Hirut Von Lany

Royal Devon and Exeter NHS Foundation Trust, Exeter, England, United Kingdom

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Publications (11)32.9 Total impact

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    ABSTRACT: Microvascular dysfunction is associated with end-organ damage. Macular oedema is an important component of diabetic retinopathy. Macular thickness can be accurately quantified by optical coherence tomography (OCT), enabling accurate assessment of the macular prior to clinically apparent abnormalities. We investigated whether macular (fovea) thickness in non-diabetic individuals is related to the microvascular variables controlling fluid filtration across a blood vessel wall, in particular capillary pressure and the microvascular filtration capacity (Kf). We recruited 50 non-diabetic individuals (25 men, 25 women; age range: 26-78 years; BMI range: 20-46 kg/m(2)). Fovea thickness was assessed by OCT. Microvascular assessments included: finger nailfold capillary pressure; Kf; microvascular structural assessments, i.e. skin vasodilatory capacity, minimum vascular resistance (MVR) and microvascular distensibility; and endothelial function. At 214.6 (19.9) microm (mean [SD]), fovea thickness was within normal range. Capillary pressure, adjusted for BMI, was associated with fovea thickness (standardised beta 0.573, p = 0.006, linear regression). Fovea thickness was not associated with Kf, microvascular structural assessments or endothelial function. Capillary pressure was still associated with fovea thickness when adjusted for microvascular variables (Kf, vasodilatory capacity, MVR, microvascular distensibility or endothelial function), or for risk factors for diabetes (systemic blood pressure, insulin sensitivity, inflammation, glycaemic status and lipids) and age. Capillary pressure, a key determinant of movement of fluid across a blood vessel wall, is associated with fovea thickness in non-diabetic individuals. This suggests that with regard to potential preventative or therapeutic targets, attention should be directed at the mechanisms determining retinal microvascular pressure.
    Diabetologia 09/2010; 53(9):2029-35. DOI:10.1007/s00125-010-1805-x · 6.88 Impact Factor
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    ABSTRACT: To identify the clinical features and outcomes of infectious endophthalmitis in New Zealand. A retrospective review was performed on all patients presenting at Auckland Public Hospital with presumed infectious endophthalmitis between 1996 and 2004. One hundred and six patients were diagnosed with infectious endophthalmitis over the 9-year study period. More than half the infections occurred in the perioperative setting (58.5%), with the next most common group being patients with a history of ocular trauma (18.9%). Endogenous endophthalmitis accounted for 16.0% of the cases while a small percentage arose from other causes. The mean interval between the onset of symptoms and presentation was 4.2 +/- 7.9 days. There was no significant difference in outcomes between clinical settings (P = 0.616) or between gram-positive, gram-negative and fungal infections (P = 0.090). Evisceration/enucleation was more likely in Pacific peoples and those with poor presenting visual acuity. The most common clinical scenario for patients presenting with presumed infectious endophthalmitis in this series was in the perioperative setting. We did not find that the prognosis was influenced by the microbiological isolate or clinical setting. However, those patients presenting with poor acuities typically had the worst outcomes. Pacific ethnicity was also associated with increased rate of complications.
    Clinical and Experimental Ophthalmology 11/2008; 36(7):631-6. DOI:10.1111/j.1442-9071.2008.01813.x · 1.95 Impact Factor
  • 13th Annual Meeting of the European-Council-for-Cardiovascular-Research; 10/2008
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    ABSTRACT: To study the epidemiology and risk factors contributing to displacement of nuclear fragments into the vitreous (DNFV) complicating phacoemulsification in the UK. Cases were collected prospectively between March 2003 and March 2004 by active surveillance through the British Ophthalmological Surveillance Unit (BOSU). Case-control analysis of risk factors was performed by visiting 10 randomly selected centres using a total of 521 cases of uncomplicated phacoemulsification. Validation analysis to assess under-reporting was performed in a total of 13 randomly selected units. 610 cases of DNFV were confirmed during the reporting period. The estimated incidence of DNFV was 0.19-0.28%. The group with complications was significantly older than the control group (mean 76.8 vs 74.3 years: p<0.001). Significant preoperative risk factors were posterior synechiae (5.1% vs 2.2%), incomplete pupil dilation (59.5% vs 8.8%), pseudoexfoliation (5.6% vs 1.4%) and previous vitrectomy (7.8% vs 2.2%). Significant operative variables related to surgical experience, topical (14.3% vs 3.1%) and sub-Tenon's (51.4% vs 37.2%) anaesthesia, and requirement for vision blue (trypan blue ophthalmic solution) (13.7% vs 2.4%). The estimated incidence of DNFV during phacoemulsification surgery in the UK is two or three per 1000 operations. Risk factors have been identified that should help to guide case selection for phacoemulsification surgery and modify techniques.
    The British journal of ophthalmology 04/2008; 92(4):488-92. DOI:10.1136/bjo.2007.113936 · 2.81 Impact Factor
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    ABSTRACT: To study the clinical features, management and outcomes of displacement of nuclear fragments into the vitreous (DNFV) complicating phacoemulsification in the UK. Cases were collected prospectively between March 2003 and March 2004 inclusive by active surveillance through the British Ophthalmological Surveillance Unit. Details were obtained using incidence questionnaires and follow-up questionnaires after 6 months. The data used in this paper were obtained from the follow-up questionnaires. 610 cases were confirmed during the reporting period, for which 387 follow-up questionnaires were received. In 67% of cases, a best-corrected visual acuity of 6/12 or better was reported at final follow-up. The most common immediate sequelae of DNFV were intraocular inflammation (85%), corneal oedema (55%) and an intraocular pressure >30 mm Hg (34%). Pars plana vitreolensectomy was used in 97% of cases, and fragmatome ultrasound lensectomy was used in over half of these procedures. The median time from cataract surgery to pars plana vitrectomy for the removal of DNFV was 3 days, and most patients (68%) had vitrectomy within 1 week of the first procedure. An intraocular lens had been inserted at the time of the complicated cataract surgery (defined as a "primary IOL") in 40% of cases, and over three-quarters of these primary IOLs were subsequently removed (with or without a replacement IOL). Only 67% of eyes that had a primary IOL inserted after DNFV were pseudophakic at final follow-up, in contrast with 79% of eyes that were left aphakic after DNFV (p = 0.008). A best-corrected visual acuity of 6/60 or worse was reported in 14% of cases at final follow-up and was most commonly associated with persistent uveitis, corneal oedema, cystoid macular oedema, optic atrophy or retinal detachment. DNFV complicating cataract surgery was followed by a secondary procedure in 97% of cases. About three-quarters (77%) of "primary IOLs" inserted at the time of DNFV were subsequently removed or replaced, and eyes that had received a primary IOL had significantly less chance of being pseudophakic at final follow-up than eyes that had been left primarily aphakic at the time of the complicated cataract surgery. The delay before secondary intervention was shorter, fragmatome ultrasound lensectomy use was higher, and the retinal detachment rate was lower than in previous studies. Affected eyes still had a worse outcome in terms of visual acuity compared with eyes after uncomplicated cataract surgery.
    The British journal of ophthalmology 04/2008; 92(4):493-5. DOI:10.1136/bjo.2007.114637 · 2.81 Impact Factor
  • J S Gilhotra, H Von Lany, D M Sharp
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    ABSTRACT: A 35-year-old female who had suffered from acute lead poisoning when she was 22 years old, presented 13 years later with loss of vision in the right eye and normal vision in the left eye. She had a pale disc, narrowed arterioles and mid-peripheral heavy pigmentation, right eye being more affected than the left eye. Electrodiagnostic tests identified marked asymmetry of visual function. We would postulate lead retinal toxicity as the cause of the asymmetric findings.
    Indian Journal of Ophthalmology 01/2007; 55(2):152-4. DOI:10.4103/0301-4738.30716 · 0.93 Impact Factor
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    ABSTRACT: To evaluate the effect of on-axis opposite clear corneal incisions (OCCIs) in phacoemulsification on reducing preoperative corneal astigmatism and to predict the astigmatic outcome of the incisions. Royal Eye Infirmary, Dorset County Hospital, and Winterbourne Hospital, Dorchester, Dorset, and the Department of Ophthalmology, East Somerset Hospital, Yeovil, Somerset, United Kingdom. This prospective study included all patients (n = 103) who had on-axis OCCIs as a part of routine phacoemulsification with foldable intraocular lens (IOL) implantation performed by 1 surgeon during 2000. Keratometry was done 6 to 8 weeks postoperatively. The differences in the preoperative and postoperative corneal astigmatism and corneal spherical equivalent (SE) were recorded. Surgically induced astigmatism (SIA) was calculated using vector analysis. The mean reduction in corneal astigmatism was 0.50 diopter (D) (P<.001). The mean SIA was 1.57 D (95% confidence interval [CI], 1.42 to 1.71). There was a weak association between the SIA and the patient's age and axis of preoperative astigmatism. The mean change in SE was +0.02 D (95% CI, -0.08 to +0.12). Results indicate that on-axis OCCIs are a reliable and practical way of reducing preexisting corneal astigmatism. The change in SE was negligible and thus can be ignored during biometry.
    Journal of Cataract and Refractive Surgery 02/2004; 30(2):414-7. DOI:10.1016/S0886-3350(03)00649-7 · 2.55 Impact Factor
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    C T Ung, H Von Lany, K G Claridge
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    ABSTRACT: Case reportsThe demographic details of all cases are summarised in Table 1 1.Table 1Demographic details of patientsGlaucoma surgery had taken place between 8 and 31 years before bleb needling and in no case had antimitotics been used at the original surgery. Before bleb needling the average intraocular pressure (IOP) among the patients was 29.4 mm Hg (range 19–58). Each patient showed glaucomatous deterioration despite being on maximum tolerated medical therapy, taking on average three ocular hypotensive agents, and in two cases oral acetazolamide. In all cases an open sclerotomy was confirmed by gonioscopy.All procedures were performed in the outpatient clinic, by either a consultant or associate specialist, using a slit lamp. The eye was anaesthetised with amethocaine eye drops 1%, and phenylephrine eye drops 2.5% were used for vasoconstriction. After several drops of chloramphenicol the conjunctiva was entered several millimetres from the flap site with a 27 gauge needle mounted on an insulin syringe. In one case aqueous flow was established after perforating scar tissue around an encysted bleb, whereas in the others it was necessary to dissect beneath the scleral flap and enter the anterior chamber. After creating a bleb and confirming a reduction in IOP by applanation tonometry, 5 mg 5-FU (25 mg/ml) were injected into the subconjunctival space around the bleb. After needling, all hypotensive therapies were stopped and replaced by intensive topical steroids and chloramphenicol. The steroid was titrated, and repeat injections of 5-FU with or without needling were given, according to the IOP and appearance of the bleb.After 12 months’ follow up from the last needling (Table 2 2),), average IOP was reduced to 14 mm Hg (range 9–17). There was no change in the patients′ visual acuity. Two cases developed a mild corneal epitheliopathy that healed within 8 weeks. There were no other complications from the needling procedure.Table 2Results of pre-bleb and post-bleb needling with a 12 month follow up period
    British Journal of Ophthalmology 12/2003; 87(11):1430-1. · 2.81 Impact Factor
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    A Berry-Brincat, H Von Lany, N Evans
    Eye 05/2003; 17(3):449-51. DOI:10.1038/sj.eye.6700336 · 1.90 Impact Factor
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    Eye 05/2001; 15(Pt 2):235-6. DOI:10.1038/eye.2001.72 · 1.90 Impact Factor
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    ABSTRACT: Adjustable sutures are widely used in adult strabismus surgery, with a second procedure performed to close the conjunctiva irrespective of whether adjustment is required. We describe a technique where the conjunctiva is closed using a buried releasable suture, eliminating the second procedure if adjustment is deemed unnecessary. The conjunctiva is closed using a 6/0 absorbable polyglactin 910 releasable suture. It is tied in a bow, like the muscle sutures, and tucked under the conjunctiva. If adjustment is not required, the eye does not need to be touched because the conjunctiva is secured by the suture. If adjustment is required, it is easy to untie the conjunctival suture, allowing good exposure to the underlying muscle sutures. In our prospective series of 30 patients, we found our technique effective and patient friendly. Patients had at least 3 months of follow-up with no significant complications. This technique is acceptable, accessible, and time saving for both surgeons and patients. It is especially useful for anxious patients and adolescents, for whom postoperative manipulation can be difficult, and for cases where the probability of adjustment is low.
    Journal of Pediatric Ophthalmology & Strabismus 44(1):35-8. · 0.73 Impact Factor

Publication Stats

72 Citations
32.90 Total Impact Points


  • 2010
    • Royal Devon and Exeter NHS Foundation Trust
      Exeter, England, United Kingdom
  • 2008
    • University of Auckland
      • Department of Ophthalmology
      Окленд, Auckland, New Zealand
  • 2004
    • Dorset County Hospital NHS Foundation Trust
      Dorchester, England, United Kingdom