Providing a safe and effective intravitreal treatment service: strategies for service delivery (2020)

Type of publication:
Journal article

Author(s):
Amoaku W.; Bailey C.; Downey L.; Gale R.P.; Ghanchi F.; Hamilton R.; Mahmood S.; Menon G.; *Nosek J. ; Pearce I.; Yang Y

Citation:
Clinical Ophthalmology; 2020; vol. 14 ; p. 1315-1328

Abstract:
An aging population leads to increasing demand for medical retina services with chronic diseases being managed in long-term care pathways. Many hospital services struggle to deliver efficient and effective MR care due, at least in part, to infrastructure that does not expand responsively enough to meet the increased demand. A steering committee of retinal specialists from a variety of UK NHS hospital ophthalmology departments with experience of leading and managing NHS retinal services in the intravitreal era came together for the generation of this document to review and compile key aspects that should be considered when optimising intravitreal treatment capacity within MR services. This article aims to provide a useful collation and signposting of key published evidence, consensus and insights on aspects of delivering an intravitreal service, including treatment regimens, virtual clinics, staff training and governance, telemedicine and information technology, and data collection and key performance indicators. The objective is to equip ophthalmologic healthcare professionals with the necessary tools to develop and adapt their local service in the face of current and projected increased demand.

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Descemet’s membrane endothelial keratoplasty (DMEK): first UK prospective study of 1-year visual outcomes, graft survival and endothelial cell count (2015)

Type of publication:
Journal article

Author(s):
*Robert A Reid, *Ewan A Craig, *Hanif Suleman

Citation:
British Journal of Ophthalmology, February 2015, vol./is. 99/2(166-169), 0007-1161;1468-2079 (01 Feb 2015)

Abstract:

Aim: To evaluate the clinical outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) in the treatment of patients with Fuchs’ endothelial dystrophy.

Methods: This prospective study involved 16 consecutive patients who had DMEK done and who were evaluated over a year. Measurements included best corrected visual acuity (BCVA), endothelial cell count, and central corneal thickness.

Results: Two patients had failed grafts. Of the remaining 14 patients with successful grafts, after 12 months, 79% had BCVA of 6/6 or better, and all patients had a BCVA of 6/9 or better. Median endothelial cell count was 1567 cells per mm2 (range=900–2359) representing a 40% reduction compared with preoperative counts. Median central corneal thickness was 498 µm (range 445–567 µm) compared with a median of 649 µm (range 548–740 µm) preoperatively. All patients attained total visual rehabilitation without further surgical intervention.

Conclusions: In our experience, DMEK has the potential to become the primary procedure for treating Fuchs’ endothelial dystrophy and endothelial disease as it produces rapid total visual rehabilitation with few complications, and an easy follow-up and management regimen. Donor preparation and graft insertion, however, remain important challenges.