to a key focus on antibiotic stewardship. Among the many strands that come together to provide a complete picture of stewardship is the issue of how antibiotic classes are deployed. Based on consistent results from mathematical modelling studies, the concept of a structured approach to such class use has evolved over the last decade. Whereas antibiotic cycling was initially perceived to be the strongest candidate for investigation in this field, over recent years the focus has shifted to antibiotic heterogeneity. Although there is presently little clinical work available on antibiotic heterogeneity, the available data demonstrate that this is an attractive option for enabling clinicians to make the most of their existing pool of antimicrobial classes by holding at bay, as much as possible, the emergence of resistance. © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Smart C.M.,Ayr Hospital | Primrose C.W.,University of Glasgow | Peters A.L.,University of Glasgow | Speirits E.J.,University of Glasgow
Anaesthesia | Year: 2014

To maximise the effect of a small fluid load, it is occasionally desirable to bolus manually with multiple depressions of a large-capacity syringe. This is usually achieved by placing the syringe on the side port of a three-way tap. We modified this technique by placing two-one-way valves in line with the three-way tap, effectively creating a piston pump, the infusion rates via which we compared with those achieved by an inflatable pressure-infuser in a simulated resuscitation. Fluid flow was faster using the piston pump than with the pressure-infuser (mean (SD) time to infuse 2000 ml saline 0.9% via a 16-G cannula 352 (10) s vs 495 (19) s, respectively, p < 0.0001). The piston pump appears to have potential for both tight control of fluid delivery and major high-volume resuscitation. The lightweight nature of the pump and its lack of reliance on gravity may also make it suitable for the pre-hospital setting. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Ting D.S.J.,Ayr Hospital | Sau C.Y.,University of Glasgow | Srinivasan S.,Ayr Hospital | Ramaesh K.,Tennent Institute of Ophthalmology | And 2 more authors.
British Journal of Ophthalmology | Year: 2012

Background/aims: To review the indications and types of keratoplasty performed in the West of Scotland between 2001 and 2010. Methods: A retrospective analysis of the histopathological diagnoses of all corneal buttons submitted to the regional Ocular Pathology Laboratory (Glasgow, UK) between January 2001 and December 2010 was performed. Results: Between 2001 and 2010, a total of 921 keratoplasties were performed in the West of Scotland. These included 646 (70.1%) penetrating keratoplasties and 275 (29.9%) lamellar keratoplasties (LK). Keratoconus (n=264, 28.7%) was the leading indication for keratoplasty, followed by graft failure (n=177, 19.2%), Fuch's endothelial dystrophy (n=124, 13.5%), keratitis (n=106, 11.5%), pseudophakic/aphakic bullous keratopathy (n=88, 9.6%), endothelial failure (n=67, 7.3%), non-Fuch's corneal dystrophies (n=21, 2.3%), trauma (n=19, 2.0%), autoimmune/inflammatory diseases (n=16, 1.7%) and others (n=39, 4.2%). A significant increase in the proportion of LK over penetrating keratoplasty was observed during this 10-year period: from 14.1% LK (2001-2005) to 40.4% LK (χ 2=71.78, p value<0.001). Conclusion: Keratoconus was the leading indication for keratoplasty in the West of Scotland. Both anterior LK and endothelial keratoplasty seemed to show an emerging trend as the procedures of choice for dealing with anterior and posterior corneal pathologies, respectively.

Srinivasan S.,Ayr Hospital | Srinivasan S.,University of Glasgow | Hanumanthu S.,Ayr Hospital | Varikkara M.,Ayr Hospital
Journal of Cataract and Refractive Surgery | Year: 2013

A 78-year-old man had uneventful cataract surgery with implantation of a 1-piece plate-haptic intraocular lens in the capsular bag. Seven weeks later, he presented as an emergency with intense fibrinous uveitis and increased intraocular pressure (IOP). Examination revealed an inflammatory capsular block syndrome (CBS) causing fibrinous anterior uveitis and secondary angle-closure glaucoma. The glaucoma resolved and the patient's vision improved following neodymium:YAG laser posterior capsulotomy. Inflammatory CBS should be considered in pseudophakic patients presenting with fibrinous anterior uveitis, increased IOP, and secondary angle closure. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2012 ASCRS and ESCRS Published by Elsevier Inc.

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