Publications by staff affiliated to the Royal Victoria Eye and Ear Hospital, Dublin

Recent Submissions

  • Presentation of Infectious Keratitis to ED during COVID-19 Lockdown.

    Power, Barry; Donnelly, Aaron; Murphy, Conor; Fulcher, Timothy; Power, William (2021-06-08)
    Objectives: To compare presentation of infectious keratitis during COVID-19 lockdown with previous years, assess relative severity, and compare outcomes between COVID-19 and pre-COVID-19 era groups. Methods: Acute presentations of infectious keratitis during a strict government-mandated COVID-19 lockdown period were analysed retrospectively (March-May 2020). Data were compared with the same periods in 2018-2019. The clinical notes of patients undergoing corneal scrapes were reviewed, and data were collected on treatment, culture growth, surgical interventions, visual outcomes, admission rates, and risk factors. Results: There were 37% fewer presentations of infectious keratitis to the ED in 2020 (N = 29, 47, and 45, respectively). Risk factor profiles and microbial data were similar across all periods. Admission rates and use of fortified antibiotics were lower in 2020. COVID-19 era cases recovered less vision (LogMAR 0.26, 0.67, and 0.45, respectively; p = 0.04) and were more likely to require surgical intervention (10%, 4%, and 2%, respectively; OR 3.4 (CI 0.7-17.9, p = 0.1)). Conclusion: A concerning fall in presentations of infectious keratitis to ED during the pandemic lockdown was observed. Though societal behaviour changed during the lockdown, our data suggest it is unlikely that the incidence of infectious keratitis fell significantly. It is unclear how and where these patients were treated. We postulate that lower levels of visual recovery and higher rates of surgical intervention may have been caused by delays in accessing care. To minimise avoidable ocular morbidity as COVID-19 resurges, we must communicate clearly with patients and health professionals on how to access available emergency eye care services.
  • Cross-sectional Analysis of the Standards of Consent Applied to Anaesthesia in Ireland: Are Anaesthetists Aware of their Legal and Ethical Obligations?

    Cafferkey A; Lyons, B (Irish Medical Journal, 2018-01)
    Consent to a medical intervention has legally and ethically evolved to a process prioritising autonomy and patient-led decision-making. This cross-sectional analysis investigated Irish anaesthetists’ practices of taking consent. Following ethical approval, trainees and fellows of the College of Anaesthetists of Ireland were invited to participate in a 33 question online survey. One hundred and sixty responses (11.8%) were received, an equal number coming from consultants and trainees. The majority (93.7%) worked in a teaching hospital. Fifteen percent said their department had guidelines on obtaining consent for anaesthesia, but only 4.5% said their department used a separate consent form. Most (63.8%) do not usually document consent. A significant number rarely (21.8%) or never (27.8%) explained risks to patients. Lack of time was identified as the most frequent barrier (77.6%), with just under half first meeting the patient in the theatre holding-bay or the anaesthetic room. Forty-one percent felt the ultimate decision regarding which anaesthetic technique is employed should usually lie with the anaesthetist alone. These results suggest a wide variation in the practice of obtaining consent for anaesthesia. Less than half deemed their practice to be adequate in this regard, while 50% were concerned about litigation stemming from inadequate consent.
  • A novel homozygous truncating GNAT1 mutation implicated in retinal degeneration.

    Carrigan, Matthew; Duignan, Emma; Humphries, Pete; Palfi, Arpad; Kenna, Paul F; Farrar, G Jane (2016-04)
    The GNAT1 gene encodes the α subunit of the rod transducin protein, a key element in the rod phototransduction cascade. Variants in GNAT1 have been implicated in stationary night-blindness in the past, but unlike other proteins in the same pathway, it has not previously been implicated in retinitis pigmentosa.
  • Royal Victoria Eye and Ear Hospital annual report and accounts,1996: celebrating 100 years.

    Royal Victoria Eye and Ear Hospital (Royal Victoria Eye and Ear Hosital, 1997)
    The Dublin Eye and Ear Hospital Act, 1897 came in to force on 15th July 1897. The Act provided for the amalgamation of the National Eye and Ear Hospital in Molesworth Street (founded in 1814) and St Mark's Ophthalmic Hospital in Lincoln Place founded in 1844 by Sir William R. Wilde) and established this Hospital. We are therefore celebrating this year the completion of one hundred year of service by the Hospital to the citizens of Dublin and indeed to people from all parts of Ireland.
  • Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: case reports and a review of the literature.

    Duignan, Emma; Kenna, Paul; Watson, Rosemarie; Fitzsimon, Susan; Brosnahan, Donal (Karger Publishing, 2015-01)
    We describe the cases of 2 autistic children with ophthalmic and systemic manifestations of vitamin A deficiency due to food faddism. Although vitamin A deficiency is common in the developing world, reports in developed societies are rare. Our patients presented over a 1-year period. The patients were 14 and 13 years old at the time of presentation and were both found to have marked features of vitamin A deficiency related to unusual dietary habits. Anterior segment signs of xerophthalmia were present in both patients. In addition, patient 1 showed evidence of a rod-predominant retinopathy, which resolved with vitamin A supplementation. Due to its rare occurrence, hypovitaminosis A must be highlighted and anticipated in this cohort.
  • Proteomics in uveal melanoma.

    Ramasamy, Pathma; Murphy, Conor C; Clynes, Martin; Horgan, Noel; Moriarty, Paul; Tiernan, Damien; Beatty, Stephen; Kennedy, Susan; Meleady, Paula; Royal College of Surgeons Ireland, Stephen's Green, Dublin 2, Ireland; National Institute for Cellular Biotechnology, Dublin City University, Collins Avenue, Glasnevin, Dublin 9, Ireland. Electronic address: Pathma.Ramasamy@dcu.ie. (2014-01)
    Uveal melanoma is the most common primary intraocular malignancy in adults, with an incidence of 5-7 per million per year. It is associated with the development of metastasis in about 50% of cases, and 40% of patients with uveal melanoma die of metastatic disease despite successful treatment of the primary tumour. The survival rates at 5, 10 and 15 years are 65%, 50% and 45% respectively. Unlike progress made in many other areas of cancer, uveal melanoma is still poorly understood and survival rates have remained similar over the past 25 years. Recently, advances made in molecular genetics have improved our understanding of this disease and stratification of patients into low risk and high risk for developing metastasis. However, only a limited number of studies have been performed using proteomic methods. This review will give an overview of various proteomic technologies currently employed in life sciences research, and discuss proteomic studies of uveal melanoma.
  • Lemierres syndrome: the forgotten disease

    Morariu, I; Curran, A; Killeen, RP (Irish Medical Journal, 2014-09)
    Lemierres syndrome is a rare and potentially fatal entity affecting otherwise healthy and young adults. The infection originates in the throat and spreads via a septic trombophlebitis of the internal jugular vein, with development of distant septic emboli. This clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.
  • Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

    Barry, Peter; Royal Victoria Eye and Ear Hospital and St Vincent's University Hospital, Dublin, Ireland. (2014-01)
    To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.
  • "Tarantula keratitis": a case report.

    McAnena, L; Murphy, C; O'Connor, J; Royal Victoria Eye and Ear Hospital (RVEEH), Adelaide Road, Dublin 2, Ireland. lmcanena@yahoo.co.uk (2013-09)
    A case of an 11-year-old boy presenting with a two-week history of a red, irritated right eye after handling a Chilean Rose Tarantula at an exotic pet exhibition. Examination revealed innumerable microscopic hairs embedded at all levels of the cornea. He was commenced on steroid drops with subjective and objective improvement at follow up.
  • Systematic review and meta-analysis of wound drains after thyroid surgery.

    Woods, R S R; Woods, J F C; Duignan, E S; Timon, C; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland. (2014-04)
    Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
  • Glomangiopericytoma (sinonasal-type haemangiopericytoma).

    Oosthuizen, J C; Kennedy, S; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland. C.Oosth@gmail.com (2012-10)
    Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.
  • The case for intraocular delivery of PPAR agonists in the treatment of diabetic retinopathy.

    Treacy, Maxwell P; Hurst, Tara P; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Dublin, Ireland. max@treacy.ie (2012-09)
    Systemic therapeutics targeting the peroxisome proliferator-activated receptors have been found to be beneficial in the treatment of diabetic retinopathy. In this paper, we provide a rationale for the use of these therapeutics as intraocular agents. In addition, we introduce the peroxisome proliferator-activated receptors and describe their functions in response to the drugs.
  • The changing face of informed surgical consent.

    Oosthuizen, J C; Burns, P; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Ireland. C.Oosth@gmail.com (2012-03)
    To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed 'Request for Treatment' consenting process is viable on a large scale.
  • A rare angiosarcoma: retiform haemangioendothelioma.

    O'Duffy, F; Timon, C; Toner, M; Department of Otorhinolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland. fergaloduffy@hotmail.com (2012-02)
    We report the case of a rare angiosarcoma, retiform haemangioendothelioma, in an 18-year-old young man, which presented as a recurrent ulcerating lesion of the left pinna.
  • Changing trends in Thyroidectomy

    Chukudebelu, Obinna; Dias, Andrew; Timon, Conrad (Irish Medical Journal, 2012-06)
  • Patients' quality of life post thyroidectomy.

    Cashman, E C; Bresnihan, M; Timon, C; Royal Victoria Eye & Ear Hospital, Adelaide rd, Dublin 2, Ireland. emmacashman@gmail.com (2011)
    This study was designed to evaluate health related quality of life post thyroidectomy for hyperthyroidism with respect to clinical benefit and patient satisfaction. This is one of the first such studies in the literature evaluating quality of life post thyroidectomy for hyperthyroidism.
  • Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years.

    Kieran, S M; McKusker, M; Keogh, I; Timon, C; Department of Otolaryngology, Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. skieran@rcsi.ie (2012-02-01)
    OBJECTIVES: The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN: We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS: One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION: In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.
  • Outcome measures and scar aesthetics in minimally invasive video-assisted parathyroidectomy.

    Casserly, Paula; Kirby, Rachel; Timon, Conrad; Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. paulacasserly@hotmail.com (2012-02-01)
    OBJECTIVES: To compare the scar outcome of video-assisted parathyroidectomy (VAP) with traditional bilateral cervical exploration (BCE) using previously validated scar assessment scales, and to examine the feasibility of introducing VAP into a general otolaryngology-head and neck practice. DESIGN: A retrospective review of medical records from a prospectively obtained database of patients and long-term follow-up of scar analysis. PATIENTS: The records of 60 patients undergoing parathyroidectomy were reviewed: 29 patients underwent VAP and 31 patients underwent an open procedure with BCE. The groups were matched for age and sex. A total of 46 patients were followed up to assess scar outcome. MAIN OUTCOME MEASURES: The primary outcome was a comparison of patient and observer scar satisfaction between VAP and traditional BCE using validated scar assessment tools: the Patient Scar Assessment Scale and the Manchester Scar Scale. The secondary outcomes were to retrospectively evaluate our results with VAP and to assess the suitability of introducing this technique into a general otolaryngology-head and neck practice. RESULTS: The average scar length in the VAP group was 1.7 cm, and the average scar length in the BCE group was 4.3 cm. The patients in the BCE group scored higher than the patients in the VAP group on the Manchester Scar Scale (P < .01) and on the Patient and Observer Scar Scales (P = .02), indicating a worse scar outcome. The mean operative time in the VAP group was 41 minutes compared with 115 minutes in the open procedure BCE group. There was no difference between the 2 groups in terms of postoperative complications. CONCLUSIONS: Video-assisted parathyroidectomy is a safe and feasible procedure in the setting of a general otolaryngology-head and neck practice, with outcomes and complication rates that are comparable to those of traditional bilateral neck exploration. Both patient and observer analysis demonstrated that VAP was associated with a more favorable scar outcome when compared with BCE.
  • Effect of tonsillectomy on the adult voice.

    Heffernan, Colleen B; Rafferty, Mark A; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland., heffernan_colleen@hotmail.com (2012-02-01)
    OBJECTIVES AND HYPOTHESIS: Anecdotal evidence suggests that tonsillectomy has no deleterious consequences on a person's voice under normal vocal demand. However, whether the enlarged dimensions of the oropharynx after tonsillectomy impair the quality of a professional voice user remains unclear. Therefore, we designed a study to determine whether adult tonsillectomy altered the resonance characteristics of the vocal tract in any way and whether these changes were transient or permanent. STUDY DESIGN: This is a prospective observational study with full institutional ethical approval. METHODS: All adult patients presenting for tonsillectomy for recurrent tonsillitis in our institution were recruited. Their voice was recorded preoperatively, postoperatively, and at 4 weeks postoperatively. The values of the first four formants were calculated in all recordings. The oropharyngeal dimensions were measured preoperatively and postoperatively. Tonsillar weights and volumes were also measured. RESULTS: The first formant was noted to rise postoperatively. The average value of F2 and F3 did not alter postoperatively or at 4 weeks. However, it was noted that the fourth formant was not universally present preoperatively but was present in all patients postoperatively and at 4 weeks. CONCLUSIONS: Altering the dimensions of the oropharynx after tonsillectomy causes the first formant to rise but has no effect on the third and fourth formants. However, the fourth formant appears in patients who previously did not demonstrate it. The fourth formant was present in a greater proportion of male patients preoperatively than female patients, but it was universally present postoperatively and at 4 weeks in both sexes. This suggests that increasing the horizontal dimensions of the oropharynx has a nontransient effect on the higher order formants of the voice.

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