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P S Phelan

Publications and source records attributed to P S Phelan.

8 recordsLinked to original sources
PubMed2006

The relation of volume and outcome in trabeculectomy.

BACKGROUND/AIMS: Higher case volume has been associated with improved outcomes for a number of procedures. This study was designed to investigate whether this relationship existed for trabeculectomy. METHODS: The study was retrospective and conducted at an ophthalmic unit in the UK. All patients who had unenhanced trabeculectomy between 1996 and 2000 were identified. From their notes, the surgeon who performed the trabeculectomy was ascertained as were any unplanned interventions (eg conjunctival suturing, anterior chamber reformation, repeated attendances) within the first month of surgery. RESULTS: Two hundred and eleven trabeculectomies were performed over the study period. Twenty nine had unplanned interventions within the first postoperative month. Analysis of the data indicated that surgeons who performed less than eight operations per year had more complications than those who performed more than 10 per annum. This difference was only significant (chi(2)=4.0, P=0.045) when the data were aggregated. When separated per year, although not significant, the complication rate of the lower volume group was always higher than the group performing more than 10 per year. CONCLUSIONS: The results suggest that trabeculectomy can be added to the list of procedures in which larger case volume is associated with fewer early complications and potentially a better outcome. The findings, if replicated, tend to strengthen the argument for subspecialisation in glaucoma with its implications for training and revalidation.

Adult↗
PubMed2006

Viscogonioplasty: an effective procedure for lowering intraocular pressure in primary angle closure glaucoma.

PURPOSE: To evaluate the safety and intraocular pressure (IOP) lowering effect of combined phacoemulsification and viscogonioplasty (Phaco-VGP) in managing primary acute closed-angle glaucoma (ACAG) unresponsive to conventional therapy (patent PI). PATIENT AND METHODS: In all, 15 consecutive eyes of patients with refractory ACAG and greater than 270 degrees peripheral anterior synechiae (PAS) underwent VGP. The technique of VGP involved routine phacoemulsification with intraocular lens implantation (Phaco/IOL) under topical anaesthetic. Following IOL implantation a heavy viscoelastic was used to deepen the anterior chamber and then injected near the angle for 360 degrees (without touching the trabecular meshwork) to break the PAS. No surgical instrument was used to physically break the PAS. Upon completion of VGP, automated irrigation with balanced salt solution to remove the viscoelastic was performed. RESULTS: Mean IOP reduced from 52.1 to 14.1 mmHg by Phaco-VGP at 6-months review. 14/15 patients were free of glaucoma medications at 6-month review. All angles showed exposure of the trabecular meshwork over 360 degrees postoperatively without evidence of residual synechiae. No untoward complications were observed in any patient. CONCLUSION: VGP may have a role in controlling IOP effectively and safely in patients with refractory ACAG. It produces a large drop in the IOP and opening of the angle. It is a relatively simple technique to learn and we would recommend its use in the eyes of all patients who have had ACAG and are undergoing cataract extraction.

Acute Disease↗
PubMed1999

Measuring visual symptoms in British cataract patients: the cataract symptom scale.

AIMS: To develop and validate a scale for the measurement of visual symptoms and functional disability due to cataract in older UK residents. METHODS: In depth semistructured interviews were undertaken with 44 consecutive patients awaiting cataract surgery. Patients were asked to describe visual symptoms and problems with social functioning which were then incorporated into a questionnaire, the cataract symptom scale (CSS). The CSS was further examined in a cohort of 118 consecutive cataract patients awaiting surgery. Further assessments in these patients included visual acuity, visual function using an existing scale (the VF-14), activities of daily living, perceived health status, anxiety and depression, and a global assessment of how much patients felt their visual symptoms affected their daily life. RESULTS: A 15 item scale was derived which was simple to administer to older patients and had a high internal consistency. The test-retest correlation coefficient for the total instrument score was r = 0.91 (p<0.0001). The CSS correlated well with the VF-14 and to a lesser extent with visual acuity in the better eye, activities of daily living, perceived health status, anxiety and depression, and the patients' global assessment of visual symptoms. CONCLUSION: The CSS provides information regarding the symptomatic and functional status of older cataract patients resident in the UK which cannot be obtained by measurement of visual acuity alone.

Activities of Daily Living↗
PubMed1997

Catching glaucoma.

Explore the source record for details and available documents.

Diagnostic Errors↗
PubMed1997

The outcome of 2.3 mm incision combined phacoemulsification, trabeculectomy and lens implantation of non-foldable intraocular lenses.

We report the results of 100 eyes in 88 patients that underwent combined phacoemulsification and implantation of non-foldable intraocular lenses (IOLs) following enlargement of the initial 2.3 mm opening and trabeculectomy. Intraocular pressure (IOP) control (< 21 mmHg) was attained in 96% of the eyes. Visual acuity of 6/12 or better was attained in 76% of the eyes. A filtering bleb was absent in only 11% of the eyes. All these outcomes were favourable compared with previously reported series in which foldable IOLs were inserted without enlargement of the initial trabeculectomy openings. We conclude that the combination of small-incision cataract surgery and trabeculectomy with implantation of non-foldable IOLs is a successful surgical approach for visual rehabilitation and glaucoma control in patients with concurrent cataract and glaucoma.

Cataract↗