Recent Submissions

  • Quantum molecular resonance electrotherapy for the treatment of pediatric ocular rosacea

    Surapaneni, Leena; Giachos, Ioannis; Palioura, Sotiria; Giachos, Ioannis; Ophthalmology; Medical and Dental; Yale University School of Medicine; Sandwell and West Birmingham NHS Trust; University of Cyprus Medical School (Lippincott, Williams & Wilkins, 2024-07-05)
    Purpose: The purpose of this study was to report the outcomes of quantum molecular resonance (QMR) electrotherapy in the management of refractory pediatric ocular rosacea. Methods: This is a retrospective case series on 3 female pediatric patients (ages 12, 15, 14 years) with ocular rosacea. Two patients presented with corneal stromal neovascularization and punctate epithelial erosions while 1 patient presented with corneal scarring and paracentral stromal thinning. After failing conservative management, the patients were treated with 4 consecutive QMR electrotherapy sessions with the intensity set at 5 corresponding on average to a power of 12 W, with 60 V voltage and 200 mA current. Informed consent was obtained for off-label use. Patients were assessed for changes in vision, foreign body sensation, tearing, photophobia, and redness at each visit to determine symptomatic improvement. Outcome measures include best-corrected visual acuity, use of supplemental therapies (eg topical steroids) for symptom relief, extent of corneal neovascularization via serial slitlamp photography, and corneal scar remodeling via high resolution anterior segment optical coherence tomography (OCT). Results: Two of the 3 patients experienced improvement in visual acuity after QMR electrotherapy. Corneal neovascularization and scarring regressed significantly in all 3 patients. Two months post-QMR electrotherapy, corneal remodeling was evident on optical coherence tomography in 2 patients. All 3 patients were able to discontinue topical immunosuppressants and remain symptom-free at 1.5 years of follow-up. Conclusions: QMR electrotherapy is a promising alternative in the treatment of refractory ocular rosacea in childhood and puberty, and it may potentiate corneal remodeling.
  • Aggressive angiomyxoma of the ischioanal fossa in a post-menopausal woman.

    Peterknecht, Elizabeth; Agerbak, E; Mohamedahmed, Ayy; Stonelake, Stephen; Kulkarni, K; Peravali, R; Zaman, S; Peterknecht, E; agerbak, E; Mohamedahmed, Ayy; et al. (Royal College of Surgeons of England, 2021-02)
    Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.
  • Adherence to Topical Medication in Patients with Inflammatory Eye Disease.

    Javidi, Hedayat; Poonit, Nat; Patel, Radhika P; Barry, Robert; Rauz, Saaeha; Murray, Philip; Javidi, Hedayat; Poonit, Nat; Patel, Radhika; Barry, Robert; et al. (Taylor and Francis Group, 2020-01-16)
    Purpose: To evaluate adherence to topical medication in patients with inflammatory eye disease.Methods: Questionnaire survey of patients attending inflammatory eye disease clinics. Treatment regimen was validated against hospital-generated clinic letters.Results: There were 86 patients (52 uveitis and 34 ocular surface disease) with 30% (26/86) failing to identify one or more of the medications they were using, and 28% (24/86) unable to offer the correct indication for their treatment. A total of 64% (55/86) failed to use their medication as advised (27% on a daily basis); the commonest reason being forgetfulness. In patients using multiple eye drops, 26% left insufficient time intervals between successive eye drops, and 58% (50/86) reported not being given any instruction on drop instillation.Conclusions: We highlight poor adherence to topical medication in patients with inflammatory eye disease. We recommend a dedicated practitioner providing a proactive approach to patient education to improve adherence.
  • Evaluation of allied health professional-led keratoconus management service in the United Kingdom : the Birmingham and Midland Eye Centre (BMEC) study

    Bourlaki, Marianthi; Khan, Murad; Bandyopadhyay, Saliamma; Sahota, Rashvinder; Khan, Emadur; Patel, Urvasee; Pajaujis, Mykolas; Aralikatti, Anil; Barua, Ankur; Ting, Darren Shu Jeng; et al. (Springer Nature, 2024-06-13)
    No abstract available.
  • Rethinking the urgency priority system in round hole detachments, which should be done first? Macula on or macula off

    Javed, A; Qadir, M O; Lee, S; Mitra, A; Tyagi, A; Sharma, A; Lett, K; Ch'ng, Soon; Javed, Ahmed; Qadir, Muhammed Omar; et al. (Springer Nature, 2024-01-26)
    No abstract available.
  • Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity

    Lewis, Thomas L; Goff, Thomas A J; Ray, Robbie; Dhaliwal, Jagwinder; Carmody, David; Wines, Andrew P; Dhaliwal, Jagwinder; Trauma and Orthopaedics; Medical and Dental; King's College Hospital NHS Foundation Trust; Mid Yorkshire Hospitals NHS Trust; Sandwell and West Birmingham NHS Trust; North Sydney Orthopaedic and Sports Medicine Centre (Springer, 2024-05-30)
    Background: The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. Methods: A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. Results: Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). Conclusion: Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal.
  • Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches.

    KALOGEROPOULOS, DIMITRIOS; Sakkas, Hercules; Mohammed, Bashar; Vartholomatos, Georgios; Malamos, Konstantinos; Sreekantam, Sreekanth; Kanavaros, Panagiotis; Kalogeropoulos, Chris; Mohammed, B,; Sreekantam, S; et al. (Springer, 2021-08-09)
    Purpose: This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease. Methods: A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. Results: Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used. Conclusion: Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
  • Whole-body photobiomodulation therapy propels the Fibromyalgia patient into the recomposition phase : a reflexive thematic analysis

    Fitzmaurice, Bethany; Grenfell, Rebecca; Heneghan, Nicola R; Rayen, Asius T A; Soundy, Andrew A; Fitzmaurice, Bethany C.; Grenfell, Rebecca L.; Rayen, Asius TA.; Soundy, Andrew A.; Pain Management; et al. (MDPI, 2024-05-17)
    Background: Recent evidence has identified great promise for the novel whole-body photobiomodulation therapy (PBMT) for individuals with fibromyalgia (FM). However, currently no evidence has documented the experiences of participants. The objective of this study was to qualitatively assess treatment experience and response in a group of participants with FM undergoing a course of whole-body PBMT. Methods: An interpretive hermeneutic phenomenological study situated within the worldview of pragmatism was undertaken. A convenience sample of individuals with FM were included if they had undertaken a novel 6-week trial of PBMT. Individuals undertook semi-structured interviews exploring treatment experience and multidimensional treatment responses during Week 3 and Week 6. Results: Sixteen trial participants (47.3 ± 10.9 years) took part in this study. The analysis produced three overarching themes that were previously identified from a baseline study (namely, 'Body Structure & Function', 'Activities & Participation', and 'Environment') with an additional five sub-themes that highlighted the intervention experience. Subsequently, four important processes were observed and identified: increased motivation; feeling proud; improved confidence; feeling like 'old self'. This ultimately culminated in the identification of a positive spiral, which we have termed 'recomposition'. Conclusions: We believe our study is the first in the field of chronic pain management to utilise qualitative methodology to directly assess the acceptability and efficacy of a specific medical intervention in a clinical trial, and the first study to qualitatively assess whole-body PBMT experience. The findings are compelling and warrant further work to support the introduction of this device into the National Health Service (NHS).
  • Staged versus concomitant TAVI and PCI for the treatment of coexisting aortic stenosis and coronary artery disease

    Shirke, Manasi Mahesh; Wang, William; Welch, Joseph; Faisal, Farqhan; Nguyen, Dang; Harky, Amer; Welch, Joseph; General Surgery; Medical and Dental; University Hospitals NHS Trust, Nottingham; Queen Mary University Of London; Sandwell and West Birmingham NHS Trust; New Vision University; et al. (Lippincott, Williams & Wilkins, 2024-05-17)
    Aortic stenosis (AS) is one of the most common valvular pathologies. Severe coronary artery disease (CAD) often coexists with AS. Transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) have been established as alternatives to open surgical interventions. The data on the timing for the treatment of the 2 conditions are scarce and depend on multiple factors. This review compares the clinical outcomes of the concomitant versus staged PCI and TAVI for the treatment of AS and CAD. A systematic, electronic search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to identify relevant articles that compared outcomes of the staged versus concomitant approaches for the TAVI and PCI. Seven studies were included involving 3745 patients. We found no statistically significant difference in primary outcomes such as 30-day mortality [odds ratio (OR) = 0.78; 95% confidence interval (CI): 0.39-1.57] and secondary outcomes including length of hospital stay (mean difference = -4.74, 95% CI: -10.96 to 1.48), new-onset renal failure (OR = 0.83, 95% CI: 0.22-3.13), cerebrovascular accidents (OR = 1.28, 95% CI: 0.64-2.57), and intraoperative blood loss (OR = 0.83, 95% CI: 0.32-2.12). New pacemaker insertion was statistically significant in favor of the concomitant approach (OR = 0.78, 95% CI: 0.63-0.96). This analysis suggests that while the 2 approaches are largely comparable in terms of most outcomes, patients at risk of requiring a pacemaker postprocedure may benefit from a concomitant approach. In conclusion, concomitant TAVI + PCI approach is nonsuperior to the staged approach for the treatment of CAD and AS. This review calls for robust trials in the field to further strengthen the evidence.
  • Ethnic differences in the rates of posterior capsule rupture and long-term sequelae in phacoemulsification Cataract surgery

    Mohite, Abhijit A; Panthagani, Jesse; Sharif, Walid; Feinberg, Leo; Shah, Peter; Masood, Imran; Mohite, Abhijit A.; Panthagani, Jesse; Sharif, Walid; Feinberg, Leo; et al. (Springer, 2024-02-29)
    Purpose The purpose of this study is to investigate the rates of posterior capsular rupture (PCR) and its sequelae during phacoemulsification across different ethnicities. Methods This is a retrospective cohort study of all consecutive phacoemulsification cases complicated by PCR that met the inclusion criteria over a four-year period at a single tertiary eye centre in the United Kingdom (UK). Results PCR occurred in 0.85% of cases overall (157/18,481). PCR rates were 1.8% (26/1485), 1.2% (51/4350), and 0.7% (75/10,927) in African-Caribbean, Indian subcontinent, and Caucasian patients, respectively (p < 0.001). Mean final corrected distance visual acuity improved (p < 0.05) in all ethnic groups (0.40 ± 0.57 logMAR) compared to pre-op (0.78 ± 0.61 logMAR). Post-operative cystoid macular oedema and unstable intraocular pressure rates following PCR did not statistically differ amongst ethnicities (p = 0.37 and p = 0.75, respectively). However, post-operative uveitis rates significantly differed at 11.5%, 15.7%, and 1.3% amongst the three ethnic groups, respectively (p = 0.01). Conclusion This is the first study to highlight a possible link between patient ethnicity and the risk of PCR during phacoemulsification cataract surgery. We observed significantly greater numbers of PCR cases amongst certain ethnic groups (highest in African-Caribbean eyes, then Indian subcontinental eyes, and lowest in Caucasian eyes) within the same multi-cultural urban population. Ethnicity may therefore be a contributing factor for PCR and should potentially be taken into consideration during preoperative risk stratification.
  • Melanocytic ocular surface squamous neoplasia successfully managed with no-touch excisional biopsy, cryotherapy and amniotic membrane transplantation

    Giachos, Ioannis; Thaung, Caroline; Ting, Darren Shu Jeng; Giachos, Ioannis; Ting, Darren SJ.; Ophthalmology; Medical and Dental; Sandwell and West Birmingham NHS Trust; Moorfields Eye Hospital; University College London Institute of Ophthalmology; University of Birmingham; et al. (Springer Nature, 2024-04-22)
    No abstract available.
  • Large language models approach expert-level clinical knowledge and reasoning in ophthalmology : a head-to-head cross-sectional study

    Thirunavukarasu, Arun James; Mahmood, Shathar; Malem, Andrew; Foster, William Paul; Sanghera, Rohan; Hassan, Refaat; Zhou, Sean; Wong, Shiao Wei; Wong, Yee Ling; Chong, Yu Jeat; et al. (Public Library of Science, 2024-04-17)
    Large language models (LLMs) underlie remarkable recent advanced in natural language processing, and they are beginning to be applied in clinical contexts. We aimed to evaluate the clinical potential of state-of-the-art LLMs in ophthalmology using a more robust benchmark than raw examination scores. We trialled GPT-3.5 and GPT-4 on 347 ophthalmology questions before GPT-3.5, GPT-4, PaLM 2, LLaMA, expert ophthalmologists, and doctors in training were trialled on a mock examination of 87 questions. Performance was analysed with respect to question subject and type (first order recall and higher order reasoning). Masked ophthalmologists graded the accuracy, relevance, and overall preference of GPT-3.5 and GPT-4 responses to the same questions. The performance of GPT-4 (69%) was superior to GPT-3.5 (48%), LLaMA (32%), and PaLM 2 (56%). GPT-4 compared favourably with expert ophthalmologists (median 76%, range 64-90%), ophthalmology trainees (median 59%, range 57-63%), and unspecialised junior doctors (median 43%, range 41-44%). Low agreement between LLMs and doctors reflected idiosyncratic differences in knowledge and reasoning with overall consistency across subjects and types (p>0.05). All ophthalmologists preferred GPT-4 responses over GPT-3.5 and rated the accuracy and relevance of GPT-4 as higher (p<0.05). LLMs are approaching expert-level knowledge and reasoning skills in ophthalmology. In view of the comparable or superior performance to trainee-grade ophthalmologists and unspecialised junior doctors, state-of-the-art LLMs such as GPT-4 may provide useful medical advice and assistance where access to expert ophthalmologists is limited. Clinical benchmarks provide useful assays of LLM capabilities in healthcare before clinical trials can be designed and conducted.
  • Mortality Following Hip Fracture Surgery During COVID-19 Pandemic Compared to Pre-COVID-19 Period: A Case Matched Cohort Series.

    De, C; Harbham, P K; Postoyalko, C; Bhavanasi, B; Paringe, V; Theivendran, K; De, C; Harbham, P K; Postoyalko, C; Bhavanasi, B; et al. (Kuala Lumpur, 2021-07)
    Introduction: This study aims to report on clinical outcomes and 30-day mortality of patients with neck of femur fracture during COVID-19 pandemic and compare the outcomes in a cohort during the same period prior to the pandemic. Material and methods: The study included 66 patients with hip fracture over the age of 60 years, presented between 1st March and 15th May 2020 and matched with the patients with hip fractures (75 patients) managed during the corresponding period in 2019 as control. Data was collected on demographics, comorbidities, COVID-19 status, procedures and mortality and complications. Results: Thirty-day mortality following hip surgery was 13.6% during COVID-19 pandemic with all the mortalities in patients with ASA Grade 3 and 4. Mortality was considerably high for intracapsular fracture (20%) but highest in cemented hemiarthroplasty (20%). One third of the hip fractures operated in COVID-19 designated theatre died within 30 days of surgery. Thirty-day mortality rate for COVID-19 positive hip fracture patients were 55.5%. There has been higher 30-day mortality for hip surgeries during COVID-19 pandemic with positive correlation between patient's COVID-19 test status and 30-day mortality following hip surgeries. Conclusion: There is strong association between 30-day mortality and the designated theatre (Clean/COVID) where the patients were operated on with higher mortality for intracapsular neck of femur fractures with significant mortality associated with cemented hemiarthroplasty particularly among symptomatic or COVID-19 positive patients. Therefore, adoption of a multidisciplinary approach is recommended to optimally balance the risk-benefit ratio for planning of management of hip fractures while considering patient's peri-operative outcomes.
  • Migration of the XEN45 Gel Stent into the Anterior Chamber Managed by Trimming the Implant.

    Sigona, Mark; Murthy, Shashidhar; Sigona, Mark; Sandwell and West Birmingham NHS Trust; Medical and Dental; Sandwell and West Birmingham NHS Trust; Royal Wolverhampton NHS Trust (Lippincott, Williams & Wilkins, 2021-07)
    We report a case of migration of the XEN45 gel stent into the anterior chamber successfully treated with trimming of the implant. To the best of our knowledge, this management strategy for migration of the implant has not previously been reported.
  • Meta-analysis of randomised controlled trials comparing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: upgrading the level of evidence.

    Hajibandeh, Shahin; Hajibandeh, Shahab; Mankotia, Rajnish; Akingboye, Akinfemi; Peravali, Rajeev; Mankotia, Rajnish; Hajibandeh, Shahin; Sandwell and West Birmingham NHS Trust; Medical and Dental; Hereford County Hospital; Sandwell and West Birmingham NHS Trust; Glan Clwyd Hospital (Springer, 2021-02-03)
    The need for escalation of level of evidence regarding the comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy has been persistently highlighted by previous meta-analyses of level 2 and 3 evidence. A systematic search of electronic databases and bibliographic reference lists were conducted. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, length of incision, conversion to an open procedure, harvested lymph nodes, procedure time, and length of hospital stay were the evaluated outcome parameters. Four randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy were included. The ICA was associated with significantly shorter length of incision (MD - 1.82, p < 0.00001), lower postoperative pain score on day 2 (MD - 0.69, p = 0.0007), day 3 (MD - 0.80, p = 0.02), day 4 (MD - 0.83, p = 0.01) and day 5 (MD - 0.49, p < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD - 0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR 0.79, p = 0.47), anastomotic leak (RR 1.29, p = 0.65), SSI (RR 0.61, p = 0.42), bleeding (RR 0.70, p = 0.71), paralytic ileus (RR 0.60, p = 0.45), conversion to open (RD: - 0.02, p = 0.45), number of harvested lymph nodes (MD 0.82, p = 0.06), and procedure time (MD 16.04, p = 0.06) between two groups. The meta-analysis of level 1 evidence demonstrated that laparoscopic right hemicolectomy with ICA has comparable perioperative morbidity but better postoperative recovery than with ECA. The ICA is safe to be practiced more routinely where technical challenges allow.
  • Meta-analysis of laparoscopic mesh rectopexy versus posterior sutured rectopexy for management of complete rectal prolapse.

    Hajibandeh, Shahin; Hajibandeh, Shahab; Arun, Chokkalingam; Adeyemo, Adedayo; McIlroy, Brendan; Peravali, Rajeev; Peravali, Rajeev; Sandwell and West Birmingham NHS Trust; Medical and Dental; Hereford County Hospital; Wrexham Maelor Hospital; Sandwell and West Birmingham NHS Trust (Wiley, 2021-02-23)
    Objectives: To evaluate comparative outcomes of laparoscopic mesh rectopexy (LMR) and laparoscopic posterior sutured rectopexy (LPSR) in patients with rectal prolapse. Methods: We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Recurrence, Cleveland Clinic Incontinence Score (CCIS), Cleveland Clinic Constipation Score (CCCS), surgical site infections, procedure time, and length of hospital stay were the evaluated outcome measures. Results: We identified 5 comparative studies reporting a total of 307 patients evaluating outcomes of LMR (n=160) or LPSR (n=147) in patients with rectal prolapse. LMR was associated with significantly lower recurrence rate (OR: 0.28, P=0.009) but longer procedure time (MD: 23.93, P<0.0001) compared to LPSR. However, there was no significant difference in CCIS (MD: -1.02, P=0.50), CCCS (MD: -1.54, P=0.47), surgical site infection (OR: 1.48, P=0.71), and length of hospital stay (MD: -1.54, P=0.47) between two groups. No mesh erosion was reported in any of the included studies at maximum follow-up point. Sub-group analyses with respect to ventral mesh rectopexy, posterior mesh rectopexy, randomised studies, and adult patients were consistent with the main analysis. Conclusions: LMR seems to be associated with lower recurrence but longer procedure time compared to LPSR. Although no mesh-related complications have been reported by the included studies, no definitive conclusions can be made considering that the included studies were inadequately powered for such outcome. Future high-quality randomised studies with adequate sample size are required.
  • Meta-analysis and trial sequential analysis of three-port vs four-port laparoscopic cholecystectomy (level 1 evidence)

    Hajibandeh, Shahab; Finch, David A.; Mohamedahmed, Ali Yasen Y.; Iskandar, Amir; Venkatesan, Gowtham; Hajibandeh, Shahin; Satyadas, Thomas; Mohamedahmed, Ali Yasen Y; Sandwell and West Birmingham NHS Trust; Medical and Dental; et al. (Springer, 2021-02-15)
    To compare the outcomes of three-port and four-port laparoscopic cholecystectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port vs four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model. The risks of type 1 or type 2 error in the meta-analysis model were assessed using trial sequential analysis model. The certainty of evidence was assessed using GRADE system. Random effects modelling was applied to calculate pooled outcome data. Analysis of 2524 patients from 17 studies showed that both techniques were comparable in terms of operative time (MD:- 0.13, P = 0.88), conversion to open operation (OR:0.80, P = 0.43), gallbladder perforation (OR: 1.43, P = 0.13), bleeding from gallbladder bed (OR:0.81, P = 0.34), bile duct injury (RD: 0.00, P = 0.97), iatrogenic visceral injury (RD: - 0.00, P = 0.81), bile or stone spillage (OR:1.67, P = 0.08), port site infection (OR: 0.90, P = 0.76), port site hernia (RD: 0.00, P = 0.89), port site haematoma (RD: - 0.01, P = 0.23), port site seroma (RD: 0.00, P = 1.00), and need for reoperation (RD: - 0.00, P = 0.94). However, the three-port technique was associated with lower VAS pain score at 12 h (MD: - 0.66, P < 0.00001) and 24 h (MD: - 0.54, P < 0.00001) postoperatively, shorter length of hospital stay (MD:-0.09, P = 0.41), and shorter time to return to normal activities (MD: - 0.79, P = 0.02). Trial sequential analysis confirmed that the meta-analysis was conclusive with no significant risks of type 1 or type 2 error. Robust evidence (level 1 with high certainty) suggests that in an elective setting with uncomplicated cholelithiasis as indication for cholecystectomy, three-port laparoscopic cholecystectomy is comparable with the four-port technique in terms of procedural and morbidity outcomes and may be associated with less postoperative pain, shorter length of hospital stay and shorter time to return to normal activities.
  • Impact of thermo-mechanical skin treatment on refraction and keratometry in patients with dry eye disease and the implications for cataract surgery

    Blanco-Vázquez, Marta; Gil-Cazorla, Raquel; Barua, Ankur; Taneja, Mukesh; Hanneken, Ludger; Shah, Sunil; Barua, Ankur; Shah, Sunil; Ophthalmology; Medical and Dental; et al. (Elsevier, 2024-04-08)
    Purpose: To determine the changes in keratometry measurements and refraction in patients having the thermo-mechanical periorbital skin treatment, Tixel®, to treat dry eye disease (DED). Methods: A multi-centre, prospective, non-masked study was conducted. DED patients were recruited in 3 international centres and were evaluated in 5 visits separated by an interval of 2 weeks except for the last visit which took place after 18 weeks from visit 1. The same clinical examination was performed at all visits: OSDI questionnaire, tear stability, keratometry, best corrected visual acuity and refraction. Tixel® treatment was applied at the first 3 visits. Results: 89 participants (24 males/65 females; mean age: 55.0 ± 14.2 years) were included: 20 presented moderate DED symptoms and 69 severe DED symptoms. Significant differences were found for the spherocylindrical refraction (vector analysis) between visit 1 and visits 2 and 3. Following cumulative analysis, 11.86 % and 16.94 % of participants had more than 0.5 dioptre (D) change in mean keratometry and keratometric astigmatism, respectively, at 3 months post-treatment. A total of 5.40 % had a sphere and cylinder change greater than 0.50D and 16.21 % had the axis changed more than 10 degrees (vector analysis). These changes were particularly significant in patients with severe DED symptoms. Conclusions: Keratometry readings and refraction can change following thermo-mechanical skin treatment for DED, especially in those patients with severe DED symptoms. This should be considered as potential errors in intraocular lens calculations may be induced.
  • Outer retinopathies associated with COVID-19 Infection :case reports and review of literature

    Zaheer, Naima; Tallouzi, Mohammad; Kumar, N Ajith; Sreekantam, Sreekanth; Zaheer, Naima; Tallouzi, Mohammad O.; Kumar, N Ajith; Sreekantam, Sreekanth; Ophthalmology; Additional Professional Scientific and Technical Field; et al. (Hindawi, 2024-03-08)
    Background: The coronavirus disease (COVID-19) is a highly contagious disease with profound health implications. It can affect any part of the body with variable severity. Various ophthalmic manifestations of coronavirus disease have been documented. Case Presentations. We reported three cases of outer retinopathies associated with COVID-19 infection. All three patients were young females. The first two patients presented within days of COVID-19 infection with complaints of black spots in the eyes. Multimodal retinal imaging showed lesions consistent with acute macular neuroretinopathy. Lesions were bilateral in the first patient and unilateral in the second one. Our third patient presented with blurred vision in one eye, 3 months after a suspected COVID-19 infection. Retinal imaging showed outer retinopathy. Our patients' vision was good and maintained during the follow-up. All three were monitored on observation only, and symptoms and lesions improved with time. Conclusion: In conclusion, COVID-19-related thromboinflammatory response can result in localized vascular inflammation and hypoperfusion in any of the retinal capillary plexuses or choriocapillaris resulting in ischemia of the corresponding retinal or choroidal layers.
  • Cosmetic contact lenses in the United Kingdom : assessment of online regulation and quality of consumer health information

    Ng, Benjamin; Azzopardi, Matthew; Ditchfield, Alice; Zi, Jin; Logeswaran, Abison; Hawthorne, Imogen; Ting, Darren S J; Chong, Yu Jeat; Ng, Benjamin; Ting, Darren SJ.; et al. (Lippincott, Williams & Wilkins, 2024-03-13)
    Objectives: To determine the compliance of online vendors to the UK Opticians Act 1989 Section 27 requirements and safety regulations for cosmetic contact lens (CCL) sales and the quality of online CCL health information. Methods: The top 50 websites selling CCLs on each three search engines, namely Google, Yahoo, and Bing, were selected. Duplicates were removed, and the remaining websites were systematically analyzed in February 2023. UK legal authorization for CCL sales was assessed using the Opticians Act Section 27 and safety regulations determined by the presence of Conformité Européene (CE) marking. The quality and reliability of online information was graded using the DISCERN (16-80) and JAMA (0-4) scores by two independent reviewers. Results: Forty-seven eligible websites were analyzed. Only six (12.7%) met the UK legal authorization for CCL sales. Forty-nine different brands of CCLs were sold on these websites, of which 13 (26.5%) had no CE marking. The mean DISCERN and JAMA benchmark scores were 26 ± 12.2 and 1.3 ± 0.6, respectively (intraclass correlation scores: 0.99 for both). Conclusions: A significant number of websites provide consumers with easy, unsafe, and unregulated access to CCLs. Most online stores do not meet the requirements set out in the Opticians Act for CCL sales in the United Kingdom. A significant number of CCLs lack CE marking, while the average quality of information on websites selling CCLs is poor. Together, these pose a risk to consumers purchasing CCLs from unregulated websites, and therefore, further stringent regulations on the online sales of these products are needed.

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