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PurposeThe purpose of this study was to introduce nurse-delivered intravitreal injections to increase medical retina treatment capacity.MethodsIndemnity, clinical governance, training, planning, and implementation issues were addressed. The outcome measures were patient safety, patient experience, and clinic capacity.ResultsNo serious vision-threatening complications were recorded in a consecutive series of 4000 nurse-delivered intravitreal injections. A Mann-Whitney test showed a significant increase in intravitreal injections (P=0.003) in the medical retina service after introduction of nurse-delivered intravitreal injections. The majority of patients accepted and were satisfied with a nurse-delivered intravitreal injection.DiscussionNurse-delivered intravitreal injections appear safe, acceptable to patients, and are an effective means to increase intravitreal injection capacity in medical retina clinics. [ABSTRACT FROM AUTHOR]

Background: Objective: The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition. Design: Cross-sectional study of nutritional risk screen conducted over a six month period. Participants and setting: Patients attending a general practice clinic in Victoria, Australia, who attended for the '75 plus' health assessment check. Measurements: The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded. Results: Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category. Conclusion: In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese. [ABSTRACT FROM AUTHOR]

PurposeCentral retinal vein occlusions (CRVOs) are rarely treatable; most therapy is directed towards prevention or treatment of complications. Bilateral CRVO can be due to serum hyperviscosity, which affects 15% of all patients with Waldenstrom's macroglobulinaemia (WM). Although previously reported in a handful of cases, bilateral CRVO is a rare presenting feature.Patients and methodsIllustrated case reports of three patients presenting with bilateral CRVO due to undiagnosed WM.ResultsPlasma exchange, which successfully restored vision in two patients, was followed by long-term cytotoxic therapy.ConclusionsPlasma electrophoresis should be performed in all patients with retinal vein occlusions to exclude a paraproteinaemia. In patients with bilateral venous changes, there should be a very high level of suspicion of hyperviscosity, with the possibility of effective early therapy.Eye (2008) 22, 1089–1092; doi:10.1038/eye.2008.193; published online 4 July 2008 [ABSTRACT FROM AUTHOR]

PurposeThis study investigates the current practice of United Kingdom (UK) ophthalmologists in perioperative antibiotic and antiseptic use in cataract surgery.Materials and methodsA telephone interview survey was conducted with ophthalmic staff at all ophthalmic training units in the UK in October and November 2005.ResultsThe practices of a total of 800 consultants were ascertained. Preoperatively, 795 (99.4%) surgeons used povidone-iodine to prepare the skin. In all, 558 (69.8%) instilled 5 or 10% povidone-iodine in the conjunctival sac; 47 (5.9%) gave preoperative antibiotic eyedrops. Intraoperatively, intracameral antibiotics were given either as a bolus [80 (10.0%) intracameral cefuroxime, 29 (3.6%) intracameral vancomycin] or in the irrigating fluid [33 (4.1%) vancomycin]. 48 (6.0%) gave subconjunctival gentamycin only routinely, 531 (66.4%) gave subconjunctival cefuroxime, and 39 (4.9%) gave other subconjunctival antibiotics. A single dose of topical antibiotics was given by 134 (16.8%) surgeons. Postoperatively, 515 (64.4%) used a combination steroid and neomycin eyedrop, and 213 (26.6%) gave a separate steroid and chloramphenicol eyedrop.ConclusionsThis study reveals wide variations in the choice and duration of antibiotics used by UK ophthalmologists. The predominant methods of intraoperative prophylaxis are subconjunctival cefuroxime and intracameral cefuroxime. Most surgeons used a neomycin eyedrop for postoperative prophylaxis.Eye (2008) 22, 620–627; doi:10.1038/sj.eye.6702675; published online 15 December 2006 [ABSTRACT FROM AUTHOR]

Purpose To compare the detection of diabetic retinopathy from digital images with slit-lamp biomicroscopy, and to determine whether British Diabetic Association (BDA) screening criteria are attained (>80% sensitivity, >95% specificity, <5% technical failure). Methods Diabetics referred for screening were studied in a prospective fashion. A single 45° fundus image was obtained using the nonmydriatic digital camera. Each patient subsequently underwent slit-lamp biomicroscopy and diabetic retinopathy grading by a consultant ophthalmologist. Diabetic retinopathy and maculopathy was graded according to the Early Treatment of Diabetic Retinopathy Study. Results A total of 145 patients (288 eyes) were identified for screening. Of these, 26% of eyes had diabetic retinopathy, and eight eyes (3%) had sight-threatening diabetic retinopathy requiring treatment. The sensitivity for detection of any diabetic retinopathy was 38% and the specificity 95%. There was a 4% technical failure rate. There were 42/288 false negatives and 10/288 false positives. Of the 42 false negatives, 18 represented diabetic maculopathy, 20 represented peripheral diabetic retinopathy and four eyes had both macular and peripheral changes. Three eyes in the false-negative group (1% of total eyes) had sight-threatening retinopathy. There was good concordance between the two consultants (79% agreement on slit-lamp biomicroscopy and 84% on digital image interpretation). Conclusion The specificity value and technical failure rate compare favourably with BDA guidelines. The low sensitivity for detection of any retinopathy reflects failure to detect minimal maculopathy and retinopathy outside the 45° image. This could be improved by an additional nasal image and careful evaluation of macular images with a low threshold for slit-lamp biomicroscopy if image quality is poor. [ABSTRACT FROM AUTHOR]

Summary Background. Inflammatory conditions of the pituitary are rare and consequently there are a number of single case reports of this condition but few reports of series. The condition is often divided into lymphocytic and granulomatous hypophysitis and it has been suggested that these two conditions represent the ends of a spectrum of disease. Method. We present our experience with 14 cases of this condition, correlating the presenting symptoms with the neuroradiology, surgical findings and subsequent histology. Findings. The subjects (11 female 3 male) ranged in age from 13 to 64 years. Final histopathological diagnoses included 5 cases of lymphocytic hypophysitis, 4 cases of Rathke's pouch cyst with granulomatous response, 2 cases of granulomatous hypophysitis and 1 case with an inflammatory process that did not fit the current classification. Two subjects did not undergo surgery. Headache was a presenting feature in 11 of 14 cases and fever in 3 of 14 cases. Length of symptoms prior to presentation varied from acute onset to 9 years. One case of lymphocytic hypophysitis was associated with pregnancy. Evidence of hypopituitarism was present in 9 of 10 subjects assessed preoperatively. Preoperative radiology showed three patterns of disease: A cystic appearance was common with low signal content on MRI T1 weighting with an enhancing ring and a thickened enhancing stalk (5 patients). 4 patients showed a solid enhancing mass. A third group (2 patients) showed cysts with high signal content on T1 weighting – both of these were Rathke's cysts on histology. Interpretation. Overall there were no striking features in the clinical presentation to distinguish pituitary inflammation from pituitary adenoma. The prognosis was generally good. [ABSTRACT FROM AUTHOR]

Objective: The aim of these experiments was to compare the cutting dynamics of high-speed high-torque (speed-increasing) and high-speed low-torque (air-turbine) handpieces and evaluate the effect of handpiece torque and bur type on sub-surface enamel cracking. Temperature changes were also recorded in teeth during cavity preparation with high and low torque handpieces with diamond and tungsten carbide (TC) burs. The null hypothesis of this study was that high torque handpieces cause more damage to tooth structure during cutting and lead to a rise in temperature within the pulp-chamber.Materials and Methods: Images of the dynamic interactions between burs and enamel were recorded at video rate using a confocal microscope. Central incisors were mounted on a specially made servomotor driven stage for cutting with a type 57 TC bur. The two handpiece types were used with simultaneous recording of cutting load and rate. Sub-surface enamel cracking caused by the use of diamond and TC burs with high and low torque was also examined. Lower third molars were sectioned horizontally to remove the cusp tips and then the two remaining crowns cemented together with cyanoacrylate adhesive, by their flat surfaces. Axial surfaces of the crowns were then prepared with the burs and handpieces. The teeth were then separated and the original sectioned surface examined for any cracks using a confocal microscope. Heat generation was measured using thermocouples placed into the pulp chambers of extracted premolars, with diamond and TC burs/high-low torque handpiece variables, when cutting occlusal and cervical cavities.Results: When lightly loaded the two handpiece types performed similarly. However, marked differences in cutting mechanisms were noted when increased forces were applied to the handpieces with, generally, an increase in cutting rate. The air turbine could not cope with steady heavy loads, tending to stall. 'Rippling' was seen in the interface as this stall developed, coinciding with the bur 'clearing' itself. No differences were noted between different handpieces and burs, in terms of sub-surface enamel cracking. Similarly, no differences were recorded for temperature rise during cavity preparation.Conclusions: Differences in cutting mechanisms were seen between handpieces with high and low torque, especially when the loads and cutting rates were increased. The speed increasing handpiece was better able to cope with increased loading. Nevertheless, there was no evidence of increased tooth cracking or heating with this type handpiece, indicating that these do not have any deleterious effects on the tooth. [ABSTRACT FROM AUTHOR]

The cloning of white spruce ( Picea glauca) mitochondrial DNA homologous to the cytochrome oxidase II and ATPaseα genes of maize is described. These probes were used to define restriction fragment length polymorphisms which distinguish the white, Engelmann ( P. engelmannii) and Sitka spruce ( P. sitchensis) populations that occur in British Columbia. Analysis of progeny from crosses between the species revealed that mitochondrial DNA was maternally inherited in all cases (32 progeny from five independent crosses). The inheritance of chloroplast DNA was determined using a probe described previously; in this case, all progeny exhibited paternal inheritance (27 progeny from four crosses). Mitochondrial and chloroplast probes were used to test trees from zones of introgression between coastal (Sitka) and interior spruces (white and Engelmann). In most cases mitochondria and chloroplasts within individuals were contributed by different species. The data shows that there is a significant Sitka spruce component in trees east of the coastal watershed in British Columbia. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Utilisation of orthoptists to give intravitreal injections—a multidisciplinary approach," by S. P. Mall and colleagues in the 2015 issue.

Eye (2003) 17, 114. doi:10.1038/sj.eye.6700274 [ABSTRACT FROM AUTHOR]