News & Views

The Royal College of Ophthalmologists supports the quality standard but believes the implementation will be challenging for the overwhelmed hospital eye service.

The Academy of Medical Royal Colleges (AoMRC) have published their response to the government consultation on the ‘Development of a Serious Shortage Protocol’ for drug supplies in the possible event of a no-deal Brexit.

The Genomics Education Programme (GEP), run by Health Education England, has launched a new resource for ophthalmologists and others involved in the delivery of ophthalmology services.

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.

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.

The College has received queries from members to clarify whether there is a specific cut off for glycaemic control, either measured via HbA1C or a blood glucose level on the day, beyond which it is unsafe to proceed with cataract surgery.

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.

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.