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Quiz Dec/Jan 2020

History A 69-year-old female patient was referred to the uveitis clinic from her local district general hospital with a left posterior uveitis which had been unresponsive to high dose steroids. She had no other previous ophthalmic history nor significant systems...

Quiz Feb/Mar 2024

History A 21-month-old boy presented to his local ophthalmology department with a left proptotic eye from a growing cystic lesion known to be present from birth. Notes taken on presentation were: Known left microphthalmia with chorio-retinal coloboma, contralateral eye was...

The results of the last survey Apr21

There was a really fascinating response to the last edition’s practice variance survey. Strictly speaking, I cheated and this was not really about practice variation, but more about your impressions about what represents negligent practice. For the first time ever,...

Acute retinal necrosis presumably caused by Epstein-Barr virus infection

Acute retinal necrosis (ARN) is an uncommon, but serious and potentially blinding condition. ARN is characterised by panuveitis, occlusive vasculopathy and progressive peripheral necrotising retinitis. The diagnosis is clinical but confirmation is sought via aqueous and vitreous sampling. Varicella zoster...

Refractive surprise after cataract surgery caused by posterior capsular striae

Cataract removal with intraocular lens (IOL) implantation is one of the most frequently performed surgeries in current clinical practice [1,2]. New microsurgical techniques and refined IOL power calculations allow excellent refractive outcomes. Refractive surprise following cataract surgery is uncommon [1-3]...

Iris chafing from displaced single-piece acrylic IOL

A 74-year-old man had persistent 3+ cell one month following left eye cataract extraction, complicated by anterior capsular rent and zonular dialysis at 7 o’clock, with single-piece acrylic intraocular lens implantation (IOL) in the capsular bag. Figure 1: Haptic-like transillumination...

Birdshot retinochoroiditis

Birdshot retinochoroiditis (BRC) is a chronic, sight-threatening uveitis, most commonly affecting caucasian individuals in their fourth to sixth decades [1]. The disease is associated with HLA-29 and is characterised by progressive inflammation at the level of retina and choroid, with...

Preventing refractive surprises by real time biometry during cataract surgery

A few months ago a retired lady presented for second eye cataract surgery. I noted on the pre-op ward round that the outcome of her first eye’s surgery looked like a refractive surprise as her spherical equivalent in that eye...

Refined glaucoma referral practice offers prospect of improved capacity and expanded role for primary eye care professionals

Glaucoma is the most frequent cause of irreversible blindness worldwide and the second leading cause of blindness in the UK [1,2]. The global prevalence of glaucoma in 2010 was approximately 3.5% for people aged 40-80 years, according to Jonas et...

A closer look at the new wave of glaucoma surgery – radical or old school?

Glaucoma is a challenging condition to treat because the exact pathophysiology remains unclear and the only readily modifiable factor is the intraocular pressure (IOP). Additionally, most glaucoma patients are completely asymptomatic, yet are often subjected to lifelong medical therapy. The...

Cutting-edge practice in glaucoma care: what, how and why?

More effective treatments and drug delivery modalities, implantable minimally invasive glaucoma surgical (MIGS) devices, as well as accelerating clinical research programmes, will transform the surgical and clinical management of glaucoma in the near future. There is also an ever-greater emphasis...

Use of off-the-shelf magnifying glasses as a cost-effective alternative for surgical loupes

Surgical loupes are an integral part of ophthalmic surgery on the ocular surface and in the periocular area. Available in different magnifications, they provide a clear view of the field of surgery which can greatly assist in identifying fine structures...