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Jefferis JM, Littlewood RA, Pepper IM, Hickman SJ, Salvi SM. Optic nerve sheath fenestration via a supero-medial eyelid skin crease approach for the treatment of idiopathic intracranial hypertension in a UK population. Eye (Lond) 2020; 35:1418-1426. [PMID: 32555545 DOI: 10.1038/s41433-020-1024-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/AIMS Optic nerve sheath fenestration (ONSF) is a surgical intervention in the management of idiopathic intracranial hypertension (IIH) infrequently performed in the United Kingdom. Numerous surgical approaches have been described, including medial transconjunctival, lateral and endoscopic. We describe our outcomes and complications from ONSF via a supero-medial eyelid skin crease incision in patients with IIH. METHODS We performed a retrospective review of consecutive patients undergoing ONSF for IIH between January 2011 and December 2017 by a single surgeon. RESULTS Thirty patients were included in the analysis with a median follow-up of 14.5 months. Bilateral ONSFs were undertaken in 27 (90%). The data from one eye per patient were analysed. The mean kinetic perimetry score in mean radial degrees of the I4e isopter improved from 27.3° to 35.7°, p = 0.04. After removing cases with optic atrophy, the median modified Frisén grade of papilloedema improved from 2.5 to 1.0, p = 0.007. A total of 5/30 (17%) patients had complications: two (7%) had recurrence/late failure (one managed medically and one with cerebrospinal fluid [CSF] diversion surgery), one had transient cotton wool spots post-operatively, one had transient retinal haemorrhages and one patient had a transiently oval pupil. No patients had repeat ONSF, but CSF diversion surgery was subsequently carried out in 4/30 (13%) patients. CONCLUSIONS ONSF via a supero-medial eyelid skin crease approach is effective at improving visual function in patients with IIH. The complication rates are low when compared with CSF diversion surgery and other surgical approaches for ONSF.
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Affiliation(s)
- J M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK. .,The University of Sheffield, Sheffield, S10 2TN, UK.
| | - R A Littlewood
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - I M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.,The University of Sheffield, Sheffield, S10 2TN, UK
| | - S J Hickman
- The University of Sheffield, Sheffield, S10 2TN, UK.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - S M Salvi
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.,The University of Sheffield, Sheffield, S10 2TN, UK
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Jefferis JM, Jones RK, Currie ZI, Tan JH, Salvi SM. Orbital decompression for thyroid eye disease: methods, outcomes, and complications. Eye (Lond) 2017; 32:626-636. [PMID: 29243735 DOI: 10.1038/eye.2017.260] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/04/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature.Patients and methodsA retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED.ResultsWithin the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7-4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1-3.7), and for the two-and-a-half walls it was 7.6 mm (5.8-9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12-2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5-30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6-4.8 mm, with new diplopia 0-38% and postoperative numbness 12-50%. For other bony decompressions, reduction in exophthalmometry was 2.5-8.0 mm with new diplopia 0-45% and postoperative numbness up to 52%.ConclusionDiffering approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.
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Affiliation(s)
- J M Jefferis
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - R K Jones
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - Z I Currie
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - J H Tan
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - S M Salvi
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
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Affiliation(s)
- R K Jones
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffiled, UK
| | - J M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffiled, UK
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Jefferis JM, Taylor JP, Clarke MP. Does cognitive impairment influence outcomes from cataract surgery? Results from a 1-year follow-up cohort study. Br J Ophthalmol 2015; 99:412-7. [PMID: 25287367 PMCID: PMC4345983 DOI: 10.1136/bjophthalmol-2014-305657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/04/2014] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS To assess the impact of impaired cognition on visual outcomes 1 year following cataract surgery in a cohort of older people. METHODS Participants aged 75 years or more with bilateral cataract and scheduled for cataract surgery were recruited consecutively. Cognition was assessed using the revised Addenbrooke's cognitive examination (ACE-R). Participants were divided into two groups: normal (ACE-R ≥88) and impaired cognition (ACE-R <88). Visual quality of life (VQOL) and logarithm of minimum angle of resolution visual acuity (VA) were assessed at baseline and 1 year following cataract surgery. RESULTS Of 112 participants, 48 (43%) had normal cognition and 64 (57%) had impaired cognition. One year following cataract surgery participants in both groups had significant improvements in VQOL and VA. Visual outcomes at 1 year were significantly better in participants with normal cognition than in those with impaired cognition (95% CIs for difference 0.4-7.0 and 0.02-0.1, for VQOL and VA, respectively). Regression analyses correcting for potential confounders showed a relationship between baseline cognition and VA at 1 year (R(2)=0.30, p=0.001) and a possible relationship between baseline cognition and VQOL at 1 year (R(2)=0.41, p=0.01, this became insignificant after removal of outliers). CONCLUSIONS Patients with impaired cognition benefit from cataract surgery, but not to the same extent as patients with normal cognition.
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Affiliation(s)
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Jefferis JM, Clarke MP, Taylor JP, Brittain KR. Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices. Clin Ophthalmol 2014; 8:1993-9. [PMID: 25328382 PMCID: PMC4196883 DOI: 10.2147/opth.s69388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions. Methods This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis. Results Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon’s, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. Conclusion This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support may be beneficial.
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Affiliation(s)
- Joanna Mary Jefferis
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK ; Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK ; Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Patrick Clarke
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK ; Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Killen A, Firbank MJ, Collerton D, Clarke M, Jefferis JM, Taylor JP, McKeith IG, Mosimann UP. The assessment of cognition in visually impaired older adults. Age Ageing 2013; 42:98-102. [PMID: 23108164 DOI: 10.1093/ageing/afs157] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND visual and cognitive impairments are common in later life. Yet there are very few cognitive screening tests for the visually impaired. OBJECTIVE to screen for cognitive impairment in the visually impaired. METHODS case-control study including 150 elderly participants with visual impairment (n = 74) and a control group without visual impairment (n = 76) using vision-independent cognitive tests and cognitive screening tests (MMSE and clock drawing tests (CDT)) which are in part vision dependent. RESULTS the scoring of the two groups did not differ in the vision-independent cognitive tests. Visually impaired patients performed poorer than controls in the vision-dependent items of the MMSE (T = 7.3; df: 148; P < 0.001) and in CDT (T = 3.1; df: 145; P = 0.003). No group difference was found when vision-independent items were added to MMSE and CDT. The test score gain by the use of vision-independent items correlated with the severity of visual impairment (P < 0.002). CONCLUSION visually impaired patients benefit from cognitive tests, which do not rely on vision. The more visually impaired the greater the benefit.
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Affiliation(s)
- Alison Killen
- Newcastle University - Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom
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Jefferis JM, Collerton J, Taylor JP, Jagger C, Kingston A, Davies K, Kirkwood T, Clarke MP. The impact of visual impairment on Mini-Mental State Examination Scores in the Newcastle 85+ study. Age Ageing 2012; 41:565-8. [PMID: 22431154 DOI: 10.1093/ageing/afs042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cognitive test scores and visual acuity are strongly associated in older people. This may be due to poor vision limiting performance on cognitive tasks specifically requiring vision, or an association between visual and neurodegenerative disorders. OBJECTIVE to explore, using data from the Newcastle 85+ cohort study, the impact of sight impairment (SI) on Mini-Mental State Examination (MMSE) scores and whether reduced scores among SI participants are limited to tasks requiring vision. RESULTS of 839 participants aged 85 years, 44 (5.2%) were registered SI. Median (inter-quartile range) sMMSE scores were 25 (22-29) for SI and 28 (25-29) for non-SI participants (P=0.006). SI participants had lower subscale scores on tasks requiring vision (P<0.001 for each) but also for some subscale scores not obviously requiring vision: orientation (P=0.018) and repetition (P=0.030). Excluding visual items, there was no significant difference in MMSE scores between those with/without SI. CONCLUSION SI may be an obstacle to older people completing cognitive assessments including tasks requiring vision. People with SI also scored lower on some tasks not obviously requiring vision. An association between cognitive impairment and SI may exist beyond simply being unable to see the test material in cognitive tests.
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Affiliation(s)
- Joanna Mary Jefferis
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
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Abstract
Acquired cataract and cognitive impairment are both common age-related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Patients with dementia types who display early visuoperceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract, it may be difficult to distinguish visual complaints due to cataract from those due to dementia. The interaction between visual impairment due to cataract and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however, the benefits of cataract surgery in established dementia are less clear. In this study, the literature on this subject was reviewed and the implications for practice were considered.
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Affiliation(s)
- J M Jefferis
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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