The PAUL Glaucoma Implant in the management of uveitic glaucoma-3-year follow-up.

Background/objectives: Evaluate the mid-term outcomes of the PAUL Glaucoma Implant (PGI) in the management of uveitic glaucoma.

Subjects/methods: This was a single-centre, multi-surgeon, retrospective analysis of 50 consecutive cases of PGI for uveitic glaucoma performed between April 2019 and August 2021. Primary outcomes include: complete and qualified success (IOP ≥5 mmHg to ≤21 mmHg with ≥20% IOP reduction) or failure (IOP exceeding the success criteria, additional glaucoma procedures, no perception of light vision).

Deprivation and NHS General Ophthalmic Service sight testing activity in England in 2022-2023.

Purpose: Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England.

Methods: Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing.

Glaucoma treatment and deprivation: time-series analysis of general practice prescribing in England.

Background: Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care.

Aim: To explore PGA prescribing in general practice over a 6-year timeline, assessing associations with deprivation.

Providing capacity in glaucoma care using trained and accredited optometrists: A qualitative evaluation.

Introduction: The role of optometrists in glaucoma within primary and secondary care has been well described. Whilst many studies examined safety and clinical effectiveness, there is a paucity of qualitative research evaluating enablers and barriers for optometrists delivering glaucoma care. The aims of this study are to investigate qualitatively, and from a multi-stakeholder perspective whether optometric glaucoma care is accepted as an effective alternative to traditional models and what contextual factors impact upon their success.

The PAUL® glaucoma implant: 1-year results of a novel glaucoma drainage device in a paediatric cohort.

Purpose: The PAUL® glaucoma implant (PGI) is a novel glaucoma drainage device, which has not been previously reported in paediatric glaucoma management. This study aims to evaluate the safety and effectiveness of the PGI in a paediatric cohort.

Methods: A retrospective evaluation of 25 cases of paediatric PGI surgery (age 8 months to 16 years) was performed at Manchester Royal Eye Hospital between September 2019 and July 2020.

High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy.

Purpose: To present a case of severe retinal toxicity secondary to high dose intracameral cefuroxime administered during trabeculectomy glaucoma surgery. We describe the clinical features and management, and describe serial multimodal imaging and electrophysiological findings. Intracameral cefuroxime (ICC) and subconjunctival cefuroxime (SCC) are routinely administered during ocular surgeries to prevent postoperative endophthalmitis.

Surgical technique, perioperative management and early outcome data of the PAUL® glaucoma drainage device.

Objectives: To describe a surgical technique and early post-operative outcomes for a novel glaucoma drainage device-the PAUL® glaucoma implant (PGI).

Methods: A consecutive cohort study of subjects who had PGI surgery between February 2019 and May 2020 with a minimum of 6-month follow-up. Primary outcome measures included failure (intraocular pressure (IOP) > 21 mmHg or a <20% reduction of IOP, removal of the implant, further glaucoma intervention or visual loss to no light perception).

Outcomes of Primary Trabeculectomy From Two Same-centre Cohorts 10 Years Apart.

Precis: Trabeculectomy can effectively lower intraocular pressure (IOP). A more junior surgeon profile is emerging. Mitomycin C (MMC) has replaced 5-fluorouracil (5-FU) intraoperatively with comparable success rates and a decrease in postoperative antimetabolite administration.

Trabeculectomy Training: Review of Current Teaching Strategies.

The aim of this paper is to introduce readers to potential strategies available for teaching trabeculectomy surgery. Trainee surgical outcomes and various surgical simulation techniques are discussed, with suggestions on how to measure progress and consideration of relevant educational theories.

Spontaneous Resolution of a Rapidly Formed Dense Cataract Following Nd: YAG Laser Peripheral Iridotomy in a Case of Pigmentary Glaucoma.

A 54-year-old man was referred for a senior opinion. His vision had acutely dropped in his right eye from 6/6 to hand movements following Nd:YAG laser peripheral iridotomy for treatment of pigmentary glaucoma. A dense rosette posterior subcapsular cataract had formed in his right eye rapidly after surgery.

Clinical utility of genetic testing in 201 preschool children with inherited eye disorders.

Purpose: A key property to consider in all genetic tests is clinical utility, the ability of the test to influence patient management and health outcomes. Here we assess the current clinical utility of genetic testing in diverse pediatric inherited eye disorders (IEDs).

Methods: Two hundred one unrelated children (0-5 years old) with IEDs were ascertained through the database of the North West Genomic Laboratory Hub, Manchester, UK.

Care pathways for glaucoma detection and monitoring in the UK.

Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways.

Impact of the Manchester Glaucoma Enhanced Referral Scheme on NHS costs.

Objectives: Glaucoma filtering schemes such as the Manchester Glaucoma Enhanced Referral Scheme (GERS) aim to reduce the number of false positive cases referred to Hospital Eye Services. Such schemes can also have wider system benefits, as they may reduce waiting times for other patients. However, previous studies of the cost consequences and wider system benefits of glaucoma filtering schemes are inconclusive.

Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management: A Comparative Laboratory Study.

Aim: Concerns regarding 5-Fluorouracil (5-FU) corneal toxicity have resulted in various ways of reducing its corneal exposure during post-operative trabeculectomy bleb manipulation. This study investigates the properties of various topical agents used to induce the precipitation of this compound.

Materials And Methods: This is a double-blind, descriptive, laboratory study comparing five different potential precipitants of 5-FU (proxymetacaine (proxy), oxybuprocaine (oxy), ametho-caine (ameth), fluorescein (flor), proxymetacaine + fluorescein (proxy-flor) to a control group (normal saline).

Clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme.

Background: Glaucoma referral filtering schemes have operated in the UK for many years. However, there is a paucity of data on the false-negative (FN) rate. This study evaluated the clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme (GERS), estimating both the false-positive (FP) and FN rates.

Long-Term Outcomes and Complications of Baerveldt Glaucoma Drainage Implants in Adults with Glaucoma Secondary to Uveitis.

This study investigated the efficacy and safety of Baerveldt glaucoma implants (BGI) in adults with uveitic glaucoma (UG) at the Manchester Uveitis Clinic. This was a retrospective study of 42 patients with UG who underwent BGI implantation between 2006 and 2015. Primary outcome measures were intraocular pressure (IOP) reduction and number of medications at 5-year follow-up.

Incidence, management and outcome of raised intraocular pressure in childhood-onset uveitis at a tertiary referral centre.

Background/aims: To investigate the incidence, management and outcome of uveitis and raised intraocular pressure (IOP) in children treated at the Manchester Uveitis Clinic (MUC).

Methods: This was a retrospective, observational study of patients who presented with uveitis under the age of 16 to the MUC from July 2002 to June 2016.

Results: A total of 320 children were included in the study.

Diagnostic Performance and Repeatability of a Novel Game-Based Visual Field Test for Children.

Purpose: To demonstrate utility of a game-based test ("Caspar's Castle") for the detection of visual field defects in children.

Methods: A validity and reliability study was carried out at Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department. We recruited 108 children with no eye pathology (aged 4-12 years) and examined a single eye with the Caspar's Castle system using either normal thresholds or thresholds artificially adapted to recreate defects to assess diagnostic utility.

Trabeculectomy bleb needling and antimetabolite administration practices in the UK: a glaucoma specialist national survey.

Aims: To evaluate, describe and quantify the diversity in postoperative antimetabolite administration and bleb needling practices among glaucoma specialists performing trabeculectomy surgery within the UK and Ireland.

Methods: A cross-sectional online survey was distributed to all consultant glaucoma specialists who are on the United Kingdom and Eire Glaucoma Society (UKEGS) contact list. Participants were asked specific questions about their current practices for post-trabeculectomy antimetabolite administration followed by questions directly related to bleb needling procedures.

Development of a Pediatric Visual Field Test.

Purpose: We describe a pediatric visual field (VF) test based on a computer game where software and hardware combine to provide an enjoyable test experience.

Methods: The test software consists of a platform-based computer game presented to the central VF. A storyline was created around the game as was a structure surrounding the computer monitor to enhance patients' experience.