The British journal of ophthalmology
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The changing profile of patients undergoing ophthalmic surgery, with an increase in prevalence of antiplatelet and anticoagulant drug use, predisposes to bleeding complications. This mandates an awareness of these agents, allowing optimal patient management. We review traditional and newer agents in the context of cataract, vitreoretinal, glaucoma and oculoplastic surgery. Recommendations are given for continuation, cessation and re-commencement of these agents in order to minimise the risk of bleeding and thrombotic/thromboembolic complications.
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Review
Managing antiplatelet and anticoagulant drugs in patients undergoing elective ophthalmic surgery.
The management of antiplatelet and anticoagulant treatment can be challenging for the ophthalmic surgeon with the risk of impaired surgical view or potentially sight-threatening haemorrhage. With the advent of newer medications and the expanding usage of these drugs, there is a need for up-to-date guidance on the subject. ⋯ A multidisciplinary approach has been used to develop a guideline for the management of antiplatelet and anticoagulation treatment in elective ophthalmic surgery. Specifically, guidance is provided on when and how to stop antiplatelet and anticoagulant treatment and, importantly, when to seek specialist medical advice.
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To evaluate the reporting of harms by randomised controlled trials investigating intravitreal therapies for diabetic macular oedema. A thorough literature search identified eligible reports. Two authors independently extracted data from these articles using a prospectively created checklist. ⋯ The least frequently met recommendations were numbers 3 (list addressed adverse events with definitions of each), 31%, and 6 (describe participant withdrawals because of harms), 36%. The mean percentage of the results section devoted to harms-related data was 25.8%, SD 10.8%. Harms reporting in published reports of trials of intravitreal therapies for diabetic macular oedema is still not entirely adequate despite increased attention and efforts to standardise it.
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Review
Nanotechnology and glaucoma: a review of the potential implications of glaucoma nanomedicine.
The purpose of this review is to discuss the evolution of nanotechnology and its potential diagnostic and therapeutic applications in the field of ophthalmology, particularly as it pertains to glaucoma. We reviewed literature using MEDLINE and PubMed databases with the following search terms: glaucoma, nanotechnology, nanomedicine, nanoparticles, ophthalmology and liposomes. We also reviewed pertinent references from articles found in this search. ⋯ In particular, the challenges of assuring safety and efficacy of nanomedicine will be examined. We conclude that nanotechnology offers a novel approach to expanding diagnostic, imaging and surgical modalities in glaucoma and may contribute to the knowledge of disease pathogenesis at a molecular level. However, more research is needed to better elucidate the mechanism of cellular entry, the potential for nanoparticle cytotoxicity and the assurance of clinical efficacy.
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Virtual simulators have been widely implemented in medical and surgical training, including ophthalmology. The increasing number of published articles in this field mandates a review of the available results to assess current technology and explore future opportunities. ⋯ Virtual reality simulators are an effective tool in measuring performance and differentiating trainee skill level. Additionally, they may be useful in improving surgical skill and patient outcomes in cataract surgery. Future opportunities rely on taking advantage of technical improvements in simulators for education and research.