Enderby
LE19 1SW
by Dr Ahmed Ageed, FY2, Glenfield Hospital, NHS Foundation Trust, UK.
The Leicester Eye Meeting, now running for its 8th successive year, brought ophthalmologists and Allied Healthcare Professionals alike for a day of enriching education from well-esteemed ophthalmologists. The day kicked off with presentations from three ophthalmology residents, the first of whom being Modupe Sodeinde and her talk on the Leicester Royal Infirmary (LRI) ‘PreserFlo’ Microshunt Surgery Audit.
PreserFlo has been a hot topic in the world of glaucoma surgery since its release in 2019 for treating patients with early to advanced open angle glaucoma. Much like many other ophthalmology departments in the UK and around the world, LRI collected its own data locally to contribute to the ongoing discussion and comparison between PreserFlo, other minimally invasive glaucoma surgery (MiGS) and the gold standard Trabeculectomy. Data was collected on 83 eyes with an average follow up period 9.9 months. Outcome of surgery was split into three categories: ‘Complete success’, ‘Overall success’ and ‘Failure’ based primarily on reduction of intraocular pressure (IOP). Results showed that ‘Complete success’ was achieved in 77.1% of patients and ‘Overall success’ was achieved in 81.9% in patients. While long-term data on PreserFlo is pending, it appears successful in lowering IOP and is useful in all stages of glaucoma. Time will tell whether PreserFlo can challenge Trabeculectomy as the ‘gold standard’ surgical treatment for patients with primary open angle glaucoma.
This was followed by a fascinating case study by ophthalmology resident Dr Chung Shen Chean. His case study, titled ‘The Eye Window to a rare Endocrine Disorder’, captivated the attention of the audience as he told the case of a 14-year-old boy referred from paediatrics who was being treated as bilateral atopic conjunctivitis. On examination, this boy had significant corneal scarring. He had multiple eye casualty attendances and was referred to corneal clinic. He was deemed to be suffering from recurrent blepharoconjunctivitis and keratopathy and treated accordingly. Unfortunately, despite multiple treatments with topical steroids, antihistamines and antibiotics his vision continued to deteriorate. He was then referred to a specialist centre for further treatment with topical tacrolimus, anti-VEGF injection for peripheral vascularisation, however, unfortunately this was also to no avail with the boy now awaiting limbal stem cell transplant. Dr Chean noticed while examining this patient that he had nail dystrophy and candidiasis which made him delve deeper into this patient’s medical background. This patient had multiple hospital admissions for hypoglycaemia and was also being treated for adrenal insufficiency. Following multi-disciplinary discussion between endocrinology and ophthalmology, his ocular symptoms were found to be explained by a rare autoimmune condition known as ‘autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy’ (APECED). This was a fascinating case that really brought home the importance of a systemic examination when evaluating patients as the ocular manifestations may only be the window to something deeper.
We were then fortunate enough to hear from our very own esteemed NIHR academic clinical lecturer Dr Sohaib Rufai, who spoke to us about ‘The RIO Diagnostic Accuracy Study’. Dr Rufai received a prestigious NIHR Doctoral Fellowship grant of £426,000 to lead this world-first diagnostic accuracy study on the role of handheld OCT in the recognition of intracranial hypertension (IH) in children. This was a multi-centre prospective diagnostic accuracy study at Great Ormond Street Hospital (GOSH) and Oxford. In terms of best predictor of future vision, grading of vision using OCT was found to be far more accurate (R=0.80, P<0.0001) in comparison to using the ‘preferential looking’ method (R=0.47, P<0.0001). As well as this, the feasibility of handheld OCT use in children was also found to be a success. In the majority of cases, undilated examination was feasible with varying techniques such as distraction techniques for toddlers and feeding babies prior to examination. Handheld OCT was successful in 41 of 42 (98%) eligible children. Diagnoses such as craniosynostosis, hydrocephalus, intracranial hypertension were able to be made using this innovative non-invasive method for recognising IH in children. This ground-breaking world-first study could pave way for the future use of handheld OCT in children.
My final highlight of the day was the talk delivered by Mrs Sarah Maling, the lead for specialty recruitment on ‘ISTC’s and Impact on Training’. She passionately educated the audience on the current state of ophthalmological surgical apprenticeship, highlighting the lack of standard curricula, learning outcomes and practice domains. Despite procedures being standard worldwide, such as cataract surgery, there are differences in the required completed number of independent cases. Trainees in the audience also expressed concern that they are struggling to obtain the required number of cases required for their portfolio due to local Independent Sector Treatment Centres performing treatments for NHS patients which reduces exposure.
