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S Sandramouli

Publications and source records attributed to S Sandramouli.

At least 19 recordsLinked to original sources
PubMed2006

Evidence-based practice in acute ophthalmology.

AIM: To study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs). METHODS: The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis-intervention pair. Each diagnosis-intervention pair was evaluated and graded to assess the best level of evidence provided. RESULTS: A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, meta-analysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with P<0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials. CONCLUSION: This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.

Adolescent↗
PubMed2006

'Fast-tracking' cancer referrals: application for periocular basal cell carcinoma.

AIM: To study the feasibility of a modified fast-track protocol for periocular basal cell carcinoma (BCC). METHODS: A modified protocol was set up with an aim to examine all periocular BCCs within 6 weeks of referral to our oculoplastic clinic. An audit of this protocol was performed over a 2-year period. RESULTS: A total of 65 patients were referred as a 'possible BCC' over the 2-year period. In all, 32 of these patients were referred by dermatologists (49%), followed by fellow consultant ophthalmologists (20 patients, 31%) and general practitioners (11 patients, 17%). The clinical suspicion in the oculoplastic clinic agreed with the referral diagnosis in 71% (46 of the 65) of patients. This figure was particularly high for referrals from dermatologists (84%). In all, 44 out of the 46 'clinically suspected BCC' underwent surgical excision. Histopathology confirmed BCC in 39 of these 44 patients, a diagnostic accuracy of 89%. Among the subgroup of patients referred by the dermatologists, the largest source of referrals, 24 out of 30 patients that underwent surgical excision had histologically proven BCC; a diagnostic accuracy of 80%. CONCLUSION: Our study shows that the modified fast-track protocol for periocular BCCs is practical and feasible. Such a practice is highly desirable since it prevents a long wait for patients who are aware of a possible malignant periocular lesion.

Basal Cell Carcinoma↗
PubMed2005

Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population.

AIM: To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting. METHODS: All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted. RESULTS: Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR. CONCLUSION: Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.

Adrenergic alpha-Agonists↗
PubMed2005

The consent and counselling of patients for cataract surgery: a prospective audit.

PURPOSE: The aims of ideal preoperative informed consent include educating the patient adequately to enable an autonomous decision to be made without causing undue anxiety. We study how the paternalistic and nonpaternalistic approaches meet this ideal. The influence of the new patient consent forms is also assessed. METHODS: Two cycles of a prospective clinical audit are presented. An assessment of relevant patient knowledge was performed by patient interview. Visual analogue scales were used to quantify patient anxiety. RESULTS: The first cycle, examining a paternalistic approach, demonstrated: 37% of patients understood what a cataract was and 48% understood what surgery involved. 48% misunderstood that cataract surgery was completely risk free. In total, 80% of patients undergoing second eye surgery believed that it was completely risk-free. Average anxiety visual analogue scores (VAS) for cataract surgery were low (2.89). The second cycle, examining the nonpaternalistic approach combined with the implementation of new consent forms showed that, despite more explicit repeated preoperative consent: 39% of patients understood correctly what a cataract was, 28% understood what surgery involved and 43% misunderstood that surgery was completely risk-free. All patients undergoing second eye surgery thought that it was risk-free. The average anxiety VAS for cataract surgery were moderate (5.00). CONCLUSIONS: Both paternalistic and non-paternalistic approaches to informed consent are inadequate in meeting the demands of the ideal informed consent. The new patient consent forms appear to have little effect in influencing patient knowledge about their surgery. Patients undergoing second eye surgery often have an overoptimistic view of cataract surgery.

Aged↗
PubMed2005

Pyogenic granuloma following silicone punctal plugs: report of two cases.

PURPOSE: To report two cases of pyogenic granuloma following silicone punctal plugs. METHODS: Interventional case reports. RESULTS: The authors report two cases of pyogenic granuloma secondary to silicone punctal plugs and their lacrimal sequelae following surgical removal in one case and conservative treatment with removal of the plug alone in another. The former case developed no lacrimal sequelae while the second case developed punctal scarring. Spontaneous loss of plugs was common to both the cases. CONCLUSIONS: Patients with punctal plugs should be informed about plug-related problems and encouraged to report them.

Aged↗
PubMed2003

Use of inhaled nitrous oxide for minor eyelid surgery: a placebo-controlled study.

BACKGROUND: Pain from local anaesthetic injection for minor eyelid surgery can often be severe enough to be the most unpleasant part of the procedure. This study was aimed at assessing the efficacy of 50 : 50 N(2)O/O( 2) (Entonox) in relieving such pain. METHODS: In this randomised placebo-controlled double blind trial, 100 patients were randomised to receive either Entonox or air. Questions regarding pain during the administration of local anaesthetic, discomfort during the procedure and side effects experienced were asked by an investigator who was blinded to the type of gas inhaled. RESULTS: The difference in pain score between the Entonox and control groups was not statistically significant (p = 0.474). The difference in discomfort score between the two groups was also not statistically significant (p = 0.948). More side effects were noted with Entonox than with air (p = 0.003, statistically significant). However, this was not clinically significant. CONCLUSION: Entonox has been used effectively in different specialties for pain relief. However, our study was unable to show this beneficial effect in relieving pain from local anaesthetic injections for minor eyelid surgery.

Administration, Inhalation↗
PubMed2003

The use of botulinum toxin A in the treatment of functional epiphora.

AIM: The purpose of this study was to investigate the hitherto undescribed effects of botulinum toxin A injected into the lacrimal gland in patients with functional epiphora. METHODS: A prospective non-comparative interventional case series study was designed to include patients with functional epiphora who presented to the Oculoplastic unit at the Wolverhampton and Midland Counties Eye Infirmary. Botulinum toxin A (2.5-5 units) was injected into the palpebral lobe of the lacrimal gland on the worst affected side via a transconjunctival approach under topical anaesthesia. Patients underwent a Schirmer test and provided a subjective evaluation of their epiphora symptoms, indoors and outdoors, at baseline and at 1, 4 and 13 weeks after injection. The mean score for symptoms indoors and outdoors was calculated. RESULTS: Fourteen patients agreed to take part in the study. Subjective epiphora scores improved in 8 out of the 11 patients (72.7%) who completed 13 weeks of follow-up. Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient mild ptosis and diplopia were experienced by two patients. CONCLUSION: The results from this small pilot study are encouraging, although larger, controlled trials are needed to assess the optimal dose of BTX-A, its long-term efficacy and safety, and the role of multiple injections.

Adult↗
PubMed2003

Diagnostic accuracy of benign eyelid skin lesions in the minor operation theatre.

PURPOSE: To determine the accuracy of the clinical diagnosis of benign eyelid skin lesions in a minor operation theatre (MOT) setting. METHODS: This study was carried out prospectively over a 6-month period. Subjects attending the minor operation theatre set-up with eyelid skin lesions were assessed and lesions were labelled as benign, pre-malignant or malignant. All patients underwent excision biopsy of the lesion. Histopathologic diagnosis was obtained for each lesion, which was then matched with the respective clinical diagnosis. The Diagnostic Accuracy (DA) was calculated for benign lesions using the formula proposed by Lightstone et al. RESULTS: Two hundred eyelid skin lesions from 183 consecutive patients were included in the study. Clinically, 187 lesions were labelled as benign, 12 as malignant and 1 as pre-malignant. The histopathologic report matched with the clinical diagnosis in 192 cases (96%). However, incorrect diagnoses included 3 malignant and 3 pre-malignant lesions that were labelled as benign clinically. The DA for benign lesion was 95.7%. CONCLUSION: Histopathologic confirmation may be necessary for most cases in the MOT.

Adolescent↗
PubMed2002

Ocular surface squamous neoplasia: report of an unusual case and review of the literature.

OBJECTIVE: To describe a case of leukoplakia and underlying intraepithelial squamous cell neoplasia of the palpebral conjunctiva presenting in a patient wearing an ocular prosthesis. METHODS: The clinical presentation, histopathological findings and surgical outcome are described in a 62-year-old man in whom leukoplakic lesions of the palpebral conjunctiva in a socket fitted with an ocular prosthesis were noted in addition to squamous cell carcinoma of the lower lid skin. RESULTS: Histopathological examination revealed islands of squamous cell carcinoma in the skin lesion and squamous cell carcinoma-in-situ in the leukoplakic conjunctival specimen. Successful tumour excision and lid reconstruction were performed. CONCLUSION: This report highlights the successful treatment of long-standing conjunctival squamous cell carcinoma-in-situ associated with an ocular prosthesis and a general tendency to pre-neoplastic lesions of the skin. Regular examination of the sockets of patients wearing long-standing ocular prostheses is recommended.

Carcinoma in Situ↗
PubMed1998

The association between the oculocardiac reflex and post-operative vomiting in children undergoing strabismus surgery.

The oculocardiac reflex (OCR) is a potentially serious complication of ophthalmic surgery which is most commonly elicited during paediatric strabismus surgery. Post-operative vomiting (POV) is also extremely common after such procedures and may result in admission following planned day-case surgery. Although many factors play a part in the occurrence of POV, stimulation of the trigemino-vagal reflex arc is thought to explain the particularly high rate of vomiting after strabismus surgery. The OCR and the vaso-vagal response share this neuronal pathway, the bradycardia of the OCR often being the only objective feature of the vaso-vagal response while the patient is anaesthetised. The aim of this study was to investigate the possible association between the occurrence of the OCR and subsequent POV in children undergoing strabismus surgery. We have studied this relationship in 79 children, aged between 1 and 13 years, undergoing strabismus surgery under standardised anaesthetic conditions. A positive OCR was regarded as a drop in heart rate of 10% or more, or the onset of a dysrhythmia. An intraoperative OCR was elicited in 51 (64.6%) of the 79 children, whilst 29 (36.7%) developed POV in the subsequent 24 h period. There was a significant association between a positive intraoperative OCR and POV (p = 0.01): children with a positive OCR were 2.6 times more likely to vomit than those without the reflex. We conclude that there is an association between the occurrence of the OCR and POV and discuss possible preventive strategies.

Adolescent↗