Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases

AimTo investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery.MethodsStudy population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations.Results490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (−0.38/+0.04×72), glaucoma (−0.10/+0.05×95), previous vitrectomy (−0.049/+0.03×66) and high myopia (−0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (−0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome.ConclusionPatient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small.

Epidemic (rheumatic) facial nerve palsy

Herzog, (Zeitschr fr die gesamte N. und P. 119 Band. 1929), excluding cases of paralysis n. facialis, as a separate symptom in diseases of the middle ear, brain tumors or luese, as well as in cases of infection with herpes zoster, stops at the group of peripheral lesions n. facialis of an epidemic nature. The symptomatology of this form is characterized by a slight swelling of the skin of the face in front of and under the ear, a slight increase in the area of ​​the salivary glands, and a slight rise in temperature. In some cases, a. finds inflammation of the salivary glands of the mouth, especially gl. parotis, which is often the starting point of facial nerve disease. The author gives 4 cases of paralysis n. facialis observed by him in the same autumn month.

Child-onset Hemifacial Spasm-a case report

BackgroundHemifacial spasm (HFS) is a common cranial nerve disease, with peak onset in the forty to sixty years old and child-onset HFS is rare. HFS brings many negative effects on the physical and mental health of patients. Here, we report a 10-year-old case of primary HFS patient.Case PresentationHere we report an 11-year-old HFS case last for more than 1 year. An 11-year-old girl complained of frequently involuntary twitch in lower eyelid as the girl was 10 years old, then symptom worsen gradually involved right upper lip in recently months. The girl’s daily life was badly influenced. Brain magnetic resonance imaging indicated that AICA compressed right facial nerve. The patient was treated with carbamazepine 200mg per day, and symptom gradually relieve. But bad treatment compliance appeared, and we introduced the advantages and disadvantages of botulinum toxin and MVD to her parents. However, considering the young age, above mentioned options are not considered for the time being. And more observations of medications treatment were needed to guide further treatment.ConclusionChild-onset hemifacial spasm is rare and the case we report is one of the youngest known cases of such disease. For such patients, medication is the first choice, but the exact mechanisms remain to be further explored.

Approach to: Acute vision loss

Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.