London Eye Hospital

We report the first case of concurrent iridocorneal endothelial (ICE) syndrome and keratoconus, treated successfully with Descemet’s membrane endothelial keratoplasty (DMEK). A 60-year-old male presented with gradual visual deterioration in his left eye over 4 years. Best corrected visual acuity was 1.1 LogMar, with corneal stromal oedema. Hypertonic saline and systemic acyclovir provided no improvement. Further examination revealed peripheral anterior synechiae and possible ICE syndrome. Combined cataract surgery and adapted DMEK were performed, using right eye data for intraocular lens calculation. Postoperative histopathology confirmed ICE syndrome. Two months postoperatively, vision improved to 0.54 LogMar, with normal intraocular pressure and optical coherence tomography. Ten months later, unaided visual acuity reached 0.4 LogMar, with no significant changes observed in regular follow-ups. The patient remains satisfied with his vision. This case highlights the rare association of keratoconus with Chandler Syndrome and the first report of such a case where DMEK was used as management. The diagnosis of ICE syndrome complicates treatment, however, despite the challenges, DMEK demonstrated promising results for ICE-related corneal oedema in a patient with concurrent keratoconus, offering improved visual acuity and no complications.

Trauma-informed care is growing in importance in health and social care, with disclosure as a vital first step. Yet evidence suggests that individual interactions with professionals may not facilitate trauma disclosure. ‘Flow’ aimed to address this. The film represents a high-quality, behaviour change resource that can be utilised in a wide range of circumstances. It was co-produced by representatives from the University of Sheffield, NHS England, the Department of Health and people with lived experience of childhood sexual abuse. The film follows the story of Amy, who is preparing for her art exhibition when a comment reignites traumatic childhood memories. She wants to approach her General Practitioner for help but is hindered both by family loyalty and barriers to disclosure within the NHS. ‘Flow’ has been used both in statutory services and non-governmental organisations, as well as being selected for inclusion in two film festivals. It represents an innovative way to communicate research results and foster change.

Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

The first successful planned extracapsular cataract extraction was reported by Jacques Daviel in 1752. The history of European cataract surgery in the first half of the 18th century, immediately preceding Daviel's report, contains interesting information that explains the foundations of this accomplishment. Daviel himself credited the prior work of Francois Pourfour du Petit. Other important advances were reported by Michel Brisseau, Antoine Maitre-Jan, Jean Méry and others. A critical insight during this time period was the realization that the cataract was, in fact, the opacified crystalline lens, rather than a membrane or opacity located anterior to the lens.

PurposePatients with center-involved diabetic macular edema (CI-DME) with good visual acuity (VA) represent a controversial clinical scenario in which a subthreshold laser might be a reasonable approach. We report a case series of patients with CI-DME with VA better than 20/32 who were treated with a subthreshold 577 nm (yellow) laser.MethodsThe area of retinal thickening on OCT was treated with confluent laser spots at individually titrated power. The fovea was spared from treatment. Effectiveness and safety were evaluated through OCT and autofluorescence (AF) as well as BCVA.ResultsA total of 23 eyes from 19 patients were treated. VA ranged from 20/20 to 20/30. The follow-up period ranged from 6 to 18 months. Edema in OCT resolved completely at the end of follow-up in 56.5% (13/23) of the cases. Central retinal thickness was reduced at 12 weeks and at the end of follow-up, with a mean reduction of 16.9 μm and 22 μm, respectively (paired t-test p = 0.001 and 0.0003). VA remained stable. The laser was invisible (OCT, AF, Fundoscopy) in 91,3% (21/23) of eyes.ConclusionsA fovea-sparing yellow subthreshold laser was safe and effective for treating CI-DME patients with good VA in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies. Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners.

Purpose: Amblyopia is a leading cause of preventable visual impairment which can have consequences on psychosocial wellbeing. This study aims to find out the prevalence of amblyopia reported in 2018. Methods: PubMed was searched for amblyopia prevalence. Relevant articles were reviewed.