John Eye Hospital Research Articles

Enucleation and evisceration in the Palestinian territories

Purpose:To examine the demographics and indications in patients undergoing eye removal at St. John Eye Hospital (SJEH) in Jerusalem, the largest single provider of ophthalmic care in the Palestinian Territories.Materials and Methods:In this retrospective study, medical records were reviewed for patients undergoing enucleation or evisceration at SJEH from November 2004 to March 2007. Calculation of percentage, mean and median was performed for the demographics, and indications for enucleation and evisceration.Results:Thirty-three eyes of 32 patients were removed during the period under study. Twelve enucleations and 21 eviscerations were performed. Mean age was 39 years, and 19 patients were male. Indications included severe trauma (8 eyes), painful blind eye with (5 eyes) or without (9 eyes) infection, and ophthalmic neoplasm (3 eyes).Conclusion:The incidence of surgical eye removal at SJEH from 2004 to 2007 was around one patient per month for a population over three million. This rate appears far lower than those reported in previous studies of similar Palestinian populations. Prompt access to medical care for Palestinians is required to mitigate ophthalmic morbidity. Approximately half of the cases were caused by severe trauma or infection, with rubber bullet injuries responsible for 20% of the traumatic cases.

The St John Eye Hospital: A Bridge for Peace

The article offers information on the Saint John Eye Hospital in east Jerusalem. It is stated to be a bridge for peace in a world at war. It serves as the main center for specialized eye care in the West Bank, Gaza, and east Jerusalem. The eye hospital started in 1882, and was then located in Ottoman Empire Jerusalem. It closed in 1914, during World War I, but reopened in 1919. It is said to be the only public hospital in the region specializing in ophthalmology. It is stated to place a high priority on training local doctors and nurses. Patients are predominantly Palestinians. The hospital operates a number of satellite clinics in areas where public services are not easily available. It works to eliminate the main causes of preventable blindness.

Corneal transplant outcome in the Palestinian territories: a 2-year follow-up study

To review the 2-year corneal transplant outcome in a cohort of patients from the Palestinian territories transplanted at the St John Eye Hospital in East Jerusalem in 2001-2002. Two-year follow-up data were recorded on the Swedish Corneal Transplant Register for 99 of the 161 patients originally transplanted. Multiple regression analyses (linear and logistic) were carried out to determine the influence of diagnosis, preoperative risk factors, and postoperative complications on graft survival and visual outcome. The incidence of preoperative risk factors in keratoconus patients was similar to other diagnoses (P=0.4) but they had fewer postoperative complications (39 vs 77%, P<0.001). Graft survival was higher in the keratoconus group (96 vs 49%, P<0.001). Visual outcome was also better with 47% of patients achieving VA >or=0.5 (6/12) whereas 88% of the other patients had VA <or=0.2 (6/30). However, 49% of these other patients did gain at least one Snellen line. Indication had the strongest influence on graft survival and visual outcome. Although the overall results were not so good as in Sweden, the majority of Palestinian patients did show some improvement in vision after corneal transplantation.

The neurosurgeon shadowed by Ian McEwan for his latest book

N eil Kitchen is a consultant neurosurgeon and associate clinical director at the National Hospital for Neurology and Neurosurgery in London. He studied medicine at Bart's and University College Hospitals in London and at Addenbrooke's Hospital in Cambridge. (He opted to do his clinical training at Addenbrooke's because it was six months shorter than in London and he says he was impatient.) Before heading up to Cambridge he squeezed in a BSc in the history of medicine at the Wellcome Institute. He briefly flirted with ophthalmology and spent a month at the St John Eye Hospital in Jerusalem before taking up a surgical house post at Addenbrooke's. Mr Kitchen has also worked at Bart's, Charing Cross Hospital, the Royal Free, Atkinson Morley's, Southend Hospital, and the National Hospital for Neurology and Neurosurgery.⇓ He was introduced to me by a mutual friend, …

Nonpenetrating filtration surgery for glaucoma: control by surgery only

Purpose To report on intraocular pressure (IOP) control by nonpenetrating filtration surgery without medical treatment in eyes with primary open-angle glaucoma (POAG). Setting Oxford Eye Center and St. John Eye Hospital, Johannesburg, South Africa. Methods This retrospective study evaluated IOP control by nonpenetrating filtration surgery in 46 patients (86 eyes) with POAG who had surgery between February 1992 and February 1998 (mean follow-up 46 months); 48 eyes were previously treated, and 38 were newly diagnosed, untreated eyes. Under a trapezoidal scleral flap, a deep sclerectomy and a fenestration in Schlemm’s canal were created without penetrating the anterior chamber. Postoperatively, when IOP rose above 20 mm Hg, instead of adding medical treatment, the filtration site was revised to re-establish filtration. Results The mean drop in IOP was 50%, from a mean of 30.4 mm Hg preoperatively to a mean of 15.35 mm Hg postoperatively. After a mean period of successful filtration of 29.9 months, the filtration site was revised in 48 eyes (56%) to maintain the IOP below 21 mm Hg without medication. The reoperation rate was 4.7 times higher in previously treated patients than in untreated patients. Conclusions Nonpenetrating filtration surgery in eyes with POAG was more rewarding in untreated patients than in medically treated patients. To control IOP without medication, revision of the filtration site is feasible and needed in the medium and long term.

Choice of lens and dioptric power in pediatric pseudophakia

Purpose: To evaluate lens choice and dioptric power in pediatric eyes having posterior chamber intraocular lens (IOL) implantation.Setting: Oxford Eye Center and the St. John Eye Hospital, Johannesburg, South Africa.Methods: This retrospective study evaluated the refractive development in 156 pseudophakic eyes of 99 children aged 1 month to 8 years who had surgery between June 1983 and April 1994. The children were divided into three groups based on age at time of IOL implantation: Group A (68 eyes), 1 to 18 months; Group B (32 eyes), 19 to 36 months; Group C (48 eyes), 3 to 8 years. Poly(methyl methacrylate) posterior chamber IOLs with an overall diameter between 10.5 and 12.0 mm were used. The dioptric power was 3.00 to 6.00 diopters (D) less than that needed to achieve emmetropia.Results: In Group A, the mean growth in axial length was 3.59 mm ± 1.80 (SD) and the mean change in refraction was 6.39 ± 3.68 D. In Group B, the respective means were 0.75 ± 0.85 mm and 2.73 ± 1.40 D and in Group C, 0.76 ± 0.69 mm and 2.60 ± 1.84 D.Conclusions: The younger the child at time of implantation, the greater the myopic shift. To reduce the necessity of IOL exchange, these eyes should be undercorrected, with the residual refractive error corrected by spectacles that are adjusted throughout life according to refractive development. This leads to initial hypermetropia that gradually moves to emmetropia or moderate myopia in adulthood.

Comparison of Early Postoperative Complications in Trabeculectomies Alone Versus Trabeculectomies with Cataract Extraction

OBJECTIVE: To compare the rate of early postoperative complications in trabeculectomies alone vs. combined procedures. STUDY DESIGN: Retrospective analysis of files of patients who underwent trabeculectomies or combined procedures between 1 January 1988 and 31 December 1990. SETTING: St John Eye Hospital, Johannesburg. PATIENTS: One hundred and twenty-one patients underwent trabeculectomy alone and 55 had combined procedures. All patients were older than 58 years. MAIN OUTCOME MEASURES: Postoperative complications, cataract formation, change in visual acuity and IOP control. RESULTS: The incidence of anterior chamber loss in trabeculectomies was 20.7% vs . 5.4% in combined procedures. Choroidal detachments (4%), hyphemas (10%), and transient elevation of IOP (11%) occurred almost equally in both groups. Cataract formation was accelerated particularly in trabeculectomy patients who suffered from transient loss of anterior chamber. Consequently, the visual acuity dropped markedly in 20.7% of the trabeculectomy patients postoperatively, whereas 90.9% of patients in the combined procedure group improved their visual acuity. The IOP control was similar in both groups. CONCLUSIONS: The cataractogenic effect of trabeculectomies in elderly patients is amplified when transient loss of anterior chamber occurs. These data suggest that a combined procedure may be not only safer, but also more rewarding than trabeculectomy alone in an elderly patient requiring filtering surgery.