7 research outputs found
Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32)
No full textPurpose: To compare Kaplan-Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes. Methods: We obtained data on all patients with Fuchs endothelial dystrophy (FED) receiving a first corneal transplant in one eye between January 2012 and December 2017. We produced 2-year Kaplan-Meier graft survival curves to compare a simulated individual surgeon's graft survival rate to national pooled data. We used funnel plots to compare all surgeon outcomes to the national graft survival rate with superimposed 95 and 99.8% confidence limits. We defined an outlier as a surgeon who performed ≥10 transplants and had graft survival below the 99.8% national lower limit. To assess the effect of the surgeon case mix, we also compared unadjusted and risk-adjusted graft survival rates. Results: There were 3616 first corneal transplants for FED patients with complete data, performed or overseen by 196 surgeons. The 2-year national graft survival rate was 88%. The median change from the unadjusted to the risk-adjusted graft survival rate for individual surgeons was 0% (IQR: 0%- -2%). Of the 108 surgeons who had performed ≥10 transplants, we identified two outliers based on the unadjusted graft survival funnel plot, compared to four outliers based on the risk-adjusted graft survival funnel plot. Conclusion: Funnel plots provide a visually accessible method for comparing individual graft survival rates to the national rate. Risk-adjustment accounts for clinical factors, and this has advantages for audit and clinical governance.https://www.nature.com/articles/s41433-022-02100-
Primary Myoepithelial Carcinoma of the Conjunctiva
No full textA 38-year-old female, otherwise fit and well, presented with a mass on her left medial bulbar conjunctiva that had been enlarging for several months. Examinations showed a fixed pinkish tumour, 9 mm in maximum extent, spanning from the plica to the medial limbus. The tumour was removed in toto. Histology revealed it to be a biphasic tumour composed of lobules and infiltrative cords within a sclerotic matrix. The cells were spindle-shaped to epithelioid, with nuclear atypia and occasional mitotic figures. The tumour was positive for smooth muscle actin, beta-catenin, and vimentin. All other markers of myoepithelial differentiation and cytokeratins were negative. Genetic analysis showed no evidence of <i>EWSR1</i> or <i>PLAG1</i> rearrangements. The light microscopic features and immunohistochemistry strongly supported a tumour with myoepithelial differentiation. The cellular atypia, mitotic activity, and infiltrative edges all pointed to myoepithelial carcinoma. Body imaging/screening showed no evidence of tumour elsewhere, supporting that the tumour was a primary of the conjunctiva. This is the first report of a myoepithelial tumour of the conjunctiva. The patient remains recurrence-free after 3 years of follow-up.</jats:p
