Review of treatment of pterygium in Queensland: 10 years after a primary survey

Purpose : To assess the practices in pterygium removal as a follow‐up study to a similar project 10 years ago, in order to compare the current trends with those noted a decade ago. Methods : A survey was sent to all practising ophthalmologists in Queensland (100). Results : Eighty‐seven of the 100 ophthalmologists undertook pterygium surgery with no change in indications for removal, grading or anaesthesia compared to 10 years ago. Nearly half of the ophthalmologists varied their surgical technique from eight commonly used methods according to the individual patient. More than half the respondents used a swinging conjunctival flap and 29% used simple excision leaving the area bare for primary pterygia, although nearly one‐quarter of the ophthalmologists added adjunctive therapies such as beta irradiation or mitomycin. For recurrent pterygia, one‐third of ophthalmologists preferred adjunctive therapies, and 57% used an autoconjunctival transplant. Conclusion : There has been no consistent trend in surgical removal of pterygia with a significant number of primary pterygia still removed using bare scleral closure.     

Correlation of structural retinal nerve fibre layer parameters and functional measures using Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography at different levels of glaucoma severity

Background: To compare the structure/function relationship in glaucoma cases at different levels of severity, and with different disc sizes, between the Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography. Design: Retrospective study of glaucoma patients attending a Sydney‐based private practice. Participants: 169 eyes of 169 patients with a clinical diagnosis of glaucoma. Methods: Patients were divided on visual field criteria into early (mean deviation > –4 dB), moderate (–4 dB < mean deviation < –10 dB) and severe (mean deviation < –10 dB) disease. Bivariate correlation (Spearman's rho) between mean threshold scores for each area and the corresponding mean retinal nerve fibre layer thickness sectoral measurement were calculated. Main Outcome Measures: Correlation, as measured by Spearman's rho, between retinal nerve fibre layer measurements and mean threshold scores. Comparison of correlation strengths between the two scanning modalities with analysis of the effect of disease severity and disc size. Results: Both imaging techniques showed only moderate correlations at best. Spectral domain optical coherence tomography (global retinal nerve fibre layer Spearman's rho = 0.670, P < 0.01) had higher correlation coefficients compared with Heidelberg Retinal Tomography rim area (Spearman's rho = 0.449, P < 0.01) and retinal nerve fibre layer (Spearman's rho = 0.421, P < 0.01). Disc size did not have a significant influence on the structure/function relationship. Conclusions: Spectral domain optical coherence tomography retinal nerve fibre layer measurements demonstrated closer correlations to visual field threshold reductions using a structure/function model in varying stages of glaucoma.     

Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

INTRODUCTION: The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. AIM: This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. METHOD: The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. RESULTS: Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. CONCLUSION: Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.