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Budenz D.L.,University of North Carolina at Chapel Hill | Bandi J.R.,University of Miami | Barton K.,National Health Research Institute | Nolan W.,National Health Research Institute | And 5 more authors.
Ophthalmology | Year: 2012

Objective: To determine the prevalence, causes, and risk factors of blindness and visual impairment among persons aged 40 years or older residing in an urban West African location. Design: Population-based, cross-sectional study. Participants: A total of 5603 participants residing in Tema, Ghana. Methods: Proportionate random cluster sampling was used to select participants aged 40 years or older living in the city of Tema. Presenting distance visual acuity (VA) was measured at 4 and 1 m using a reduced logarithm of the minimum angle of resolution tumbling E chart and then with trial frame based on autorefraction. A screening examination was performed in the field on all participants. Complete clinical examination by an ophthalmologist was performed on participants with best-corrected visual acuity (BCVA) <20/40 or failure of any screening test. Main Outcome Measures: Age- and gender-specific prevalence, causes, and risk factors for blindness (VA of <20/400 in the better eye, World Health Organization definition) and visual impairment (VA of <20/40 in the better eye). Results: A total of 6806 eligible participants were identified, of whom 5603 (82.3%) participated in the study. The mean age (± standard deviation) of participants was 52.7±10.9 years. The prevalence of visual impairment and blindness was 17.1% and 1.2%, respectively. After refraction and spectacle correction, the prevalence of visual impairment and blindness decreased to 6.7% and 0.75%, respectively, suggesting that refractive error is the major correctable cause of visual impairment and blindness in this population. Of 65 subjects with a VA <20/400, 22 (34%) were correctable with refraction, 21 to the level of visual impairment and 1 to normal. The remaining 43 patients (66%) had underlying pathology (cataract in 19, glaucoma in 9, nonglaucomatous optic neuropathy in 3, corneal opacities in 3, retinal disease in 3, and undetermined in 5) that prevented refractive correction. Increased age was a significant risk factor for blindness and visual impairment. Conclusions: There is a high prevalence of blindness and visual impairment among those aged <40 years in Tema, Ghana, West Africa. Refractive error is a major cause of blindness and visual impairment in this population, followed by cataract, glaucoma, and corneal disease. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Nessim M.,Birmingham and Midland Eye Center | Denniston A.K.,Birmingham and Midland Eye Center | Nolan W.,Birmingham and Midland Eye Center | Holder R.,University of Birmingham | And 2 more authors.
British Journal of Ophthalmology | Year: 2010

Objectives: Social deprivation as measured by the Index of Multiple Deprivation (IMD) and Townsend scores has been shown to be associated with advanced presentation of primary open angle glaucoma. The aim of this study was to investigate the putative association of social deprivation as a risk factor for acute primary angle closure (APAC) in a UK urban population. Methods: Case notes of 139 consecutive patients presenting with APAC at the Birmingham and Midland Eye Centre, Birmingham, UK, were examined. Deprivation was scored using the IMD 2004 and Townsend scores. These score were compared with the West Midlands reference population. Results: The level of deprivation in patients with APAC was graded according to the IMD quintiles, in which quintile 1 represents the highest level of deprivation and quintile 5 represents the lowest level of deprivation. Of the patients studied, 66.1% (n=90) were from quintiles 1 or 2 (most deprived) whereas 9% (n=12) came from quintile 5 (least deprived), compared with predicted frequencies of 40% and 20%, respectively. Deprivation levels measured by frequency within each IMD quintile were significantly higher in the APAC group compared with the reference population (χ2, p<0.001). Conclusions: In this population patients presenting with APAC were more likely to come from areas with a high level of social deprivation.


Mroczkowska S.,Aston University | Benavente-Perez A.,Aston University | Sung V.,Birmingham and Midland Eye Center | Patel S.R.,Aston University | Gherghel D.,Aston University
Archives of Ophthalmology | Year: 2013

Objective: To compare and contrast the presence of ocular and systemic vascular function in patients with newly diagnosed and previously untreated primary openangle glaucoma (POAG) vs those with normal-tension glaucoma (NTG) and comparable early-stage, functional loss. Methods: The systemic vascular function of 19 patients with POAG, 19 patients with NTG, and 20 healthy individuals serving as controls was assessed using 24-hour ambulatory blood pressure monitoring, peripheral pulsewave analysis, and carotid intima-media thickness. Retinal vascular reactivity to flicker light was assessed using dynamic retinal vessel analysis (Imedos, GmbH). Results: Compared with controls, patients with POAG and those with NTG exhibited similarly increased nocturnal systemic blood pressure variability (P = .01), peripheral arterial stiffness (P = .02), carotid intima-media thickness (P = .04), and reduced ocular perfusion pressure (P < .001). Furthermore, on dynamic retinal vessel analysis, both glaucoma groups exhibited steeper retinal arterial constriction slopes after cessation of flicker (P = .007) and a similarly increased fluctuation in arterial and venous baseline diameter (P = .008 and P = .009, respectively) compared with controls. Conclusions: Patients with POAG or NTG exhibit similar alterations in ocular and systemic circulation in the early stages of their disease process. This finding highlights the importance of considering vascular risk factors in both conditions and raises questions about the current separation of the two conditions into distinct clinical entities. ©2013 American Medical Association. All rights reserved.


Banerjee P.J.,Moorfields Eye Hospital NHS Foundation Trust | Woodcock M.G.,Royal Air force and Worcestershire Acute Hospitals NHS Trust | Bunce C.,Moorfields Eye Hospital NHS Foundation Trust | Scott R.,Birmingham and Midland Eye Center | Charteris D.G.,Moorfields Eye Hospital NHS Foundation Trust
Trials | Year: 2013

Background: Eyes sustaining open globe trauma (OGT) is a group at high risk of severe visual impairment. Proliferative vitreoretinopathy (PVR) is the commonest cause of retinal redetachment in these eyes and is reported to occur in up to 45% of cases. Intensive anti-inflammatory agents have been shown to be effective at modifying experimental PVR and to be well tolerated clinically.The Adjuncts in Ocular Trauma (AOT) Trial was designed to investigate the benefits of using intensive anti-inflammatory agents (intravitreal and sub-Tenon's triamcinolone, oral flurbiprofen and guttae prednisolone 1.0%) perioperatively in patients undergoing vitrectomy surgery following open globe trauma.Methods/design: Patients requiring posterior vitrectomy surgery following open globe trauma will be randomised to receive either standard treatment or study treatment. Both groups will receive the standard surgical treatment appropriate for their eye condition and routine perioperative treatment and care, differing only in the addition of supplementary adjunctive agents in the treatment group. The investigated primary outcome measure is anatomical success at 6 months in the absence of internal tamponade.Discussion: This is the first randomised controlled clinical trial to investigate the use of adjunctive intensive antiinflammatory agents in patients undergoing vitrectomy following open globe trauma. It will provide evidence for the role of these adjuncts in this group of patients, as well as provide data to power a definitive study.EudraCT No: 2007/005138/35. © 2013 Banerjee et al; licensee BioMed Central Ltd.


Pandey P.,Birmingham and Midland Eye Center | Kirkby G.,Birmingham and Midland Eye Center
Canadian Journal of Ophthalmology | Year: 2012

Objective: To ascertain whether cannula displacement during cataract surgery with the use of the Luer lock is a common and recognized complication. Methods: A questionnaire was sent to attending physicians on the Royal College of Ophthalmologists U.K. register inquiring about episodes of cannula displacement and complications. Results: Despite the use of Luer locks, 60 cases of cannula detachment were reported; 196 respondents experienced this complication, and the most common cause of cannula detachment was stromal hydration (50%). Hydrodissection and viscoelastic were experienced by 18% and 17%, respectively. No severe damage resulted in most cases (76 cases), but some serious complications were reported: retinal damage (9%) and vitreous loss (17%). Conclusions: We recommend that surgeons test the union carefully themselves and then test the system by squirting outside the eye. Additionally, we recommend that a new cannula be used for each stage of the procedure. The viscoelastic cannula, in particular, should not be used for any other purpose. © 2012 Canadian Ophthalmological Society.


Jackson T.E.,Birmingham and Midland Eye Center | Madge S.N.,Hereford County Hospital
General Hospital Psychiatry | Year: 2011

Objective: The aim of this study was to report a case of Charles Bonnet syndrome secondary to eye patching following eyelid reconstruction with an unusually acute onset. Method: An observational case report was conducted. Results: The patient reported complex visual hallucinations that started less than 10 minutes after patching of her right eye (the left eye had poor vision from previous trauma). The patch was removed after 2 days, and the hallucinations gradually stopped over the subsequent 2 days. Conclusion: This case of Charles Bonnet syndrome describes an unusually acute onset of hallucinations and is only the second reported case following eye patching. Eye patching is commonly used in a number of situations, and it is important to be aware of this association, as the diagnosis of Charles Bonnet syndrome is often overlooked. © 2011 Elsevier Inc.


Kadyan A.,Birmingham and Midland Eye Center | Barry R.,Birmingham and Midland Eye Center | Murray A.,Birmingham and Midland Eye Center
Eye | Year: 2010

PurposeTo describe the outcomes of a simple technique of anterior lamellar excision (ALE) with laissez-faire healing for management of aberrant lashes in ocular cicatricial pemphigoid (OCP).MethodsProspective interventional case series.ResultsSeven OCP patients underwent grey line split and ALE with laissez-faire healing over a 24-month period in a tertiary referral centre. All patients had undergone previous interventions for the misdirected lashes. Nine procedures were undertaken (three upper and six lower lids). Mean follow-up was for 25.66±12.3 months (range: 9-43 months). Residual lashes were noted in three patients. In two cases, the lashes were isolated and managed successfully by a single electrolysis treatment. One patient needed further ALE for residual remnant of trichiatic cilia at the lateral edge of the lid. All patients were satisfied with their post-operative appearance. None of the patients showed exacerbation of disease or needed additional immunosuppression as a consequence of the lid surgery.ConclusionsAnterior lamellar excision with spontaneous granulation is a simple and effective procedure for management of aberrant lashes. Risk of disease exacerbation was reduced in OCP with minimal conjunctival manipulation and reduced post-operative lash-globe touch. © 2010 Macmillan Publishers Limited All rights reserved.


Lapenna L.,Villa Serena Hospital | Kadyan A.,Birmingham and Midland Eye Center | Busin M.,Villa Serena Hospital
Cornea | Year: 2010

Purpose: To report a case of intraocular lens (IOL) exchange performed 1 week after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Describe the clinical findings and outcome of IOL exchange in an 80-year-old man with pseudophakic bullous keratopathy and retained Artisan (Ophtec BV, Groningen, the Netherlands) iris-fixated IOL after uneventful DSAEK. Results: The patient presented on the third postoperative day after DSAEK with disenclavation of the nasal iris claw and inferior dislocation of the IOL. The dislocated IOL was removed and exchanged with an angle-supported open-loop anterior chamber lens 7 days after the initial DSAEK procedure. Conclusions: Despite the relatively traumatic intraocular manipulation, the donor tissue was unaffected in its position and clarity. This case demonstrates that successful DSAEK surgery is compatible with additional surgical procedures, even if they are performed in the early postoperative period. © 2010 by Lippincott Williams & Wilkins.


Ranganatha A.,Birmingham and Midland Eye Center
Eye and Contact Lens | Year: 2016

ABSTRACT:: Serratia liquefaciens is a rarely encountered gram-negative organism in ophthalmology practice. The only reported ocular infections are from contamination of contact lenses. The authors report the first case of a patient who developed orbital cellulitis secondary to severe S. liquefaciens microbial keratitis. © 2016 Contact Lens Association of Ophthalmologists, Inc.


Ashwin P.T.,Birmingham and Midland Eye Center | McDonnell P.J.,Birmingham and Midland Eye Center
British Journal of Ophthalmology | Year: 2010

Individuals with keratoconus form a significant proportion of patients for a practitioner specialising in corneal diseases. Yet it is a disease where the pathogenesis is poorly understood, and until recently, there has been no treatment apart from transplantation that could be offered that was curative or even capable of slowing the progression of the disease. Collagen cross-linking treatment using riboflavin and UV light has been developed to address this need, and the initial results are promising. The purpose of this review is to critically evaluate this treatment in light of the scientific basis for cross-linking, to highlight the strengths and limitations of the evidence in terms of efficacy and long-term safety, and finally to identify areas for future research in this area with a significant potential to change the way we treat our keratoconus patients. In addition, we hope that our unbiased review for the first time would bring together, in a concise fashion, scientific information for a practitioner contemplating on offering this treatment and to help inform their patients of its potential risks and benefits.

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