Laura A Wakely

Wellington Hospital, Веллингтон, England, United Kingdom

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Publications (7)14.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the effect of scleral flap size on the medium-term intraocular pressure control and complication rates after augmented trabeculectomy. Prospective randomized clinical trial. Glaucoma patients undergoing primary trabeculectomy. Exclusion criteria included previous ocular surgery apart from cataract surgery, secondary glaucoma and age under 18. Patients were randomized to either standard trabeculectomy (4 × 4 mm scleral flap) or microtrabeculectomy (2 × 2 mm scleral flap), both with adjustable sutures and antimetabolites. Bleb needling was performed as required. Patients were evaluated at day 1, weeks 1, 3, 6 and months 3, 6, 12, 18 and 24 postoperatively. Vision, intraocular pressure, complications and failure (intraocular pressure ≥ 21 mmHg or not reduced by ≥20% from baseline, intraocular pressure ≤ 5 mmHg, repeat glaucoma surgery and no light perception vision). Results: Forty-one patients were recruited; 20 had standard trabeculectomy, and 21 had microtrabeculectomy. At 2 years, the mean intraocular pressure and cumulative probability of failure was 12.4 ± 4.6 mmHg and 0.28 for standard trabeculectomy, and 11.5 ± 3.6 mmHg and 0.27 for microtrabeculectomy (P = 0.50 and 0.89, respectively). One patient in each group required Baerveldt device implantation. Vision reduced ≥2 Snellen lines in 15% in the standard trabeculectomy group and 25% in the microtrabeculectomy group, mainly from cataract (P = 0.48). Both trabeculectomy techniques achieved good intraocular pressure reduction and had similar complication rates. Scleral flap size had no significant effect on medium-term intraocular pressure control and complication profile.
    Clinical and Experimental Ophthalmology 02/2011; 39(7):648-57. DOI:10.1111/j.1442-9071.2011.02534.x · 2.35 Impact Factor
  • Anthony P Wells · Laura Wakely · Wayne Birchall
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    ABSTRACT: The miniaturization of confocal imaging technology has resulted in the development of a handheld confocal microscope probe capable of fluorescence mode imaging. Findings in the subepithelial tissues of glaucoma filtering blebs using this novel approach for proof of concept are described. A fiberoptic confocal imaging probe using an illumination wavelength of 488 nm was applied to the bleb surface of 11 eyes after topical or subconjunctival administration of sodium fluorescein. The imaging plane was moved to the subepithelial region and multiple images from multiple bleb regions were captured at a resolution of 1,024 x 1,024 pixels per square inch. High-quality images of the bleb wall structure, vasculature, and superficial sclera were obtained and demonstrated subcellular detail. Lateral resolution was between 1 and 1.5 microm and axial resolution was approximately 30 microm. Identifiable structures in the failing blebs included vasculature (including individual erythrocytes, pericytes, and vascular endothelium); microcystic structures; and cells within the Tenon's tissue, some of which resembled fibroblasts. Fluorescence mode imaging of ocular subsurface detail is a viable and promising tool for assessment of wound healing and other processes in trabeculectomy blebs. The ability to image fluorophores creates the possibility of functional imaging.
    Ophthalmic Surgery Lasers and Imaging 01/2010; 41(1):78-82. DOI:10.3928/15428877-20091230-14 · 1.32 Impact Factor
  • Wayne Birchall · Laura Wakely · Anthony P Wells
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    ABSTRACT: To assess the effect on intraocular pressure (IOP) of varying the length of the side incisions of the scleral flap during trabeculectomy. Trabeculectomy operations were performed with adjustable sutures on 8 donor human eyes connected to a constant flow infusion with real-time IOP monitoring, using either a large (4 x 4 mm, 16 mm, n=8) or a small (3 x 2 mm, 6 mm, n=8) scleral flap. For each flap the side incisions began 1 mm behind the limbus and extended to the posterior edge of the flap. The side incisions were extended sequentially in 0.5-mm steps up to the limbus, then each flap dissected 1 mm further into clear cornea. Mean IOP after sclerostomy fashioning was 0.84 mm Hg (range 0 to 2.7 mm Hg). After flap closure, with side incisions extending to 1 mm behind the limbus, mean IOP was 21.6 mm Hg (79.5% of baseline) and 23.03 mm Hg (79.2% of baseline) for large and small flaps (P=0.26). In each size group, extending flap side incisions to the limbus produced a small nonsignificant fall in mean IOP, whereas flap extension 1 mm into clear cornea led to a significantly lower mean IOP relative to baseline of 43.2% (P<0.05) for large flaps and 35.4% for small flaps (P<0.01). Using this adjustable suture technique, IOP is well maintained for both flap sizes if the flap and side incisions do not extend beyond the limbus. Excessive forward dissection of a scleral flap into the clear cornea, anterior to the sclerostomy may result in increased aqueous outflow and lower IOP.
    Journal of Glaucoma 09/2006; 15(4):286-90. DOI:10.1097/01.ijg.0000212241.18842.83 · 2.11 Impact Factor
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    ABSTRACT: To assess the efficacy of Celecoxib, a cyclo-oxygenase 2 (COX-2) inhibitor, as prophylaxis for cystoid macular oedema after routine cataract surgery. A prospective, randomized, double-blind placebo-controlled trial of 69 hospital patients undergoing cataract surgery. Celecoxib 200 mg twice daily or placebo was given immediately after surgery for 14 days. Optical coherence tomography was used to quantify macular thickness before surgery and on day 1, week 2 and week 6 after surgery. Sixty-nine patients were enrolled, of which 33 received placebo and 36 received active drug. Clinically apparent cystoid macular oedema occurred in four of the treatment group and two of the placebo group (P = 0.68). No difference in best-corrected visual acuity was seen at 6 weeks (P = 0.37). Covariate analysis of the results at 2 weeks and 6 weeks showed a macular thickness of 3% less in the treatment group compared with placebo (P = 0.050). Celecoxib may decrease macular thickening following routine cataract surgery at 2 and 6 weeks after surgery as measured by Stratus OCT III. No difference in best-corrected visual acuity or clinically apparent cystoid macular oedema was seen. Further investigation of COX-2 inhibitors in a larger prospective randomized trial is required.
    Clinical and Experimental Ophthalmology 05/2006; 34(4):299-304. DOI:10.1111/j.1442-9071.2006.01213.x · 2.35 Impact Factor
  • Source
    A P Wells · L Wakely · W Birchall · P M Delaney
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    ABSTRACT: Recent developments in the miniaturization of confocal imaging technology have resulted in the development of a hand-held confocal microscope probe. There are many structures of interest in the human eye that are within reach of a fluorescence-mode confocal microscope; this study assessed the feasibility of in vivo human ocular imaging. Safety analysis was undertaken to ensure that the laser light applied to the ocular surface structures constituted no threat to patient safety. A fibreoptic confocal imaging (FOCI) probe using an illumination wavelength of 488 nm was applied to the ocular surface of four volunteers after topical administration of sodium fluorescein. Stabilization of the probe on the ocular surface was difficult, but movement artefacts could be minimized to a satisfactory level in most subjects by a variety of procedures. High-quality images of conjunctival epithelial and goblet cells, lamina propria structures, accessory lacrimal glands, lacrimal ducts and superficial sclera were obtained. Lateral resolution was 1-1.5 microm and axial resolution was approximately 30 microm; individual erythrocytes could be seen in conjunctival vessels. The rete ridges and intervening epithelial components, including the probable location of corneal limbal stem cells, could be viewed, although it was not possible to distinguish cell subgroups. The study showed that fluorescence-mode imaging of the ocular surface is a viable and promising tool for assessment of diseases and processes involving superficial ocular structures. Refinement of equipment and techniques, particularly probe stabilization, is necessary to realize fully the potential of FOCI for ocular use.
    Journal of Anatomy 03/2006; 208(2):197-203. DOI:10.1111/j.1469-7580.2006.00521.x · 2.10 Impact Factor
  • Clinical and Experimental Ophthalmology 05/2005; 33(2):218-9. DOI:10.1111/j.1442-9071.2005.00957.x · 2.35 Impact Factor
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    ABSTRACT: The case is presented of a highly aggressive congenital epithelial cyst of the anterior chamber. The patient underwent four primary procedures to remove the cyst and its three recurrences, and one procedure for secondary glaucoma. The primary cyst and first recurrence occurred in the anterior chamber, whereas the second and third recurrences occurred in the pars plana region. Attempts at optical correction of the eye were weighed against complications arising from further procedures, and a conservative approach favouring preservation of the eye became the management strategy in this case.
    Clinical and Experimental Ophthalmology 04/2005; 33(2). · 2.35 Impact Factor

Publication Stats

19 Citations
14.91 Total Impact Points


  • 2005–2011
    • Wellington Hospital
      Веллингтон, England, United Kingdom
  • 2006
    • University of Otago
      • Ophthalmology Unit
      Taieri, Otago Region, New Zealand