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Hirji N.,Moorfields at St Georges Hospital | Ionides A.,Moorfields at St Georges Hospital
BMJ Case Reports | Year: 2011

A previously healthy 61-year-old male presented to eye casualty with a left-sided Horner's syndrome. He reported that while offering strong vocal support at a football match 5 days previously, he had suddenly noticed an unusual sensation behind his left eye, accompanied by a left hemifacial headache. He had noted pupillary asymmetry soon after this. Radiological imaging revealed a left internal carotid artery dissection. Anticoagulant therapy was commenced, and all symptoms and signs had fully resolved at 1-month follow-up, with no further complications. Copyright 2011 BMJ Publishing Group. All rights reserved.

Syrimi M.,Moorfields at St Georges Hospital | Jones S.M.,Moorfields at St Georges Hospital | Thompson G.M.,Moorfields at St Georges Hospital
Journal of Pediatric Ophthalmology and Strabismus | Year: 2013

Purpose: To determine whether children tolerate cyclopentolate 1% spray better than drops and to assess the adequacy of cycloplegia achieved by spray for objective refraction. Methods: The effects of cyclopentolate 1% drops and spray on distress levels were assessed prospectively using a guardian questionnaire in consecutive patients 10 years of age or younger. Distress was graded at various points during the appointment using a Likert scale of 1 to 10 (1 = no distress, 10 = severe distress). The adequacy of cycloplegia in children receiving cyclopentolate spray and the waiting times were assessed via a Likert questionnaire completed by the examining physician. Results: The guardians of 72 and 77 children who received cyclopentolate 1% drops or spray, respectively, completed the questionnaire. The children were divided in three age groups: 1 to 4 years, 5 to 7 years, and 8 to 10 years. Children 7 years or younger were significantly less distressed by administration of cyclopentolate 1% spray (P < .005). There was no statistical difference in distress levels in children older than 7 years (P = .9719). Thirteen of the 77 children who received cyclopentolate 1% spray did not have adequate cycloplegia to allow objective refraction. Conclusion: The results demonstrate cyclopentolate 1% spray is less distressing at the time of administration than cyclopentolate 1% drops for children 7 years or younger. However, the cycloplegia achieved is not adequate in a high percentage of children. © SLACK Incorporated.

Mackenzie S.,Moorfields at St Georges Hospital | Schmermer C.,St. Georges Hospital | Charnley A.,St. Georges Hospital | Sim D.,Moorfields at St Georges Hospital | And 4 more authors.
PLoS ONE | Year: 2011

Introduction:Diabetic macular edema (DME) is an important cause of vision loss. England has a national systematic photographic retinal screening programme to identify patients with diabetic eye disease. Grading retinal photographs according to this national protocol identifies surrogate markers for DME. We audited a care pathway using a spectral-domain optical coherence tomography (SDOCT) clinic to identify macular pathology in this subset of patients.Methods:A prospective audit was performed of patients referred from screening with mild to moderate non-proliferative diabetic retinopathy (R1) and surrogate markers for diabetic macular edema (M1) attending an SDOCT clinic. The SDOCT images were graded by an ophthalmologist as SDOCT positive, borderline or negative. SDOCT positive patients were referred to the medical retina clinic. SDOCT negative and borderline patients were further reviewed in the SDOCT clinic in 6 months.Results:From a registered screening population of 17 551 patients with diabetes mellitus, 311 patients met the inclusion criteria between (March 2008 and September 2009). We analyzed images from 311 patients' SDOCT clinic episodes. There were 131 SDOCT negative and 12 borderline patients booked for revisit in the OCT clinic. Twenty-four were referred back to photographic screening for a variety of reasons. A total of 144 were referred to ophthalmology with OCT evidence of definite macular pathology requiring review by an ophthalmologist.Discussion:This analysis shows that patients with diabetes, mild to moderate non-proliferative diabetic retinopathy (R1) and evidence of diabetic maculopathy on non-stereoscopic retinal photographs (M1) have a 42.1% chance of having no macular edema on SDOCT imaging as defined by standard OCT definitions of DME when graded by a retinal specialist. SDOCT imaging is a useful adjunct to colour fundus photography in screening for referable diabetic maculopathy in our screening population. © 2011 Mackenzie et al.

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