Log in
Cataract causes blindness in millions of people worldwide. It is treated surgically by replacing the clouded lens with an artificial lens and more than 30 million such operations per year are predicted by 2020. Unfortunately, many of these patients are subsequently blighted by posterior capsule opacification (PCO) a wound-healing response by lens epithelial cells to surgical trauma. Using human donor eyes, Wormstone and Duncan developed a technique that simulated cataract operations and provided an ideal system to understand PCO biology. This technology was a key platform in developing a novel commercial intraocular lens (IOL), which shows massive reductions in PCO rates.
The most frequent surgical procedure undertaken in the NHS is cataract surgery and it improves vision and quality of life (QoL). In the 1990's there were long waiting times for cataract surgery with rationing most frequently restricting surgery on the 2nd eye. A randomised controlled trial undertaken at the University of Bristol (UoB) demonstrated clear QoL benefits from 2nd eye cataract surgery, followed by a population study quantifying population requirements for 1st and 2nd eye surgery and the surgical backlog. Government policy, announced in `Action on Cataracts — Good Practice Guidance, 2000', advised that the volume cataract surgery, including on the 2nd eye, should be increased. This policy ensured timely access to surgery becoming routine practice in the NHS, thus improving the lives of thousands of people. Second-eye surgery rates rose from ~25% of operations to 35-40%, with overall increases in operations for patients needing surgery (e.g. in England up from 201,682 operations in 1998-1999 to 332,625 in 2009-2010) and reduced waiting times. These improvements were sustained through to the end of the 2000's. The research has become highly relevant again as the NHS enters another period of constrained expenditure.
University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.
Glaucoma is one of the major causes of blindness world-wide and is characterised by visual loss arising from death of retinal ganglion cells. One important form, angle-closure glaucoma, is particularly prevalent in Asia. Based on experience of large-scale epidemiological surveys, UCL researchers devised a classification for angle-closure glaucoma that has become the international standard for this condition. The research been used as the basis for the development of the current framework for the management of angle-closure glaucoma, informing the development of both new and revised guidelines used around the world.
Our research on alternatives to medication in the treatment of childhood epilepsy has resulted in increasing rates of surgery with better outcomes, and a new clinical service — the national Children's Epilepsy Surgery Service (CESS) — being commissioned in England and Wales. We have also developed an evidence base for ketogenic dietary therapy, resulting in an increase in service provision. Many more patients are benefiting from this therapy, which is now recommended in NICE guidelines. Throughout our programme of research we have engaged with charities and patient groups to disseminate the results of our research as widely as possible.
The MRC Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer trial (CLASICC) is the largest and most successful UK trial of a technology applied to general surgery. It addressed an area of huge clinical uncertainty, providing a rigorous evaluation of a new technology and enabling its safe and widespread implementation. The impact of CLASICC has been global, confirming the advantages for patients (quicker recovery) and healthcare providers (cost-effectiveness) and so influencing national and international policy in favour of the laparoscopic technique. It informed NICE guidance and led to a major DH initiative that has seen the UK become one of the largest providers in the world of laparoscopic colorectal cancer surgery. CLASICC is regarded as a benchmark surgical trial, combining high quality trial design with rigorous quality assurance, which has informed the design of many subsequent colorectal cancer studies.
Recent advances in MRI brain scanning developed at the UCL Institute of Neurology have underpinned major improvements in the surgical treatment of epilepsy. Information about the location of critical brain structures, such as the optic radiation that carries visual signals, and language areas of the brain, are used to identify the risks of neurosurgery in specific individuals. This helps to inform patient choice and to reduce the risk of loss of any part of the visual field or language when performing the surgery. UCL's pioneering use of these imaging techniques during surgery, with correction of the movement of the brain that occurs during surgery, showed that this approach reduced the occurrence of serious loss of vision to zero. This information is now used in epilepsy surgery every week at the National Hospital for Neurology and Neurosurgery and is being rolled out to other centres.
Research at Strathclyde has brought about a change in eye surgery practice throughout Europe and worldwide. A four-year cross-Europe study in collaboration with the European Society of Cataract and Refractive Surgery (ESCRS) investigated antibiotic treatment to prevent endophthalmitis, a complication arising during cataract operations which typically results in loss of sight. The findings showed that when the treatment is given at the start of surgery it leads to a 5-fold reduction in the risk of endophthalmitis. The European Society of Cataract and Refractive Surgery has endorsed the discovery and widely promoted the uptake of the treatment through publications and guidelines, which over the last 6 years has led to the prevention of loss of sight in thousands of patients. In Europe alone it is estimated that each year there have been 7500 fewer cases of blindness following cataract surgery as a result of the ESCRS guidelines.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.
Collaboration between Professor Alison Brading at the University of Oxford and her clinical colleague, Professor Neil Mortensen, translated her pioneering research on the ability of nitric oxide to act as a neurotransmitter in smooth muscle into a new treatment for the common, painful, condition of anal fissure. For many years the principal treatment was elective surgery, which carries a risk of faecal incontinence. Nitric oxide donors are now used routinely to limit and resolve the development of anal fissure, improving the lifestyle of sufferers and reducing the economic costs associated with time off work and surgical intervention. The treatment has been in existence since 2000, but since 2008 it has repeatedly been confirmed as the most effective non-surgical intervention.