PubMed Health⌕ Search

Biomedical subjects

G R Kirkby

Publications and source records attributed to G R Kirkby.

At least 19 recordsLinked to original sources
PubMed2000

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy.

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.

Adolescent↗
PubMed1999

The posterior vitreous detachment clinic: do new retinal breaks develop in the six weeks following an isolated symptomatic posterior vitreous detachment?

PURPOSE: Symptomatic posterior vitreous detachment (PVD) is sometimes associated with sight-threatening retinal tears or retinal detachment. Patients are usually reviewed twice because it is believed that retinal breaks may develop within 6 weeks of a PVD and as such the management of a PVD consumes significant resources. The aim of this study was to find the frequency of retinal breaks developing within 6 weeks of an isolated PVD using the same experienced examiner at both visits. METHOD: Patients presenting to the eye casualty with symptomatic PVD were examined by the casualty staff. Those with a retinal break or retinal detachment were referred directly for treatment and those with only a PVD were seen within 8 days in the PVD clinic. They were examined by a vitreo-retinal Fellow using indirect ophthalmoscopy and a 20 D lens with scleral indentation. The position and nature of any retinal abnormalities were noted and compared with those described in the casualty notes. Those with sight-threatening breaks were referred for treatment and the remainder were reviewed 5 weeks later when the presence of any new breaks was noted. RESULTS: One hundred and seven patients were referred to the PVD clinic over a 6-month period, of whom 2 did not have a PVD. At the first visit to the PVD clinic 6 patients had round holes anterior to the equator, 2 had equatorial horseshoe tears and 1 had lattice with holes. At the second visit, 2 additional patients had round holes anterior to the equator but in both the retina had been obscured by vitreous haemorrhage at the first visit. No patient in whom a full examination was possible at the first visit developed further retinal pathology. CONCLUSION: These results demonstrate the need to perform a full examination of the peripheral retina with scleral indentation at the time of presentation and emphasise the importance of finding a vitreous haemorrhage following a symptomatic PVD. If no retinal breaks are detected by thorough examination at presentation, further reviews, in the absence of increasing symptoms, may not be necessary.

Adult↗
PubMed1999

Biometry of the silicone oil-filled eye.

PURPOSE: The advent of silicone oil tamponade has resulted in improved success rates in complicated retinal detachment surgery. Its use, however, can induce cataract formation in phakic eyes. In selected patients, removal of silicone oil can be combined with phacoemulsification of the cataract and intraocular lens (IOL) implantation, thus avoiding a further operation. This, however, poses a problem when trying to decide the power of IOL to be used, since the echographically measured axial length (AL) of an eye is greater in the presence of silicone oil. We performed ultrasound examination in the presence of silicone oil of viscosity 1300 centistokes, in order to determine whether the measured AL varied from the true AL by a constant factor. METHODS: The ALs of 7 phakic eyes were measured by A-mode echography, with and without silicone oil of viscosity 1300 centistokes in the posterior segment. The retina was attached in all cases. The control group consisted of 6 phakic eyes with attached retinae undergoing vitrectomy without the use of silicone oil. The ALs in the control group were measured before and after vitrectomy. RESULTS: The mean ratio of true AL to measured AL in the presence of silicone oil was 0.71 (standard deviation 0.01; range 0.70-0.73; median 0.71) in the 7 eyes in this study. In the control group, vitrectomy appeared to have no significant effect on AL. CONCLUSIONS: We have established a constant which corrects for the apparent increase in AL induced by silicone oil of viscosity 1300 centistokes. This conversion factor, when used in existing biometry formulae (SRK/T), allows estimation of the power of IOL required in eyes undergoing combined cataract extraction, removal of silicone oil and lens implantation.

Biometry↗
PubMed1998

The role of ophthalmic triage and the nurse practitioner in an eye-dedicated casualty department.

PURPOSE: To evaluate the appropriateness of triage decisions in a busy ophthalmic casualty department and to assess the diagnostic and management skills of eye-dedicated nurse practitioners. METHODS: Three hundred and one consecutive patients attending the Birmingham and Midland Eye Centre (BMEC) accident and emergency (A&E) department over a 2 week period were included in this prospective study. Patients were categorised in terms of urgency in concordance with strict guidelines, and the agreement between the final diagnosis and this system of prioritisation was then investigated. To evaluate nurse practitioner (NP) skills, all patients seen and managed by a NP were also assessed by the most senior doctor in casualty at the time in a masked fashion. Waiting times and a breakdown of waiting times were also calculated. RESULTS: Upon establishment of a diagnosis, triage category allocation was found to be appropriate in all 301 cases. Fifty patients (16.67%) were seen by the NP. Of these the supervising doctor concurred with the NP diagnosis in all cases and with the proposed management in 96% of cases. The mean waiting time (+/- SD) was 83.43 +/- 45.84 min, with a range of 5-335 min. The delay before being attended to was greater for less urgent cases as categorised by the triage system. CONCLUSION: This study confirms the high standard of diagnostic and management skills of the ophthalmic NP and indicates that the triage system of patient prioritisation is accurate. Waiting times in the A&E department remain unacceptable and ways of addressing this include improved ophthalmic training of general practitioners, diverting a greater proportion of non-acute cases to the primary care clinic and expanding the role of the NP.

Adolescent↗
PubMed1998

Simultaneous posterior chamber intraocular lens implant combined with vitreoretinal surgery for intraocular foreign body injuries.

UNLABELLED: To evaluate the safety of simultaneous posterior chamber intraocular lens (IOL) implant combined with complex vitreoretinal surgery for ocular trauma due to intraocular foreign body (IOFB). METHODS: We undertook a retrospective analysis of 10 patients who had undergone simultaneous cataract extraction, vitreoretinal surgery, removal of IOFB and posterior chamber IOL implant, for ocular trauma due to IOFB. The visual outcome and complications were noted. The surgical procedure is described. RESULTS: Ten young, male patients were followed for 5-30 months post-operatively. The post-operative visual acuity in the operated eye remained the same or improved as compared with their pre-operative vision. Eight patients had a visual acuity of 6/9 or better. One patient developed post-operative infective endophthalmitis. Three patients had retinal detachment post-operatively. The IOL was stable in all patients. CONCLUSIONS: Simultaneous posterior chamber IOL implant with vitreoretinal surgery is safe in selected cases of severe ocular trauma due to IOFB. It allows early visual rehabilitation of young, working patients.

Adult↗
PubMed1996

Ocular perforation during peribulbar anaesthesia.

Six cases of ocular perforation after peribulbar anaesthesia are reported. They were referred to our vitreoretinal unit from other hospitals over a 6 week period. Some recent reports of ocular perforation with peribulbar anaesthesia suggest a good prognosis. In this series all six required surgical intervention and most cases associated with a retinal detachment had a poor outcome. This study highlights the dangers of ocular perforation and emphasises the need for supervised training of peribulbar anaesthesia and early referral should ocular perforation occur.

Aged↗
PubMed1996

A survey of ocular perforation during ophthalmic local anaesthesia in the United Kingdom.

A survey of local anaesthetic related ocular perforation in the United Kingdom is reported. A total of 531 consultant ophthalmologists were sent a postal questionnaire and there was a 71% response rate. Thirty respondents reported 39 perforations occurring under their care during the previous year. Details of the cases are presented. The rate of local anaesthetic related ocular perforation is higher than in previous reported series. Efforts to reduce the incidence will require consideration of alternative techniques, audit, and training.

Anesthesia, Local↗
PubMed1996

Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic.

We report a case of bilateral endogenous Escherichia coli endophthalmitis in an insulin-dependent diabetic. This condition appears to occur almost exclusively in diabetics, and is invariably related to a urinary tract infection. Treatment of any infection in diabetics should be aggressive, and any deterioration in vision should be addressed promptly.

Diabetes Mellitus, Type 1↗
PubMed1995

Ocular protection in squash clubs: time for a change?

All squash clubs in the West Midlands were surveyed by postal questionnaire to determine their level of awareness to the risk of ocular injury. Of the 100 clubs surveyed, 51 questionnaires were returned. None of the clubs responding had any information warning of the potential hazards of ocular injury. Thirteen of the clubs had sporting goods shops; of these, three sold protective eye-wear. Significantly, all three stocked the open or lenseless type of eye-guard and only one had the guards with impact-resistant plastic lenses. The majority of clubs (96%) expressed a desire for further information. It is concluded that: (1) players are not warned of the hazards of playing without appropriate eye protection, (2) hazardous eye-guards (open type) continue to be sold, and (3) there is a desire to improve the safety of the sport.

Eye Injuries↗
PubMed1994

Previously undiagnosed lymphoma presenting as recurrent dacryocystitis.

Lymphoma occurring in the lacrimal sac is uncommon and usually occurs in patients with known systemic disease. We report the case of an 82-year-old woman who presented with recurrent right dacryocystitis and a mass in the left lower eyelid. The results of the biopsy of the eyelid and fine-needle aspiration of the swelling arising from the lacrimal fossa demonstrated low-grade B-cell non-Hodgkin's lymphoma. This unusual presentation and the histopathological features are described.

Aged↗