News & Views

Read the latest RCOphth news updates and guidance here.

News

Ophthalmic Safety Alert – Do not use nitrous oxide when there is gas in an operated eye

There have been several case reports on the use of nitrous oxide in the presence of intraocular gas after vitreoretinal surgery with severe loss of vision due to central retinal artery occlusion.2-6 There have also been some cases identified via national incident reporting systems. Nitrous oxide leaves the bloodstream and vitreous cavity quickly once inhalation is terminated,7 restoring the position of the lens-iris diaphragm and reperfusion of the central artery can happen. However, irreparable damage to the retina is known to occur after 100 minutes of ischaemia.7 The extent of damage to the eye may therefore be dependent on the duration of general anaesthesia / use of Entonox and the size of intraocular gas bubble at that time. There is a theoretical risk of harm (raised intraocular pressure or hypoxic iris) in anterior chamber gas bubbles during keratoplasty in the same circumstances, that is flying, high altitude or nitrous oxide use. It is currently unclear whether this represents a significant risk, as there is little published, but some corneal surgeons are warning their patients not to fly postoperatively.

News

Ozurdex recall alert

Allergan Pharmaceuticals Ireland is recalling numerous batches of Ozurdex due to the possibility that a single loose silicone particle of approximately 300 microns in diameter may become detached from the needle sleeve during administration of the implant and may be delivered into the eye along with the implant.

News

Ophthalmic Safety Alert – intracameral cefuroxime

There are a range of cefuroxime preparations currently in use for the prevention of endophthalmitis in intraocular surgery. The College recommends that for those using a non licensed product, users should check the SmPCs and avoid use of any product which specifically cautions against intraocular use.

News

Ophthalmic Safety Alert – detachment of cannulas during ophthalmic surgery

The NHS Improvement national patient safety team have informed the College of the continued trend of incidents involving issues with detachment of cannulas during ophthalmic surgery (cannula-associated ocular injury, COI). The cannula is usually attached to either a saline or a viscoelastic syringe. The combination of a small lumen and plunger pressure can result in significant hydraulic force. If the cannula does detach, it can cause extensive damage to the globe with resultant visual impairment.

News

BOSU report shows patients losing sight to follow-up appointment delays

This research, conducted through the British Ophthalmological Surveillance Unit (BOSU), found patients suffering permanent and severe visual loss due to health service initiated delays1.  The research involving all UK consultant ophthalmologists, showed that up to 22 patients per month may be losing vision by such delays. These patients are from a vulnerable social group with chronic conditions requiring long-term routine follow-up such as glaucoma, age related macular degeneration and diabetic retinopathy.

Statement

Strabismus (squint) surgical intervention is not a cosmetic procedure

The College recognises that botulinum toxin and surgical treatment for strabismus* are important procedures that are performed in children and adults to promote, improve or re-establish binocular function, manage diplopia and restore ocular alignment and balance. Surgical intervention (including botulinum toxin injections) performed to achieve these aims is thus not a cosmetic procedure and does not fall under the GMC guidance for cosmetic surgery. Commissioning pathways for the management of squints reflect this. Surgical intervention (including botulinum toxin injections) performed to achieve these aims is thus not a cosmetic procedure and does not fall under the GMC guidance for cosmetic surgery. Commissioning pathways for the management of squints reflect this.

News

NEW Retinal Vein Occlusion (RVO) Guidelines July 2015

These guidelines (July 2015) reflect changes in treatments, since the 2010 Interim RVO Guidelines. The guidelines provide evidence-based, clinical advice for the management of different aspects of RVO. The scope is limited to current diagnostic tools, management and service set-up and delivery to facilitate delivery of optimal care.

News

New Guidelines for Thyroid Eye Disease

It is hoped that the Guidelines for Thyroid Eye Disease (2015) will facilitate early diagnosis and better treatment of patients with this disease. It is estimated that there are about 2,500 new cases of Thyroid Eye Disease (TED) every year in the UK. The figures have declined over the past 10-20 years for reasons that are unclear.