• Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

      Barry, Peter; Royal Victoria Eye and Ear Hospital and St Vincent's University Hospital, Dublin, Ireland. (2014-01)
      To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.
    • The case for intraocular delivery of PPAR agonists in the treatment of diabetic retinopathy.

      Treacy, Maxwell P; Hurst, Tara P; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Dublin, Ireland. max@treacy.ie (2012-09)
      Systemic therapeutics targeting the peroxisome proliferator-activated receptors have been found to be beneficial in the treatment of diabetic retinopathy. In this paper, we provide a rationale for the use of these therapeutics as intraocular agents. In addition, we introduce the peroxisome proliferator-activated receptors and describe their functions in response to the drugs.
    • The changing face of informed surgical consent.

      Oosthuizen, J C; Burns, P; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Ireland. C.Oosth@gmail.com (2012-03)
      To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed 'Request for Treatment' consenting process is viable on a large scale.
    • Changing trends in Thyroidectomy

      Chukudebelu, Obinna; Dias, Andrew; Timon, Conrad (Irish Medical Journal, 2012-06)
    • Classification and treatment of radiation maculopathy.

      Horgan, Noel; Shields, Carol L; Mashayekhi, Arman; Shields, Jerry A; Royal Victoria Eye and Ear Hospital, Dublin, Ireland. Noel.Horgan@rveeh.ie (2012-02-01)
      PURPOSE OF REVIEW: Radiation maculopathy is a sight-limiting consequence of radiotherapy in the management of uveal melanoma and other intraocular tumors. In this review, we consider clinical, fluorescein angiographic and optical coherence tomographic findings, propose a classification for radiation maculopathy and discuss the management of this condition. RECENT FINDINGS: Radiation macular edema (RME) can be classified by optical coherence tomography into noncystoid or cystoid edema, with foveolar or extrafoveolar involvement. Optical coherence tomographic grading of RME has been found to correlate with visual acuity. Focal argon laser might have some limited benefit in the treatment of RME. Intravitreal triamcinolone and intravitreal antivascular endothelial growth factor agents can be of short-term benefit in the treatment of RME. In a randomized controlled trial, periocular triamcinolone significantly reduced rates of RME and vision loss up to 18 months following plaque radiotherapy for uveal melanoma. SUMMARY: Currently, there is no proven treatment for established RME, though periocular triamcinolone has been shown to have a preventive benefit. An accepted classification system for radiation maculopathy would be of benefit in planning and comparing future treatment trials.
    • Clinical image: keratitis in reactive arthritis.

      Collins, Niamh E; Fitzgerald, Oliver; Murphy, Conor C; Royal Victoria Eye and Ear Hospital, Royal College of Surgeons Ireland, Dublin,, Ireland. (2012-02-01)
    • Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery.

      Barry, Peter; Gardner, Susanne; Seal, David; Gettinby, George; Lees, Fiona; Peterson, Magnus; Revie, Crawford; Royal Victoria Eye and Ear Hospital, Dublin, Ireland. peterbarryfrcs@eircom.net (2012-02-01)
      PURPOSE: To describe cases of postoperative endophthalmitis in the European Society of Cataract & Refractive Surgeons (ESCRS) study of the prophylaxis of endophthalmitis, compare characteristics of unproven cases and cases proven by culture or polymerase chain reaction, and compare the characteristics with those in other reported series. SETTING: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. METHODS: Univariable and multivariable logistic regression models were used to analyze data for statistical association of signs and symptoms in cases with proven or unproven endophthalmitis. Specific data describing characteristics of the cases were compared between the 2 types of cases. RESULTS: Data from 29 endophthalmitis cases were analyzed. Swollen lids and pain were statistically associated with proven cases of endophthalmitis on univariable regression analysis. Multivariable analysis indicated that swollen lids and an opaque vitreous were associated with proven cases. Five cases of endophthalmitis occurred in the cefuroxime-treated groups. No case of streptococcal infection occurred in the cefuroxime-treated groups. However, cases of infection due to streptococci showed striking differences in visual acuity and were associated with earlier onset. Characteristics in the 29 cases parallel results in previous studies, such as the Endophthalmitis Vitrectomy Study, although the addition of a control group in the ESCRS study elicited additional findings. CONCLUSION: Swollen lids, pain, and an opaque vitreous were statistically associated with proven endophthalmitis cases in the ESCRS study.
    • A comparison of CO2 laser versus traditional stapedectomy outcomes.

      Ryan, S; Thornton, M A; Kieran, S; Charles, D; Royal Victoria Eye and Ear Hospital, Dublin. stephen.ryan@ucd.ie (2012-02-01)
      The aim of this study was to audit the introduction of the use of the CO2 laser into our department and to compare hearing outcomes and complication rates in patients who underwent either laser or mechanical stapedectomy. We found that the use of laser is at least as safe as the traditional approach with regards the rate of post-operative complications. One patient in the laser group suffered prolonged post-operative tinnitus, whilst one patient in the traditional group suffered prolonged post-operative vertigo. There was no evidence, however, of improved Air-Bone Gap closure compared to the traditional approach (Pre- and Post-Op Air Bone Gaps of 34 +/- 3 and 9 +/- 2 for laser stapedectomy versus 35 +/- 4 and 13 +/- 2 for traditional stapedectomy (mean +/- SEM)). In summary, therefore, CO2 laser surgery for otosclerosis is a safe surgical procedure resulting in similar hearing outcomes to that obtained following mechanical stapes surgery.
    • Cross-sectional Analysis of the Standards of Consent Applied to Anaesthesia in Ireland: Are Anaesthetists Aware of their Legal and Ethical Obligations?

      Cafferkey A; Lyons, B (Irish Medical Journal, 2018-01)
      Consent to a medical intervention has legally and ethically evolved to a process prioritising autonomy and patient-led decision-making. This cross-sectional analysis investigated Irish anaesthetists’ practices of taking consent. Following ethical approval, trainees and fellows of the College of Anaesthetists of Ireland were invited to participate in a 33 question online survey. One hundred and sixty responses (11.8%) were received, an equal number coming from consultants and trainees. The majority (93.7%) worked in a teaching hospital. Fifteen percent said their department had guidelines on obtaining consent for anaesthesia, but only 4.5% said their department used a separate consent form. Most (63.8%) do not usually document consent. A significant number rarely (21.8%) or never (27.8%) explained risks to patients. Lack of time was identified as the most frequent barrier (77.6%), with just under half first meeting the patient in the theatre holding-bay or the anaesthetic room. Forty-one percent felt the ultimate decision regarding which anaesthetic technique is employed should usually lie with the anaesthetist alone. These results suggest a wide variation in the practice of obtaining consent for anaesthesia. Less than half deemed their practice to be adequate in this regard, while 50% were concerned about litigation stemming from inadequate consent.
    • The effect of gastric decompression on postoperative nausea and emesis in pediatric, tonsillectomy patients.

      Chukudebelu, O; Leonard, D S; Healy, A; McCoy, D; Charles, D; Hone, S; Rafferty, M; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road,, Dublin 2, Ireland. BBChukud@yahoo.com (2012-02-01)
    • Effect of tonsillectomy on the adult voice.

      Heffernan, Colleen B; Rafferty, Mark A; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland., heffernan_colleen@hotmail.com (2012-02-01)
      OBJECTIVES AND HYPOTHESIS: Anecdotal evidence suggests that tonsillectomy has no deleterious consequences on a person's voice under normal vocal demand. However, whether the enlarged dimensions of the oropharynx after tonsillectomy impair the quality of a professional voice user remains unclear. Therefore, we designed a study to determine whether adult tonsillectomy altered the resonance characteristics of the vocal tract in any way and whether these changes were transient or permanent. STUDY DESIGN: This is a prospective observational study with full institutional ethical approval. METHODS: All adult patients presenting for tonsillectomy for recurrent tonsillitis in our institution were recruited. Their voice was recorded preoperatively, postoperatively, and at 4 weeks postoperatively. The values of the first four formants were calculated in all recordings. The oropharyngeal dimensions were measured preoperatively and postoperatively. Tonsillar weights and volumes were also measured. RESULTS: The first formant was noted to rise postoperatively. The average value of F2 and F3 did not alter postoperatively or at 4 weeks. However, it was noted that the fourth formant was not universally present preoperatively but was present in all patients postoperatively and at 4 weeks. CONCLUSIONS: Altering the dimensions of the oropharynx after tonsillectomy causes the first formant to rise but has no effect on the third and fourth formants. However, the fourth formant appears in patients who previously did not demonstrate it. The fourth formant was present in a greater proportion of male patients preoperatively than female patients, but it was universally present postoperatively and at 4 weeks in both sexes. This suggests that increasing the horizontal dimensions of the oropharynx has a nontransient effect on the higher order formants of the voice.
    • Glomangiopericytoma (sinonasal-type haemangiopericytoma).

      Oosthuizen, J C; Kennedy, S; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland. C.Oosth@gmail.com (2012-10)
      Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.
    • Lemierres syndrome: the forgotten disease

      Morariu, I; Curran, A; Killeen, RP (Irish Medical Journal, 2014-09)
      Lemierres syndrome is a rare and potentially fatal entity affecting otherwise healthy and young adults. The infection originates in the throat and spreads via a septic trombophlebitis of the internal jugular vein, with development of distant septic emboli. This clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.
    • Meta-analysis of timolol on diurnal and nighttime intraocular pressure and blood pressure.

      Lee, Princeton Wen-Yuan; Doyle, Aoife; Stewart, Jeanette A; Kristoffersen, Caroline J; Stewart, William C; Royal Victoria Eye and Ear Hospital, Dublin, Ireland. (2012-02-01)
      PURPOSE: To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma. METHODS: This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been >/=2 weeks with >/=19 patients per treatment arm for a crossover, and >/=50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves. RESULTS: For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p0.05). CONCLUSIONS: This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.
    • A method for the prescription of inexpensive spectacles by non-specialist healthcare workers: S-Glasses.

      Treacy, M P; Treacy, M G; Dimitrov, B D; Seager, F E; Stamp, M A; Murphy, C C; Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Dublin 2, Republic of Ireland. Max@Treacy.ie (2013-04)
      Globally, 153 million people are visually impaired from uncorrected refractive error. The aim of this research was to verify a method whereby autorefractors could be used by non-specialist health-workers to prescribe spectacles, which used a small stock of preformed lenses that fit frames with standardised apertures. These spectacles were named S-Glasses (Smart Glasses).
    • Minimally invasive video-assisted parathyroidectomy.

      Casserly, Paula; Timon, Conrad; Department of Otolaryngology/Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. paulacasserly@hotmail.com (2012-02-01)
    • Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage.

      Kirwan, R P; Cahill, M T; Department of Ophthalmic Surgery, The Royal Victoria Eye and Ear Hospital,, Adelaide Road, Dublin 2, Ireland. ruaidhri.kirwan@ucd.ie (2012-02-01)
      AIM: To report a case of successful drainage of a large pre-macular haemorrhage using laser photo-disruption of the posterior hyaloid membrane. MATERIALS AND METHODS: A case report. RESULTS: A 47-year-old man presented acutely to our emergency department complaining of a 24-h history of sudden onset, painless and persistent loss of vision in his left eye. Immediately before noticing this loss of vision, he had been vomiting violently from excessive alcohol intake. The left visual acuity was counting fingers. Dilated fundoscopy of the left eye revealed a large pre-macular haemorrhage which was 14 disc diametres in size. Clotting investigations were normal. A diagnosis of valsalva retinopathy was made and the patient elected to receive a prompt neodymium-doped yttrium aluminium garnet (Nd:YAG) laser posterior hyaloidotomy as an outpatient. At 1 week follow-up, the haemorrhage had drained completely into the vitreous space revealing a healthy macula and the visual acuity had improved to 6/12 unaided. At 6-month follow-up the left visual acuity stabilised at 6/9 unaided. CONCLUSION: Nd:YAG laser posterior hyaloidotomy is a useful outpatient procedure for successful clearance of large pre-macular haemorrhages that offers patients rapid recovery of visual acuity and the avoidance of more invasive intraocular surgery.
    • A novel homozygous truncating GNAT1 mutation implicated in retinal degeneration.

      Carrigan, Matthew; Duignan, Emma; Humphries, Pete; Palfi, Arpad; Kenna, Paul F; Farrar, G Jane (2016-04)
      The GNAT1 gene encodes the α subunit of the rod transducin protein, a key element in the rod phototransduction cascade. Variants in GNAT1 have been implicated in stationary night-blindness in the past, but unlike other proteins in the same pathway, it has not previously been implicated in retinitis pigmentosa.
    • Oncogenic impact of human papilloma virus in head and neck cancer.

      Heffernan, C B; O'Neill, J P; Timon, C; The Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland., Heffernan_colleen@hotmail.com (2012-02-01)
      There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.