Princess Alexandra Eye Pavilion

Edinburgh, United Kingdom

Princess Alexandra Eye Pavilion

Edinburgh, United Kingdom

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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.

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 | Fleck B.W.,Princess Alexandra Eye Pavilion | Wright A.F.,MRC Human Genetics Unit | And 2 more authors.
Retina | Year: 2010

Background: The pathogenesis of rhegmatogenous retinal detachment is complex, and our knowledge of the exact mechanism of vitreoretinal attachment and detachment remains incomplete. Methods: We performed a Medline, Ovid, and EMBASE search using search words rhegmatogenous, retinal detachment, vitreous, and retinal adhesion. All appropriate articles were reviewed, and the evidence was compiled. Results: Cortical vitreous contains fibrillar collagens type II, V/XI, and IX. The inner limiting membrane of the retina contains collagens type I, IV, VI, and XVIII as well as numerous other glycoproteins and potential adhesion molecules. The distribution and age-related changes in the structure of these molecules play an important role in the formation of a retinal break, which may compromise and disrupt the normal mechanisms of neurosensory retinal adhesion. Conclusion: Rhegmatogenous retinal detachment development is intimately related to changes in the fibrillar structure of the aging vitreous culminating in posterior vitreous detachment with regions of persistent and tangential vitreoretinal traction predisposing to retinal tear formation. A complex interplay of factors such as weakening of vitreoretinal adhesion, posterior migration of the vitreous base, and molecular changes at the vitreoretinal interface are important in predisposing to focal areas of vitreoretinal traction precipitating rhegmatogenous retinal detachment. Once formed, the passage of liquefied vitreous through a retinal break may overwhelm normal neurosensory-retinal pigment epithelium adhesion perpetuating and extending detachment and causing visual loss. To understand the molecular events underlying rhegmatogenous retinal detachment so that new therapies can be developed, it is important to appreciate the structural organization of the vitreous, the biology underlying vitreous liquefaction and posterior vitreous detachment, and the mechanisms of vitreoretinal attachment and detachment. Copyright © 2010 Lippincott Williams & Wilkins. All rights reserved.

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.

Bujarborua D.,Pragjyoti Eye Care and Research Center | Borooah S.,Princess Alexandra Eye Pavilion | Dhillon B.,Princess Alexandra Eye Pavilion
Medical Hypotheses | Year: 2013

Development of the prefrontal cortex is believed to play an important role in the maturation of higher cognitive functions such as decision making, cognition and control of part of the neural element of the stress response. The prefrontal cortex undergoes considerable maturation during childhood, including a reduction of synaptic and neural density, a growth of dendrites, and an increase in white matter volume, thereby forming distributed neural networks appropriate for complex cognitive processing, but maturation is not complete until approximately 25. years of age. Serotonin and its receptors (HTRs) play critical roles in brain development and in the regulation of cognition, mood, and anxiety. HTRs are highly expressed in the human prefrontal cortex and exert control over prefrontal excitability. Studies of post-mortem prefrontal brain tissue found distinct developmental patterns of expression of these receptors occurring in early postnatal development and also into adulthood. The general pattern of improved cognitive control and emotion regulation with maturation of the prefrontal cortex, suggests a linear increase in development from childhood to adulthood. Animal studies have shown that dopamine is crucial for communication between the accumbens, amygdala, and prefrontal cortex. Dopamine projections to the prefrontal cortex continue to develop into early adulthood. Central Serous Chorioretinopathy (CSC) is an eye disease affecting people of working age, commonly resulting in repeated unpredictable visually disabling serous retinal detachments and occasionally leading to irreversible reduction in central vision. The disease has been closely linked to the stress response. Despite a concerted effort to understand aetiopathogenesis, disease mechanisms are still largely unclear. This paper, supported by evidence in the literature, proposes a systemic approach to CSC and explains how interactions of the eye with the cerebral cortex could lead to disease. We propose that the lack of development of the neural element of the stress response and in particular the prefrontal cortex is the reason for the absence of CSC in childhood and adolescence. Additionally, we attempt to explain why excess stress hormones do not always result in CSC and why acute attacks occur only once in over half of cases. Finally, we summarise the implications that an integrated systemic hypothesis has for future CSC research and the requirement of a holistic management practice for the identification and treatment of patients with CSC. © 2013 Elsevier Ltd.

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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