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Theodoropoulou S, Grzeda MT, Donachie PHJ, Johnston RL, Sparrow JM, Tole DM. The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery. Report 5: Clinical outcome and risk factors for posterior capsule rupture and visual acuity loss following cataract surgery in patients aged 90 years and older. Eye (Lond) 2019; 33:1161-1170. [PMID: 30858564 DOI: 10.1038/s41433-019-0389-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/20/2018] [Accepted: 01/25/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Older age is commonly associated with an increased risk of surgical complications and comparatively poor outcomes. PURPOSE To report cataract surgery outcomes and risk indicators for patients aged 90 years and older. METHODS Data collected as part of routine cataract care in 34 centres contributing to the United Kingdom Royal College of Ophthalmologists' National Ophthalmology Database (NOD) were analysed. Very elderly people undergoing cataract surgery were profiled in terms of demographics, pre- and postoperative best-measured visual acuity (VA), ocular co-morbidities, intraoperative posterior capsule rupture (PCR) or vitreous loss or both, and risk indicators for operative PCR and adverse VA outcome. RESULTS 25,856 cataract operations in 19,166 people of 90 years or older between 2000 and 2014 are reported. Preoperative VA was available for 82.4% eyes, being 0.30 LogMAR or better in 21.5%. Postoperative VA was available for 61.8% eyes, being 0.30 LogMAR or better in 74.4%. For those without ocular co-morbidity, postoperative VA was 0.30 LogMAR or better in 84.7%. Various co-morbidities were present in 49% and contributed to an adverse VA outcome. PCR data were available for all operations and occurred in 2.7%. Significant risk indicators for PCR included pseudoexfoliation/phakodonesis, mature cataract, smaller pupil and worse preoperative VA. CONCLUSIONS Slightly poorer cataract surgery outcome results were noted in patients of 90 years or older, more so in patients with ocular co-morbidity which was highly prevalent. However, surgeons should not be deterred from offering cataract surgery to the very elderly as successful visual rehabilitation remains achievable.
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Affiliation(s)
- S Theodoropoulou
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK.,Department of Ophthalmology, Translational Health Sciences, Bristol Medical School, University Walk, BS8 1TD, UK
| | - M T Grzeda
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - P H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN, UK
| | - J M Sparrow
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - D M Tole
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK.
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Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Donovan JL. Cat-PROM5: a brief psychometrically robust self-report questionnaire instrument for cataract surgery. Eye (Lond) 2018. [PMID: 29521952 PMCID: PMC5898878 DOI: 10.1038/eye.2018.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To develop a short, psychometrically robust and responsive cataract patient reported outcome measure suitable for use in high-volume surgical environments. Methods A prospective study in which participants completed development versions of questionnaires exploring the quality of their eyesight using items harvested from two existing United Kingdom developed parent questionnaires. Participants were 822 patients awaiting cataract surgery recruited from 4 cataract surgical centres based in the UK. Exclusion criteria were other visually significant comorbidities and age <50 years. An iterative multi-stage process of evaluation using Rasch and factor analyses with sequential item reduction was undertaken. Results A definitive item set of just five items delivered performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch-based reliability 0.90, person separation 2.98, Cronbach’s α 0.89, good targeting of questions to patients with cataract with pre-operative item mean −0.41 logits and absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality. The test–re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, Cohen’s d −1.45 SD. Rasch calibration values are provided for Cat-PROM5 users. Conclusions A psychometrically robust and highly responsive five-item cataract surgery patient reported outcome measure has been developed, which is suitable for use in high-volume cataract surgical services.
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Affiliation(s)
- J M Sparrow
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - A Loose
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Elliott D, Donovan JL. Cataract surgery patient-reported outcome measures: a head-to-head comparison of the psychometric performance and patient acceptability of the Cat-PROM5 and Catquest-9SF self-report questionnaires. Eye (Lond) 2018; 32:788-795. [PMID: 29386619 PMCID: PMC5898871 DOI: 10.1038/eye.2017.297] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery is the most frequently undertaken NHS surgical procedure. Visual acuity (VA) provides a poor indication of visual difficulty in a complex visual world. In the absence of a suitable outcome metric, recent efforts have been directed towards the development of a cataract patient-reported outcome measure (PROM) of sufficient brevity, precision, and responsiveness to be implementable in routine high volume clinical services. Aim To compare and contrast the two most promising candidate PROMs for routine cataract surgery. Method The psychometric performance and patient acceptability of the recently UK developed five-item Cat-PROM5 questionnaire was compared with the English translation of the Swedish nine-item Catquest-9SF using Rasch-based performance metrics and qualitative semistructured interviews. Results Rasch-based performance was assessed in 822 typical NHS cataract surgery patients across four centres in England. Both questionnaires demonstrated good to excellent performance for all metrics assessed, including Person Reliability Indices of 0.90 (Cat-PROM5) and 0.88 (Catquest-9SF), responsiveness to surgery (Cohen’s standardized effect size) of 1.45 SD (Cat-PROM5) and 1.47 SD (Catquest-9SF) and they were highly correlated with each other (R=0.85). Qualitative assessments confirmed that both questionnaires were acceptable to patients, including in the presence of ocular comorbidities. Preferences were expressed for the shorter Cat-PROM5, which allowed patients to map their own issues to the questions as opposed to the more restrictive specific scenarios of Catquest-9SF. Conclusion The recently UK developed Cat-PROM5 cataract surgery questionnaire is shorter, with performance and patient acceptability at least as good or better than the previous ‘best of class’ Catquest-9SF instrument.
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Affiliation(s)
- J M Sparrow
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
| | - A Loose
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - D Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
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Shayeghi A, Schäfer R, Rayner DM, Johnston RL, Fielicke A. Charge-induced dipole vs. relativistically enhanced covalent interactions in Ar-tagged Au-Ag tetramers and pentamers. J Chem Phys 2015; 143:024310. [PMID: 26178108 DOI: 10.1063/1.4923255] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Vibrational spectra of Au(n)Ag(m)(+)⋅Ar(k) (n + m = 4, 5; k = 1-4) clusters are determined by far-infrared resonant multiple photon dissociation spectroscopy in the range ν̃=100-250 cm(-1). The experimental spectra are assigned using density functional theory for geometries obtained by the Birmingham cluster genetic algorithm. Putative global minimum candidates of the Ar complexes are generated by adding Ar atoms to the Au(n)Ag(m)(+) low energy isomers and subsequent local optimization. Differential Ar binding energies indicate exceptionally strong Au-Ar bonds in Au-rich clusters, leading to fundamental changes to the IR spectra. The stronger Ar binding is attributed to a relativistically enhanced covalent character of the Au-Ar bond, while in Au-rich species charge-induced dipole interactions overcompensate the relativistic affinity to Au. Moreover, not only the absolute composition but also the topologies are essential in the description of Ar binding to a certain cluster.
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Affiliation(s)
- A Shayeghi
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
| | - R Schäfer
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
| | - D M Rayner
- National Research Council of Canada, 100 Sussex Drive, Ottawa, Ontario K1A 0R6, Canada
| | - R L Johnston
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - A Fielicke
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Hardenbergstrasse 36, 10623 Berlin, Germany
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Day AC, Donachie PHJ, Sparrow JM, Johnston RL. The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery: report 2, relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture. Eye (Lond) 2015; 29:1528-37. [PMID: 26493034 DOI: 10.1038/eye.2015.198] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/11/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To describe the relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture rates in patients undergoing cataract surgery.DesignThe Royal College of Ophthalmologists' National Ophthalmology Database (NOD) study. METHODS Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Data parameters included: demographics, biometry, ocular copathology, visual acuity measurements, and surgical complications including posterior capsule rupture, or vitreous loss or both (PCR). RESULTS Consultant surgeons performed a higher proportion of operations on eyes whose axial length were at the extremes. Glaucoma and age related macular degeneration were more common in eyes with shorter axial lengths, whilst previous vitrectomy was associated with longer axial lengths. Eyes with brunescent or white cataracts or amblyopia were more common at both axial length extremes. Preoperative visual acuities were similar for eyes with axial length measurements up to approximately 28 mm and worse for eyes with longer axial length measurements. PCR rates showed little change with axial length (overall mean 1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of ≥20.0 mm (P=0.0373). CONCLUSION Rates of ocular comorbidities vary by axial length. PCR rates in eyes with very short or long axial lengths were lower than expected.
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Affiliation(s)
- A C Day
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - P H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Database, Euston, London, UK.,Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - J M Sparrow
- The Royal College of Ophthalmologists' National Ophthalmology Database, Euston, London, UK.,Bristol Eye Hospital, Bristol, Bristol, UK
| | - R L Johnston
- The Royal College of Ophthalmologists' National Ophthalmology Database, Euston, London, UK.,Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Kelly S, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29:721-31. [PMID: 25882328 DOI: 10.1038/eye.2015.48] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient's age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and 'recalcitrant' n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.
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Affiliation(s)
- W M Amoaku
- Division of Clinical Neurosciences, Department of Ophthalmology, Academic Ophthalmology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, and the Royal Victoria Hospitals Trust, Belfast, UK
| | - R Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Gavin
- Department of Ophthalmology, Gartnavel Hospital, NHSGG, Glasgow, UK
| | - F Ghanchi
- Department of Ophthalmology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - J Gibson
- Department of Ophthalmology, School of Life and Health Sciences, Aston University and Heart of England NHS Foundation Trust, and Birmingham and Midland Eye Centre Birmingham, Birmingham, UK
| | - S Harding
- Department of Ophthalmology, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK
| | - R L Johnston
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - S Kelly
- Department of Ophthalmology, Royal Bolton Hospital, Bolton, UK
| | - A Lotery
- Department of Ophthalmology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mahmood
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Hospitals Foundation Trust, Manchester, UK
| | - G Menon
- Department of Ophthalmology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - S Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - J Talks
- Department of Ophthalmology, Newcastle University Hospirtals NHS Trust, Newcastle, UK
| | - A Tufail
- Department of Ophthalmology, Moorfields Hospital NHS Trust, London, UK
| | - Y Yang
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Shayeghi A, Götz D, Davis JBA, Schäfer R, Johnston RL. Pool-BCGA: a parallelised generation-free genetic algorithm for the ab initio global optimisation of nanoalloy clusters. Phys Chem Chem Phys 2014; 17:2104-12. [PMID: 25482360 DOI: 10.1039/c4cp04323e] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Birmingham cluster genetic algorithm is a package that performs global optimisations for homo- and bimetallic clusters based on either first principles methods or empirical potentials. Here, we present a new parallel implementation of the code which employs a pool strategy in order to eliminate sequential steps and significantly improve performance. The new approach meets all requirements of an evolutionary algorithm and contains the main features of the previous implementation. The performance of the pool genetic algorithm is tested using the Gupta potential for the global optimisation of the Au10Pd10 cluster, which demonstrates the high efficiency of the method. The new implementation is also used for the global optimisation of the Au10 and Au20 clusters directly at the density functional theory level.
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Affiliation(s)
- A Shayeghi
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany.
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Shayeghi A, Johnston RL, Schäfer R. Communication: Global minimum search of Ag 10+ with molecular beam optical spectroscopy. J Chem Phys 2014; 141:181104. [DOI: 10.1063/1.4901109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- A. Shayeghi
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
| | - R. L. Johnston
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - R. Schäfer
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
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Abstract
We present experimental and theoretical studies of the optical response of mixed Ag(n)Au(+)(4-n) (n=1-3) clusters in the photon energy range ℏω = 1.9-3.5 eV. Absorption spectra are recorded by a newly built longitudinal molecular beam depletion spectroscopy apparatus providing lower limits to absolute photodissociation cross sections. The experimental data are compared to optical response calculations in the framework of long-range corrected time-dependent density functional theory with initial cluster geometries obtained by the unbiased Birmingham Cluster Genetic Algorithm coupled with density functional theory. Experiments and excited state calculations shed light on the structural and electronic properties of the mixed Ag-Au tetramer cations.
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Affiliation(s)
- A Shayeghi
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
| | - C J Heard
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - R L Johnston
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - R Schäfer
- Eduard-Zintl-Institut, Technische Universität Darmstadt, Alarich-Weiss-Straße 8, 64287 Darmstadt, Germany
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Götz DA, Shayeghi A, Johnston RL, Schwerdtfeger P, Schäfer R. Influence of spin-orbit effects on structures and dielectric properties of neutral lead clusters. J Chem Phys 2014; 140:164313. [DOI: 10.1063/1.4872369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bruma A, Negreiros FR, Xie S, Tsukuda T, Johnston RL, Fortunelli A, Li ZY. Direct atomic imaging and density functional theory study of the Au24Pd1 cluster catalyst. Nanoscale 2013; 5:9620-9625. [PMID: 23764617 DOI: 10.1039/c3nr01852k] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this study we report a direct, atomic-resolution imaging of calcined Au24Pd1 clusters supported on multiwall carbon nanotubes by employing aberration-corrected scanning transmission electron microscopy. Using gold atoms as mass standards, we confirm the cluster size to be 25 ± 2, in agreement with the Au24Pd1(SR)18 precursor used in the synthesis. Concurrently, a Density-Functional/Basin-Hopping computational algorithm is employed to locate the low-energy configurations of free Au24Pd1 cluster. Cage structures surrounding a single core atom are found to be favored, with a slight preference for Pd to occupy the core site. The cluster shows a tendency toward elongated arrangements, consistent with experimental data. The degree of electron transfer from the Pd dopant to Au is quantified through a Löwdin charge analysis, suggesting that Pd may act as an electron promoter to the surrounding Au atoms when they are involved in catalytic reactions.
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Affiliation(s)
- A Bruma
- Nanoscale Physics Research Laboratory, School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Shayeghi A, Johnston RL, Schäfer R. Evaluation of photodissociation spectroscopy as a structure elucidation tool for isolated clusters: a case study of Ag4+ and Au4+. Phys Chem Chem Phys 2013; 15:19715-23. [DOI: 10.1039/c3cp52160e] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Götz DA, Heiles S, Johnston RL, Schäfer R. Note: Gas phase structures of bare Si8 and Si11 clusters from molecular beam electric deflection experiments. J Chem Phys 2012; 136:186101. [DOI: 10.1063/1.4717708] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Kumar CM, Eke T, Dodds C, Deane JS, El-Hindy N, Johnston RL, Kong KL, McLure HA, Shah P, Tighe SQM, Vohra SB. Local anaesthesia for ophthalmic surgery--new guidelines from the Royal College of Anaesthetists and the Royal College of Ophthalmologists. Eye (Lond) 2012; 26:897-8. [PMID: 22538216 DOI: 10.1038/eye.2012.82] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
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Tran DT, Jones IP, Preece JA, Johnston RL, Deplanche K, Macaskie LE. Configuration of microbially synthesized Pd-Au nanoparticles studied by STEM-based techniques. Nanotechnology 2012; 23:055701. [PMID: 22236722 DOI: 10.1088/0957-4484/23/5/055701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Bimetallic Pd-Au particles synthesized using Desulfovibrio desulfuricans bacteria are characterized using scanning transmission electron microscopy (STEM) with a high-angle annular dark field (HAADF) detector combined with energy dispersive x-ray (EDX) silicon drift detector (SDD) elemental mapping and plasmon electron energy-loss spectroscopy (EELS). When combined with EDX, theoretical considerations or EELS, the atomic-number contrast (Z-contrast) provided by HAADF-STEM is effective in characterizing the compositional configuration of the bimetallic nanoparticles. Homogeneous mixing and complex segregations have been found for different particles in this work. The EELS study has also found different behaviours corresponding to surface plasmon resonances in different regions of a single particle due to its heterogeneity and anisotropy. HAADF-STEM tomography has been performed to obtain three-dimensional (3D) visualization of the nanoparticles.
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Affiliation(s)
- D T Tran
- School of Metallurgy and Materials, University of Birmingham, Birmingham B15 2TT, UK
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Sallam A, Scanlon PH, Stratton IM, Jones V, Martin CN, Brelen M, Johnston RL. Agreement and reasons for disagreement between photographic and hospital biomicroscopy grading of diabetic retinopathy. Diabet Med 2011; 28:741-6. [PMID: 21342245 DOI: 10.1111/j.1464-5491.2011.03273.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To compare agreement level and identify reasons for disagreement between grading of mydriatic digital photographs in a diabetic retinopathy screening service and hospital eye service biomicroscopy grading. METHODS Structured examination findings leading to automatically calculated National Screening Committee grades recorded on an electronic medical record system in the hospital eye service at the first clinic visit after diabetic retinopathy screening service referral between April 2006 and November 2007 were retrospectively compared with the grade at the screening visit that prompted referral. In cases of disagreement, screening images were reviewed. RESULTS Data on 452 eyes (226 patients) were analysed. For retinopathy, hospital eye service slit-lamp biomicroscopy grades were: R0 (no diabetic retinopathy) in 63 eyes; R1 (background retinopathy) in 251 eyes; R2 (pre-proliferative) in 129 eyes and R3 (proliferative) in nine eyes. Diabetic retinopathy screening service grades were in agreement in 350 eyes (77.4%), showed a lower grade in 59 eyes and a higher grade in 43. Agreement was moderate (κ=0.60). The most common reason for disagreement was overgrading of R1 by clinicians. Hospital eye service biomicroscopy maculopathy grades were: M0 (no maculopathy) in 366 eyes and M1 (maculopathy) in 86 eyes. Diabetic retinopathy screening service grades were in agreement in 327 eyes (72.3%), showed a lower grading in five eyes and a higher grade in 120 eyes. Agreement was moderate (κ=0.41). The commonest cause for disagreement was clinicians failing to identify fine macular exudates. CONCLUSIONS This study of routine clinical services demonstrates moderate agreement between non-medical grading of mydriatic digital retinal photography images and hospital slit-lamp biomicroscopy grading of patients referred with diabetic retinopathy. The majority of errors in grading were attributable to errors by hospital doctors, usually in the direction of under-grading which could be a potential source of clinical risk if treatment is delayed.
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Affiliation(s)
- A Sallam
- Gloucestershire Eye Unit Diabetic Retinal Screening Service, Delancey Hospital, Cheltenham, UK.
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Johnston RL. Responding letter. Eye (Lond) 2010. [DOI: 10.1038/eye.2009.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Johnston RL, Lutzky J, Chodhry A, Barkin JS. Cytotoxic T-lymphocyte-associated antigen 4 antibody-induced colitis and its management with infliximab. Dig Dis Sci 2009; 54:2538-40. [PMID: 19104936 DOI: 10.1007/s10620-008-0641-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 11/12/2008] [Indexed: 12/11/2022]
Abstract
Anti-CTLA-4 antibodies are human monoclonal antibodies previously studied in the treatment of metastatic melanoma (MM). CTLA-4 is an inhibitory receptor on cytotoxic T cells, blockade of which will activate T cells allowing them to attack malignant cells. Normal host cells may also be affected, and immune-mediated enterocolitis can occur. This is a prospective observational study on the use of corticosteroids and infliximab in the treatment of patients with immune-mediated colitis secondary to anti-CTLA-4 antibody treatment of MM. Five patients presented with colitis after medication administration. Patients were treated with high-dose corticosteroids for 1 week, but diarrhea did not completely abate in any of them. They were then treated successfully with infliximab. One patient had recurrence of symptoms and responded to repeat treatment with infliximab. Patients who develop immune-mediated colitis after administration of anti-CTLA-4 antibodies have previously been reported to respond to corticosteroids, but in our study, all required treatment with infliximab.
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Affiliation(s)
- R L Johnston
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL, USA
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Turner GW, Tedesco E, Harris KDM, Johnston RL, Kariuki BM. A method for understanding characteristics of multi-dimensional hypersurfaces, illustrated by energy and powder profile R-factor hypersurfaces for molecular crystals. ACTA ACUST UNITED AC 2009. [DOI: 10.1524/zkri.216.4.187.23256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
A method is described for determining general sections through multi-dimensional hypersurfaces, in which the values of all the variables that define the hypersurface are allowed to vary simultaneously. The method is general, in the sense that any trajectory through any specified point on the hypersurface may be readily defined. The application of this method is illustrated through a comparison of the energy and powder profile R-factor hypersurfaces for the β phase of L-glutamic acid.
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Knox Cartwright NE, Johnston RL, Jaycock PD, Tole DM, Sparrow JM. The Cataract National Dataset electronic multicentre audit of 55,567 operations: when should IOLMaster biometric measurements be rechecked? Eye (Lond) 2009; 24:894-900. [PMID: 19680278 DOI: 10.1038/eye.2009.196] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Calculation of intraocular lens (IOL) power for implantation during cataract surgery depends on ocular biometric measurements. The aim of this study was to characterise the normal range of intra- and interindividual variation in axial length (AL) and corneal power (K) when IOLMaster measurements were possible and to derive recommendations as to which outlying measurements merit verification before acceptance. METHODS The Medisoft electronic patient database contains prospectively collected data conforming to the United Kingdom (UK) Cataract National Dataset on 55,567 cataract operations. From this AL and K information on the 32,556 eyes (14,016 paired) of patients older than 25 years, without corneal pathology, history of intraocular surgery and who had all biometric measurements taken with the Zeiss IOLMaster (Carl Zeiss Meditec) were extracted. R 2.8.1 (R Foundation for Statistical Computing) was used for statistical analysis. RESULTS Mean age was 76.4 years and 62.0% were female. Mean (95% confidence interval) values for AL, mean K and corneal astigmatism were 23.40 (21.27-26.59) mm, 43.90 (40.94-47.01) D and 1.04 (<2.50) D. Nearly all astigmatism was either with or against the rule. Differences between paired eyes were not statistically significant. 95% individuals had asymmetry of AL and mean K<0.70 mm and 0.92 D, respectively. CONCLUSIONS On the basis of approximation of the 95% CI above, it is suggested that AL, mean K and keratometric astigmatism measurements outside the ranges 21.30-26.60 mm, 41.00-47.00 D and >2.50 D, respectively, and intraindividual asymmetry of AL >0.70 mm or mean K>0.90 D should be verified before acceptance.
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Affiliation(s)
- N E Knox Cartwright
- Department of Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, UK.
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Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Asaria RH, Galloway P, Sparrow JM. The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye (Lond) 2008; 23:31-7. [PMID: 18327164 DOI: 10.1038/sj.eye.6703049] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS To identify and quantify risk factors for posterior capsule rupture or vitreous loss or both (PCR or VL or both) during cataract surgery and provide a method of composite risk assessment for individual operations. METHODS The Cataract National Dataset was extracted on 55,567 operations from 12 National Health Service (NHS) Trusts using an electronic patient record (EPR) system between November 2001 and July 2006. Risk indicators for variations in the rate of 'PCR or VL or both' were identified by univariate and multivariate analyses. Adjusted odds ratios (ORs) were used to formulate a composite 'bespoke' risk for individual cases. RESULTS Overall 'PCR or VL or both' rate was 1.92% (95% CI=1.81-2.04%). Risk indicators for this complication were increasing age, male gender, presence of glaucoma, diabetic retinopathy, brunescent/white cataract, no fundal view/vitreous opacities, pseudo-exfoliation/phacodonesis, reducing pupil size, axial length > or = 26.0 mm, the use of the alpha-blocker doxazosin, inability to lie flat and trainee surgeons performing operations. Adjusted ORs for these variables are used to estimate overall composite risk across multiple risk indicators in the form of a predicted probability of PCR or VL or both. Predicted probability for this complication ranged from less than 0.75% to more than 75%, depending on risk profile of individual operations. CONCLUSIONS Higher-risk cases can be predicted, thus better informing the consent process and allowing surgeons to take appropriate precautions. Case-mix is a major determinant of the probability of an intraoperative complication. A simple composite risk estimation system has been developed.
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Li ZY, Wilcoxon JP, Yin F, Chen Y, Palmer RE, Johnston RL. Structures and optical properties of 4–5 nm bimetallic AgAu nanoparticles. Faraday Discuss 2008; 138:363-73; discussion 421-34. [DOI: 10.1039/b708958a] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE To establish benchmark standards for refractive outcome after cataract surgery in the National Health Service when implementing the 2004 biometry guidelines of the Royal College of Ophthalmologists and customising A constants. METHODS Three cycles of prospective data were collected throughout the cataract care pathway on all patients using an electronic medical record system (Medisoft Ophthalmology), between January 2003 and February 2006. The electronic medical record automatically recommends the formula to be used according to the College guidelines and allows A constants to be customised separately for either ultrasound or partial coherence interferometry methods of axial length measurement and for different intraocular lens models. Consultants and trainees performed routine phacoemulsification cataract surgery and new intraocular lens models were introduced during the cycles. Uncomplicated cases with 'in-the-bag fixation', achieving 6/12 Snellen acuity or better were included. Community ophthalmic opticians performed refraction at 4 weeks. RESULTS The postoperative subjective refraction was within 1 D of the predicted value in 79.7% of the 952 cases in cycle 1, 83.4% of 2406 cases in cycle 2, and 87.0% of 1448 cases in cycle 3. CONCLUSIONS On the basis of our data, using College formula, optimising A constants and partial coherence interferometry, a benchmark standard of 85% of patients achieving a final spherical equivalent within 1 D of the predicted figure and 55% of patients within 0.5 D should be adopted.
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Affiliation(s)
- R P Gale
- Department of Ophthalmology, The Leeds Teaching Hospital NHS Trust, Leeds, West Yorkshire, UK.
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Johnston RL. Adherence to college biometry guidelines. Eye (Lond) 2007. [DOI: 10.1038/sj.eye.6702765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Shah SP, Bunce C, Johnston RL, Laidlaw DAH. Are biometric parameters a risk factor for idiopathic macular hole formation? Results of a matched case-control series. Br J Ophthalmol 2006; 90:117-8. [PMID: 16361683 PMCID: PMC1856877 DOI: 10.1136/bjo.2005.077008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
PURPOSE To determine the change in compliance with the Royal College of Ophthalmologists biometry guidelines since the last National Audit 2 years ago and in particular to quantify the adoption of modern methods of axial length measurement and customization of A constants. METHOD A structured telephone questionnaire of individuals who perform biometry in all eye departments in the United Kingdom. RESULTS A biometrist was interviewed in 94 of the 178 United Kingdom Ophthalmology departments. Compared with 2 years ago, nurses alone perform biometry more frequently (67 vs 51%) and junior doctors less frequently (9 vs 15%). More biometrists now attend external training courses (45 vs 37%). The Royal College of Ophthalmologists recommended intraocular lens calculation formulae (SRK-T, Hoffer Q, and Holladay) are used more commonly (30 and 15%) and audit of prediction error is being performed more frequently (78 vs 71%). The routine use of a partial coherence laser interferometry has increased from 35 to 61% in United Kingdom Ophthalmology departments. Currently, only one United Kingdom department is routinely using immersion ultrasound biometry. 'A' constants are customized in 47% of departments. CONCLUSION Over the last 2 years, there has been improved implementation of the Royal College of Ophthalmologists guidelines on biometry. It is essential that the Royal College of Ophthalmologists guidelines are updated to include current best practice of routine use of partial coherence laser interferometry or immersion biometry and customization of A constants. A benchmark standard of 85-90% of patients achieving a final postoperative refraction within 1 dioptre of the predicted should be established.
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Affiliation(s)
- R P Gale
- Department of Ophthalmology, York Hospital, York, UK
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Abstract
OBJECTIVE To assess the long-term outcome of scleral-fixated sutured posterior chamber intraocular lens (SPCIOL) implantation in non pars plana vitrectomised eyes (1) to evaluate the long-term visual outcome, (2) to identify preoperative risk factors for poor visual outcomes, and (3) to identify the incidence of vitreoretinal complications. METHOD A retrospective review of 65 eyes, which had not undergone pars plana vitrectomy prior to scleral-fixated SPCIOL implantation. RESULTS In all, 65 eyes of 61 patients were analysed. The median follow-up period was 16 months (range 1-68 months). At final follow-up, 43 (66%) eyes had unchanged or improved BCVA at final follow-up. A total of 20 (31%) eyes had at least a two line improvement and eight (12%) eyes had at least a two line deterioration in final BCVA. No significant preoperative risk factors for a poor visual outcome were identified. In all, 24 eyes (37%) had per- and postoperative adverse events. These eyes were significantly more likely to have a poor visual outcome. Three eyes (4.6%) had a retinal detachment in the postoperative period, all of which had no perception of light at final follow-up. CONCLUSIONS This study confirmed that while scleral-fixated SPCIOL intraocular lens implantation might be beneficial, there is a significant risk of per- and postoperative complications leading to loss of best-corrected vision in some eyes.
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Affiliation(s)
- Y F Yang
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK.
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Johnston RL, Sparrow JM, Canning CR, Tole D, Price NC. Pilot National Electronic Cataract Surgery Survey: I. Method, descriptive, and process features. Eye (Lond) 2004; 19:788-94. [PMID: 15375370 DOI: 10.1038/sj.eye.6701644] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM The primary aim of this large pilot survey was to demonstrate the use and benefits of electronic data collection with respect to rapidly monitoring the access, delivery, and outcome of cataract surgery in the NHS and to update benchmark standards for these parameters of care. METHOD Eight NHS departments that currently use specialty-specific electronic clinical systems or Electronic Patient Records (EPR) to collect a minimum preoperative, operative, and anaesthetic data set for cataract surgery agreed to pool their data. RESULTS A total of 162 surgeons from 50 consultant teams and eight NHS Trusts agreed to submit their data on a total of 16,541 operations for age-related cataract. This report describes the age, sex, and ethnic profiles of the patients, waiting time for surgery, ocular copathology causing a reason for a guarded visual prognosis, visual impairment on admission, visual acuity in the operated eye, and the characteristics of the anaesthetic and surgical procedures. CONCLUSIONS This survey has raised the benchmark standards established by the last National Survey in 1997. There has been a near universal switch to day case, phacosurgery under local anaesthesia (all used in > or =99.1% of cases compared with 70, 77, and 86%, respectively in 1997). The visual impairment in the operated eye is lower with 45% having 6 / 12 or better compared with 27% in 1997. Waiting times and visual impairment in the fellow eye have probably improved although data collection for these variables was incomplete. All departments require specialty-specific clinical systems to efficiently collect and analyse these data and this survey proves their potential to form the basis for national electronic surveys in the future.
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Affiliation(s)
- R L Johnston
- Gloucestershire Eye Department, Cheltenham General Hospital, Sandford Road, Cheltenham, UK.
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Abstract
PURPOSE To determine compliance with the Royal College of Ophthalmologists' (RCOphth) biometry guidelines. METHOD A structured telephone questionnaire of individuals who perform biometry in all eye departments in the United Kingdom (UK). RESULTS A biometrist was interviewed in 107 of the UK's 178 eye departments. Nurses alone run the biometry service in 58% of departments, orthoptists alone in 13%, junior doctors alone in 6%, optometrists alone in 3%, and a combination of staff in 20%. Of the staff interviewed, 37% had been on external biometry training courses. One intraocular lens (IOL) calculation formula was used for all eyes in 61% of departments with 17% using the obsolete SRK II formula, 36% of departments used two or more formulae and only 4% adhered to the RCOphth guidelines to use Hoffer Q in eyes with axial lengths <22.0 mm, an average of all three formulae in eyes between 22.0 and 24.5 mm, Holladay in eyes between 24.6 and 26.0 mm, and SRK/T in eyes >26.0 mm. Audit of refractive results was claimed by 71% of units but in only 17 (16%) did the biometrist know the percentage of eyes with a prediction error <or=1 D. CONCLUSION This study demonstrates poor awareness and/or implementation of the RCOphth biometry guidelines and indicates that audits are either not highlighting poor results or are not resulting in a change in practice. The guidelines should be updated to emphasise the importance of customising A constants and to set benchmark standards for prediction error.
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Affiliation(s)
- R P Gale
- Department of Ophthalmology, Addenbrookes Hospital, Cambridge, UK
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Cheung EY, Harris KDM, Johnston RL, Turner GW, Habershon S, Jove A. Interpreting structural motifs of molecular materials by way of crystal structure determination directly from powder diffraction data. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302090669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Harris KDM, Johnston RL, Cheung EY, Turner GW, Habershon S, Jove DA. The development of direct-space techniques for solving crystal structures from powder diffraction data. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302086786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Transcleral suturing of posterior chamber intraocular lenses (IOLs) was developed to extend the benefits of IOL visual rehabilitation to eyes lacking capsular support and to avoid the complications of closed loop interior chamber IOLs. Although most frequently implanted after complicated cataract surgery or penetrating keratoplasty, they are indicated in several situations following pars plana vitrectomy. The surgical techniques have evolved to minimize the risk of complications, but the surgery remains technically more demanding and time-consuming than insertion of a modern open loop anterior chamber IOL. No randomized trials have compared the relative risks of each lens type, which leaves surgeon preference as the major determinant of what lens is implanted. It is likely, however, that in eyes with extensive anterior chamber angle damage or large iris defects, sutured posterior chamber IOLs will remain the first choice for surgical rehabilitation.
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Affiliation(s)
- R L Johnston
- Cheltenham General Hospital, Cheltenham, Gloucestershire, and Moorfields Eye Hospital, London, England.
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Harris KDM, Tedesco E, Johnston RL, Turner GW, Kariuki BM. New Aspects of Direct Space Structure Solution from Powder Diffraction Data. Acta Crystallogr A 2000. [DOI: 10.1107/s0108767300023217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Johnston RL, Charteris DG, Horgan SE, Cooling RJ. Combined pars plana vitrectomy and sutured posterior chamber implant. Arch Ophthalmol 2000; 118:905-10. [PMID: 10900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To describe the surgical technique, visual acuity results, and complications of sutured posterior chamber intraocular lenses with complete pars plana vitrectomy. METHOD A retrospective review of 63 eyes was combined with a telephone survey of the patients and their ophthalmologists. RESULTS The preoperative diagnoses were trauma, 25 eyes; ectopia lentis, 24 eyes; aphakia following retinal detachment surgery, 7 eyes; cataract surgery, 6 eyes; and endophthalmitis, 1 eye. Mean follow-up was 20 months. Preoperative best-corrected visual acuity was 20/40 or better in 36% (23 of 63 eyes), 20/60 to 20/120 in 33% (21 of 63 eyes), and 20/200 or worse in 31% (19 of 63 eyes) improving to 20/40 or better in 76% (48 of 63 eyes), 20/60 to 20/120 in 18% (11 of 63 eyes), and 20/200 or worse in 6% (4 of 63 eyes) at final follow-up. Preoperative complications included iatrogenic retinal breaks in 3 cases, difficulty with a fixation suture in 1 case, and mild vitreous hemorrhage in 1 case. Postoperative complications included retinal detachment in 2 cases, choroidal hemorrhage in 1 case, intermittent pupil capture in 9 cases, self-limiting vitreous hemorrhage in 3 cases, and late intraocular lenses dislocation in 1 case. CONCLUSIONS Suturing a posterior chamber implant concurrently, or following, a complete pars plana vitrectomy is a safe procedure. Complete vitrectomy may reduce the rate of long-term complications. Optimal visual rehabilitation can be achieved without the need for contact lens wear with an acceptable additional risk of surgical complications. Arch Ophthalmol. 2000;118:905-910
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Affiliation(s)
- R L Johnston
- Consultant Vitreoretinal Surgeon, Moorfields Eye Hospital, City Road, London EC1V 2PD, England
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Abstract
PURPOSE To study in vitro protein adsorption to poly(methyl methacrylate) (PMMA) and foldable AcrySof intraocular lenses (IOLs). SETTING Department of Ophthalmology, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, London, United Kingdom. METHODS Poly(methyl methacrylate) (Alcon Surgical, model MC60BM) and AcrySof (Alcon Surgical, model MA60BM) IOLs were incubated in physiological concentrations of radiolabeled albumin or fibronectin at 37 degrees C for periods between 5 minutes and 1 week. The IOLs were removed and rinsed in buffered saline, and the amount of adsorbed protein was calculated by measuring the radioactivity with scintillation spectrometry. RESULTS The adsorption of both proteins occurred rapidly over the first 2 hours; the rate of adsorption was concentration dependent. Quantitative differences were found: PMMA lenses bound significantly greater quantities of albumin. Initial fibronectin adsorption to both materials was similar, but increased adsorption to AcrySof IOLs was found at days 1 and 7. CONCLUSIONS The differences in protein absorption to PMMA and AcrySof IOLs in vitro may contribute to the differences in the biological response to these IOLs, including the lower rates of posterior capsule opacification associated with acrylic lenses.
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Affiliation(s)
- R L Johnston
- Eye Department, St. Thomas' Hospital, London, United Kingdom
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Johnston RL, Seller MJ, Behnam JT, Burdon MA, Spalton DJ. Dominant optic atrophy. Refining the clinical diagnostic criteria in light of genetic linkage studies. Ophthalmology 1999; 106:123-8. [PMID: 9917792 DOI: 10.1016/s0161-6420(99)90013-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the clinical findings and refine the clinical diagnostic criteria for dominant optic atrophy based on eight British families in which the diagnosis was confirmed by linkage analysis. DESIGN AND PARTICIPANTS Case series; 92 subjects in 8 pedigrees had both eyes examined. INTERVENTION Family members received a domiciliary examination based on best-corrected visual acuity, color vision using Ishihara and Hardy Richter Rand (HRR) plates, confrontation field testing using a red target, and optic disc evaluation using a direct ophthalmoscope. Genomic DNA was extracted from leukocytes or buccal mucosal cells and genotyped using 12 fluorescently labeled microsatellite markers from the region 3q27-q29. MAIN OUTCOME MEASURES Subjects were classified clinically as definitely or possibly affected on the basis of the domiciliary examination before genetic analysis, and these results were compared with the haplotype analysis. RESULTS Clinically, 43 subjects were identified as definitely affected, 4 as possibly affected, and 45 as unaffected. Visual acuity in affected subjects ranged from 6/6 to count fingers and declined with age. On genetic analysis, a haplotype was identified in each family, which was found in all definitely affected members but not in those regarded as unaffected. The four possibly affected individuals also bore the haplotype that segregated with the disease. CONCLUSIONS Simple clinical tests are highly efficacious in diagnosing dominant optic atrophy. Contrary to accepted criteria, symptoms begin before the age of 10 years in only 58% of affected individuals. Visual acuity in affected subjects is highly variable. A mild degree of temporal or diffuse pallor of the optic disc and minimal color vision defects, in the context of a family with dominant optic atrophy, are highly suggestive of an individual being affected, even if the visual acuity is normal. This widens the generally accepted diagnostic criteria for this disease.
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Affiliation(s)
- R L Johnston
- Department of Ophthalmology, St Thomas' Hospital, London, England, UK
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Harris KDM, Johnston RL, Kariuki BM. The Genetic Algorithm: Foundations and Apllications in Structure Solution from Powder Diffraction Data. Acta Crystallogr A 1998. [DOI: 10.1107/s0108767398003389] [Citation(s) in RCA: 151] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Johnston RL, Whitefield LA, Giralt J, Harrun S, Akerele T, Bryan SJ, Kayali N, Claoué CM. Topical versus peribulbar anesthesia, without sedation, for clear corneal phacoemulsification. J Cataract Refract Surg 1998; 24:407-10. [PMID: 9559479 DOI: 10.1016/s0886-3350(98)80332-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate patient and surgeon acceptance of topical anesthesia as an alternative to peribulbar anesthesia for clear corneal phacoemulsification. SETTING Department of Ophthalmology, Whipps Cross Hospital, London, England. METHODS All cataract surgery was performed using a temporal clear corneal approach, bimanual phacoemulsification, and in-the-bag intraocular lens implantation. The results of 51 patients having surgery under topical anesthesia (amethocaine) were compared with those of 30 patients having peribulbar anesthesia (50:50 mixture of lignocaine 2% and bupivacaine 0.5% with hyaluronidase). No sedation was used in either group. Pain perception on administration of the anesthetic, perioperatively (period immediately surrounding and during surgery), and postoperatively was assessed using a visual analog scale from 0 to 10 (0 = no pain: 10 = worst pain imaginable). A questionnaire was used to assess the degree of patient and surgeon satisfaction. RESULTS Administration of topical amethocaine was significantly less painful than peribulbar bupivacaine (P = .03). Perioperative pain showed a trend toward being worse in the topical anesthesia group but did not reach statistical significance. There was no difference in the postoperative pain scores of the two groups. The surgical experience was rated very satisfactory by 67% in the topical group and 73% in the peribulbar group. The surgeons reported no difficulties or complications. CONCLUSION Topical anesthesia was safe and effective for clear corneal phacoemulsification and was well tolerated by patients. The slightly greater awareness of ocular discomfort in the topical group perioperatively did not alter patient satisfaction with the surgical experience when compared with the peribulbar group.
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Seller MJ, Behnam JT, Lewis CM, Johnston RL, Burdon MA, Spalton DJ. Linkage studies in dominant optic atrophy, Kjer type: possible evidence for heterogeneity. J Med Genet 1997; 34:967-72. [PMID: 9429135 PMCID: PMC1051144 DOI: 10.1136/jmg.34.12.967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dominant optic atrophy, Kjer type, is an autosomal dominant disorder causing progressive loss of visual acuity and colour vision from early childhood. The gene (OPA1) has variable expressivity, a penetrance of 0.98, and the locus has been localised to 3q28-29. We have genotyped nine British families with the disease using 12 polymorphic microsatellite markers from this region. Linkage and haplotype analysis shows the OPA1 gene to be located in a 2.3 cM interval between markers D3S1601 and D3S2748. One family showed no evidence of linkage with the chromosome 3 markers, suggesting for the first time that locus heterogeneity for this disease may exist, although exclusion for linkage is based on unaffected subjects. In addition, analysis of recombinants has enabled us to order the 12 markers along chromosome 3.
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Affiliation(s)
- M J Seller
- Division of Medical and Molecular Genetics, Guy's Hospital, London, UK
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Johnston RL, Burdon MA, Spalton DJ, Bryant SP, Behnam JT, Seller MJ. Dominant optic atrophy, Kjer type. Linkage analysis and clinical features in a large British pedigree. Arch Ophthalmol 1997; 115:100-3. [PMID: 9006433 DOI: 10.1001/archopht.1997.01100150102017] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To perform DNA linkage studies in an extensive 5-generation British pedigree with dominant optic atrophy and to validate the efficacy of domiciliary screening for affected members. METHODS Family members received a domiciliary examination based on corrected visual acuity, color vision, visual field defects, and optic disc appearance; DNA linkage analysis was performed using 7 microsatellite markers on 3q27-qter. RESULTS Based on the results of the ophthalmic examination, 15 members could be classified as definitely affected, 1 probably affected, and 25 unaffected. Two-point linkage analysis gave significant maximum lod scores at theta [corrected] = 0.00, with the markers D3S3669, D3S3590, and D3S3642. A haplotype segregating with the disease was identified in affected individuals, including the probably affected subject. Informative meioses defined the disease interval between markers D3S1601 and D3S1265. CONCLUSIONS Domiciliary screening was effective in identifying all 16 affected members of a British family with dominant optic atrophy. The typical clinical features were present. The location of the OPA1 gene in this new British family seems to be in the 3q27-28 region and is the same as that reported in Danish, Cuban, and French families, suggesting no genetic heterogeneity in this disorder.
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Affiliation(s)
- R L Johnston
- Department of Ophthalmology, St Thomas's Hospital, London, England
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Johnston RL, Stanford MR, Verma S, Green WT, Graham EM. Resolution of calcific band keratopathy after lowering elevated serum calcium in a patient with sarcoidosis. Br J Ophthalmol 1995; 79:1050. [PMID: 8534653 PMCID: PMC505327 DOI: 10.1136/bjo.79.11.1050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Andersson KM, Johnston RL, Murrell JN. Empirical potential-energy function for calcium solids and clusters. Phys Rev B Condens Matter 1994; 49:3089-3097. [PMID: 10011164 DOI: 10.1103/physrevb.49.3089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Johnston RL. Cataract removal. Science 1988; 241:1739. [PMID: 3175612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Johnston RL, Mitchell PC, Berman AM. Presumed ocular histoplasmosis syndrome. J Am Optom Assoc 1988; 59:401-5. [PMID: 2456321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Presumed ocular histoplasmosis syndrome (POHS) is a commonly observed fungal infection. Ocular findings include peripapillary atrophy, peripheral punched-out lesions, and a macular subretinal neovascular membrane. Laser photocoagulation can be beneficial in reducing visual loss from macular scarring due to subretinal neovascular membranes. Herein we describe a patient with POHS in which laser treatment regressed a parafoveal subretinal neovascular membrane. Her vision improved from 20/70 to 20/20 in the treated eye.
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Johnston RL, Rao GR, Tompkins WA, Cain CA. Effects of in vivo ultrasound hyperthermia on natural killer cell cytotoxicity in the hamster. Bioelectromagnetics 1986; 7:283-93. [PMID: 3753531 DOI: 10.1002/bem.2250070305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The effects of in vivo ultrasound irradiation of the spleen on immunological functions were assessed with an in vitro natural killer (NK) cell cytotoxic assay. Anesthetized hamsters were exposed to 1 MHz ultrasound at intensity levels currently being used clinically for therapeutic diathermy and hyperthermia (1-5 W/cm2, for 500 sec with constant beam scanning). Hyperthermic levels in the spleen ranged from 38-43 degrees C. Significant depression of natural killer (NK) cell activity was seen 4 h after spleen irradiation as compared to sham irradiated and normal animals. A return towards normal levels was observed in experimental groups at 24 h after exposure. Sham and normal animals were not significantly different in NK activity, indicating no significant stress-related immunosuppressive effects due to handling. Differential leukocyte counts taken for each exposure condition showed significant lymphopenia at 4, 8, and 16 h after exposure, near normal levels at 24 h, and complete recovery by 48 h. The number of circulating mononuclear cells at 4 h showed a dose-related suppression as the exposure intensities were increased.
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Abstract
A case-control study of 225 patients with branch retinal vein occlusion (BRVO) and 100 age-matched controls was conducted to assess potential clinical risk factors for BRVO. Male gender, hypertension, and hyperopia were significantly more prevalent in patients with BRVO. There was no significant association with race, diabetes, or chronic open-angle glaucoma.
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