Hydroxychloroquine (HCQ) maculopathy is irreversible; primary prevention is done by regular monitoring. Guidelines of the Royal College of Ophthalmologists identify definite toxicity as having ...abnormal results of two screening tests, we present a quantitative method for interpreting these guidelines.
We obtained ocular coherence tomography (OCT) scans of 100 patients who have been on HCQ for 5 years or more (patients) and 70 age-matched controls. Both groups had 10'2 visual field (VF) test. We used linear regression to determine the cut-off points for each of the eight Early Treatment of Diabetic Retinopathy Study (ETDRS) macular sectors for the VF and OCT. We calculated the probability of developing maculopathy using logistic regression.
Mean patient age: 59.9 years, 85% females, no statistically significant age difference between the patients and the control groups.
64% rheumatoid arthritis, 14% Sjogren's syndrome, 16% systemic lupus and 6% various other rheumatology conditions. Mean duration of use was 6.3 years. Logistic regression results show strong negative correlation between the outer nuclear layer (ONL) volume and probability of toxicity. Goodness of fit was tested using Hosmer and Lemeshow test that indicates a high significance with a high P-value of 1.
Combining the ONL volume reduction and VF retinal sensitivity reduction per each of the eight ETDRS macular sectors provides an accurate and objective way of diagnosing HCQ maculopathy, this helps busy eye units establishing an optometrist-led or virtual service because it is independent of the assessor's level of experience.
To describe a new formula, BESSt, to estimate true corneal power after keratorefractive surgery in eyes requiring cataract surgery.
Moorfields Eye Hospital, London, United Kingdom.
The BESSt formula, ...based on the Gaussian optics formula, was developed using data from 143 eyes that had keratorefractive surgery. The formula takes into account anterior and posterior corneal radii and pachymetry (Pentacam, Oculus) and does not require pre-keratorefractive surgery information. A software program was developed (BESSt Corneal Power Calculator), and corneal power was calculated in 13 eyes that had keratorefractive surgery and required cataract surgery.
In the eyes having phacoemulsification, target refractions calculated with the BESSt formula were statistically significantly closer to the postoperative manifest refraction (mean deviation 0.08 diopters D +/- 0.62 SD) than those calculated with other methods as follows: history technique (-0.07 +/- 1.92 D; P = .05); history technique with double-K adjustment (0.13 +/- 2.39 D; P = .05); Holladay 2 with K-values estimated with the contact lens method (-0.76 +/- 1.36 D; P = .03); Holladay 2 with K-values from Atlas topographer (Humphrey) (-0.55 +/- 0.61 D; P<.01). Using the BESSt formula, 46% of eyes were within +/-0.50 D of the intended refraction and 100% were within +/-1.00 D.
The BESSt formula was statistically significantly more accurate than the other techniques tested. Thus, it could significantly improve intraocular lens power calculation accuracy after keratorefractive surgery, especially when pre-refractive surgery data are unavailable.
Hydroxychloroquine sulphate (HCQ) is widely used for the treatment of a variety of rheumatological and dermatological conditions. Despite the advantages of HCQ as a treatment option, it is important ...to be aware of its potential retinal toxicity, which may be irreversible and progressive. In December 2020, The Royal College of Ophthalmologists published revised recommendations on monitoring HCQ retinopathy. Our case report highlights some of the shortcomings of blindly following their monitoring algorithm by presenting a case where apparent HCQ retinopathy resolved after Yttrium Aluminium Garnet (YAG) laser capsulotomy. The case reiterates the importance of thorough clinical examination. We suggest that while the acquisition of the spectral domain optical coherence tomography and fundus autofluorescence may be objective, their interpretation is subjective. Even with the use of artificial intelligence algorithms, false positives may be generated if the tests are confounded by copathology. There is no gold-standard test for detecting HCQ toxicity.
To investigate the causes of nonphysiologic behavior of the SRK/T formula, assess their clinical significance, and develop and evaluate solutions.
Two NHS ophthalmology departments, United Kingdom, ...and a private practice, United States.
Evaluation of technology.
The individual steps of the SRK/T formula were examined for nonphysiologic behavior, and the clinical significance of behaviors was assessed with reference to a database of biometry and refractive outcomes in 11 189 eyes. The full data set was divided into 2 subsets, the first to develop solutions to nonphysiologic behavior of the SRK/T formula and the second to evaluate their performance.
The SRK/T formula showed nonphysiologic behavior in the calculation of corrected axial length and corneal height. Although the former is of little clinical significance, the latter showed a systematic error that contributes to inaccurate intraocular lens (IOL) power prediction. The T2 formula was developed using a regression formula for corneal height derived from the development subset. Comparison of the performance of the T2 and SRK/T formulas using the evaluation subset showed significant improvement in the mean absolute error with the T2 formula (0.3064 diopter D versus 0.3229 D; P<.0001). On average, the prediction error with the T2 formula was 9.7% less than with the SRK/T formula, with significantly higher proportions of eyes within ±0.50 D of target (P<.0001).
The SRK/T formula has nonphysiologic behavior that contributes to IOL power prediction errors. A modification to the formula algorithm, the T2 formula, can be directly substituted for SRK/T, resulting in significantly improved prediction accuracy.
A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were ...experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.
Background The management of adhesive capsulitis (frozen shoulder) is controversial. The authors present a prospective randomized study comparing the outcome, at a two-year follow-up period, of two ...groups of patients treated either by manipulation of the shoulder under anaesthetic or by intra-articular shoulder injections using steroid with distension. Methods Fifty-three patients suffering from Idiopathic “Primary” Frozen Shoulder were prospectively randomized into two treatment groups and followed up for two years from the start of treatment. Patients were assessed using the Constant score, a Visual Analogue Score, and the SF36 questionnaire. Results No statistical differences were found between the two groups of patients with regards to the outcome measures. Conclusion Treatment using steroid injections with distension as an out-patient is therefore recommended for the treatment of Idiopathic “Primary” Frozen Shoulder. This has the same clinical outcome as a manipulation under anaesthetic with less attendant risks. Level of evidence Level 1; Randomized controlled trial, therapeutic study.
Abstract
The Bernese periacetabular osteotomy (PAO) has been associated with a significant learning curve, with the majority of serious complications reported during the first 20–50 independent ...procedures. Our aim was to assess whether hip preservation fellowship training flattens the PAO learning curve with respect to complication profiles and 1-year patient-reported outcome measures (PROM). The clinical records of the first 50 PAOs (47 patients, median age 23.5 years) performed by a single surgeon after completion of a 12-month hip preservation fellowship programme were reviewed. The first 25 PAOs were compared with the second 25 PAOs with respect to complication profiles and PROM (modified Harris Hip Score, University of California Los Angeles activity score, pain visual analogue scale) at 12 months post-operatively. There were no significant between-group differences in demographic variables or pre-operative PROM. Twelve months post-operatively, no patients had experienced a major complication (Clavien–Dindo grades III–V). Twenty-three (46%) patients experienced at least one minor complication (grades I–II); 13 (52%) in the first group and 10 (40%) in the second group (no significant difference, P = 0.57). The most common complications were lateral femoral cutaneous nerve neuropraxia 14 patients (28%) and allogenic blood transfusion 7 patients (14%). There were no significant between-group differences with respect to 1-year post-operative PROM or post-operative change in PROM (all P > 0.05). Although it is difficult to definitively conclude that hip preservation fellowship training is solely responsible for the reassuring outcomes in our series, we believe that such training can significantly flatten the learning curve associated with the Bernese PAO.
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