Princess Alexandra Eye Pavilion

Edinburgh, United Kingdom

Princess Alexandra Eye Pavilion

Edinburgh, United Kingdom
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Megaw R.,University of Edinburgh | Agarwal P.K.,Princess Alexandra Eye Pavilion
Survey of Ophthalmology | Year: 2016

Posner-Schlossman syndrome, or glaucomatocyclitic crisis, is a unilateral ocular condition characterized by recurrent attacks of nongranulomatous anterior uveitis and raised intraocular pressure that can result in chronic secondary glaucoma. This relatively rare disease is most likely the result of recurrent cytomegalovirus infection and affects predominantly middle-aged males. Diagnosis is largely clinical, with aqueous and blood sampling aiding the identification of any underlying infectious cause. Successful disease management is often achieved by topical treatment, although systemic therapy and even surgical intervention may be required. We discuss our current understanding of Posner-Schlossman syndrome, from its pathophysiology through to recommended treatment options. © 2016 Elsevier Inc.


Morris B.,Princess Alexandra Eye Pavilion | Mulvihill A.,Princess Alexandra Eye Pavilion
Eye | Year: 2010

Aim: s: Coats disease is an uncommon form of retinal telangiectasis. Published case series mostly originate from tertiary referrals centres and may provide a skewed view of disease severity. We conducted a prospective population-based study of Coats disease in the United Kingdom to ascertain the incidence and provide a more representative picture. Methods: The study was conducted through the British Ophthalmological Surveillance Unit. This first paper reports the features at presentation; gender, mode of presentation, visual acuity, anterior and posterior segment findings, amount of retinal exudation, and disease staging. Results: A total of 55 eligible cases of Coats disease were identified giving an estimated population incidence of 0.09 per 100 000 of the population. All cases were unilateral and 85% were male. Mean age at presentation was 146 months (median 96 months). The mean age of diagnosis was markedly different with differing mechanisms of presentation. Cases presenting with leucocoria or strabismus presented early whereas subjective visual loss presented much later. A large proportion of eyes (44%) were blind at diagnosis. The great majority of eyes (71%) had 6 or fewer clock hours of retinal exudation. More severe forms/stages of Coats disease were more common in the youngest patients. Conclusions: Compared with published studies of Coats disease, we have found milder disease severity at presentation. This is most likely because of the population-based nature of our study reflecting the full disease spectrum. A large proportion of eyes with Coats have poor visual acuity and disease severity is worse in younger patients. © 2010 Macmillan Publishers Limited All rights reserved.


Tatham A.J.,Princess Alexandra Eye Pavilion | Medeiros F.A.,Hamilton Glaucoma Center | Zangwill L.M.,Hamilton Glaucoma Center | Weinreb R.N.,Hamilton Glaucoma Center
Progress in brain research | Year: 2015

Early diagnosis and treatment of glaucoma is important to reduce the risk of progressive and irreversible visual loss. The key to diagnosis is recognition of morphological changes to the optic nerve head and retinal nerve fiber layer, but in some patients, functional abnormalities are detected first. This review describes recent innovations with the potential to improve the early detection of glaucoma. Developments in imaging include novel optic nerve head metrics such as Bruch's membrane opening-minimum rim width, enhanced ability to quantify inner layers of the glaucomatous macula, and ability to image deep optic nerve head structures, including the lamina cribrosa. Developments in detection of early glaucomatous functional loss include novel perimetric tests using frequency-doubling technology and flicker-defined form stimuli. Methods to combine results of structural and functional assessments are also presented that may improve early detection of glaucoma. © 2015 Elsevier B.V. All rights reserved.


Fleck B.W.,Princess Alexandra Eye Pavilion | Stenson B.J.,Royal Infirmary
Clinics in Perinatology | Year: 2013

Emerging data from randomised controlled trials of different pulse oximeter oxygen saturation (SpO2) target ranges shows that higher SpO2 targets are associated with a higher risk of severe retinopathy of prematurity. However, the trials have also shown that higher SpO2 targets are associated with improved survival. In the light of these results and pending the full results for long-term outcome, it is recommended that oxygen saturation targets for preterm infants of gestational age less than 28 weeks at birth should be maintained at or more than 90%. © 2013 Elsevier Inc.


Mitry D.,Princess Alexandra Eye Pavilion | Mitry D.,University of Edinburgh | Charteris D.G.,Moorfields Eye Hospital | Fleck B.W.,Princess Alexandra Eye Pavilion | And 2 more authors.
British Journal of Ophthalmology | Year: 2010

Aims/Background: Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition. Obtaining an accurate estimate of RRD incidence in the population is essential in understanding the healthcare burden related to this disorder. Methods: A systematic review of all population-based epidemiology studies of RRD published between January 1970 and January 2009 from Medline database searches was performed. Results: RRD incidence demonstrates significant geographical variation and its incidence has been reported to be between 6.3 and 17.9 per 100 000 population. For studies with a sample size >300 the median annual incidence per 100 000 population was 10.5 (IQR 8.1-13.2) and the mean proportion of bilateral RRD was 7.26%. Overall, the mean prevalence of lattice degeneration was 45.7±20.3% and myopia was 47.28±12.59%. Conclusions: Estimates of RRD incidence have varied threefold, but inclusion criteria and other design features have differed across studies making direct comparisons difficult. The overall incidence of RRD is not yet well established: more incidence studies of adequate methodology are needed to explore temporal changes in incidence. RRD incidence varieswith ethnicity and is strongly associated with increasing age, myopia and certain vitreo-retinal degenerations. Due to changes in cataract surgery trends, the proportion of pseudophakic RRD presenting to specialised centres appears to be increasing.


Mitry D.,University of Edinburgh | Mitry D.,Moorfields Eye Hospital | Singh J.,Princess Alexandra Eye Pavilion | Yorston D.,Gartnavel General Hospital | And 5 more authors.
Ophthalmology | Year: 2011

Purpose: To describe the predisposing pathology and clinical features of all incident cases of rhegmatogenous retinal detachment (RRD) recruited in Scotland during a 2-year period. Design: Prospective surveillance study of incident cases of RRD. Participants: All incident cases of RRD recruited as part of the Scottish Retinal Detachment Study. Methods: During a 2-year period, we coordinated a comprehensive system in which every case of primary RRD presenting to 1 of 6 vitreoretinal surgical sites in Scotland was examined and approached for study inclusion. Main Outcome Measures: Rhegmatogenous retinal detachment incidence, predisposing features, and clinical characteristics. Results: A total of 1202 cases were recruited. Detailed clinical information was available on 1130 (94%) of cases. By causative break, the proportions of RRD were horseshoe tear (HST) associated with posterior vitreous detachment (PVD) in 86.2%, giant retinal tear (GRT) and PVD in 1.3%, non-PVD round hole (RH) in 4.9%, retinal dialysis in 5.9%, and retinoschisis RRD in 1.6%. One in 10 cases reported significant ocular trauma. One in 5 cases were pseudophakic. Round hole RRD more frequently presented with multiple retinal breaks compared with HST RRD (67.8% vs. 48.7%; P = 0.003). In PVD-associated RRD, 56.1% (95% confidence interval [CI], 53.858.3) of breaks were identified in the superotemporal retina. In non-PVD RRD, 54.6% (95% CI, 47.961.1) of breaks were inferotemporal, followed by superotemporal in 34.9% (95% CI, 28.741.5). Lattice degeneration was present in 18.7% of affected eyes and more common in RH RRD (35.7%) than in HST RRD (19.3%) (P = 0.003). Seven percent reported an affected first-degree relative, and these cases were significantly more myopic than nonfamilial cases. Conclusions: More than 85% of RRD cases are associated with PVD and related tractional tears. Non-PVD RH RRD occurred in younger and more myopic individuals. The majority of cases are caused by more than 1 retinal break, and the macula is affected in more than 50% at presentation. Ocular trauma, previous cataract surgery, family history, and lattice degeneration are important predisposing features. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.


Fleck B.W.,Princess Alexandra Eye Pavilion
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2013

While current management of retinopathy of prematurity (ROP) is well evidenced, the recent Neonatal Oxygenation Prospective Meta-analysis (NeoPROM) oxygen therapy trials, and the Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity (BEAT-ROP) trial of intravitreal injection bevacizumab, have reopened debate on optimal management. Early postnatal manipulation of oxygen therapy, nutrition and serum IGF 1 levels may improve early retinal blood vessel development and prevent later severe ROP. While the use of intravitreal injections of antivascular endothelial growth factor (VEGF) agents may appear to be an attractive alternative to laser ablation of the peripheral retina, caution is needed. The optimal choice of agent and dose remain unknown, and suppression of serum VEGF levels might interfere with normal angiogenesis processes in developing tissues. There is a pressing need for good Phase 1 studies of these agents, and safety trials.


Timlin H.,Princess Alexandra Eye Pavilion | Butler L.,Princess Alexandra Eye Pavilion | Wright M.,Princess Alexandra Eye Pavilion
Eye (Basingstoke) | Year: 2015

Purpose: To assess the diagnostic accuracy of the Edinburgh Red Eye Algorithm. Methods: This was a prospective study. A questionnaire was designed and made available to clinicians referring patients to the acute ophthalmology service within Edinburgh. The questionnaire involved them using the algorithm to reach a diagnosis in patients presenting with red eye(s). Patients were then referred to the emergency eye clinic and the questionnaire faxed to the clinic or sent with the patients. Patients were then examined by an experienced ophthalmologist (not blinded) to reach a 'gold standard' diagnosis. The concordance between the 'algorithm assisted' diagnosis and the 'gold standard' was then assessed. Results: All patients presenting with red eye(s) were eligible for inclusion. Forty-one questionnaires were completed, two were excluded. The algorithm assisted diagnosis was correct 72% (28/39) of the time. It correctly diagnosed: acute angle closure glaucoma in 100% of cases (4/4); iritis in 82% (9/11); stromal keratitis in 63% (5/8); epithelial keratitis in 70% (7/10); and infective conjunctivitis in 50% (3/6). Discussion: The diagnostic accuracy of The Edinburgh Red Eye Diagnostic Algorithm is 72, rising to 76% when only the most serious red eye(s) causes are included. The diagnostic accuracy of nonophthalmologists when assessing patients presenting with red eye(s) is greater when the algorithm is used. We hope that the use of this algorithm will prevent delayed presentations of certain serious eye conditions and reduce the morbidity from delayed treatment. © 2015 Macmillan Publishers Limited All rights reserved.


Mulvihill A.,Princess Alexandra Eye Pavilion | Morris B.,Princess Alexandra Eye Pavilion
Eye | Year: 2010

Aim: s: Coats disease is an uncommon form of retinal telangiectasia. We conducted a prospective population-based study of Coats disease in the United Kingdom to provide a more balanced picture. This paper reports the investigations and treatments used for Coats disease and their anatomic and visual outcomes. Methods: The study was conducted through the British Ophthalmic Surveillance Unit. All ophthalmologists notifying cases of Coats disease were sent a baseline questionnaire and a follow-up questionnaire after 6 months. Results: In total, 55 baseline and 42 follow-up questionnaires were returned. All cases were unilateral. Ultrasound was performed in 26% of cases, fluorescein angiography in 35%, and examination under anaesthesia in 42% of the cases. Laser photocoagulation was by far the primary treatment modality, used in 92%, with cryotherapy used mainly as a second-line or adjunctive treatment. In more advanced cases with significant retinal detachment, laser photocoagulation combined with pars plana vitrectomy and drainage of sub-retinal fluid can produce anatomic stability and prevent progress to end-stage disease. Intravitreal injections of steroids or VEGF inhibitors are currently of unproven efficacy in Coats disease. Overall, treatment resulted in stabilisation of visual acuity. Anatomic stabilisation or improvement was achieved in virtually all eyes. Conclusion: Laser photocoagulation to telangiectatic retinal vessels is the most commonly used treatment for Coats disease. Other treatments are either adjunctive or of unproven efficacy. A realistic treatment goal is to achieve anatomic stability and avoidance of enucleation for painful end-stage disease. Visual improvement is however unlikely. © 2010 Macmillan Publishers Limited All rights reserved.


Lascaratos G.,Princess Alexandra Eye Pavilion
Journal of pediatric ophthalmology and strabismus | Year: 2010

The authors report a novel case of solitary infantile myofibroma originating from the conjunctiva and encroaching over the limbus. This is an observational case report with clinicopathologic correlation. Immunostaining of the lesion was positive for vimentin and smooth muscle actin, and negative for pancytokeratin, desmin, myogenin, EMA, myoglobin, HMB45, and MelanA. To the authors' knowledge, this is the first reported case of myofibroma originating from the conjunctiva and this case highlights the importance of considering myofibromatosis in the differential diagnosis of unusual conjunctival lesions. Copyright 2010, SLACK Incorporated.

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