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Patients with Stickler syndrome are at high risk of giant retinal tears (GRTs) and detachments. Vitreoretinal interventions can reduce this risk but there is presently no consensus about the optimal prophylactic approach. The aim of our study was to determine whether 360° laser prophylaxis is a safe and effective procedure to prevent GRT detachments in Stickler syndrome patients.Study subjects were recruited retrospectively through the databases of the vitreoretinal and ophthalmic genetic tertiary services in Manchester, UK. Clinical data were collected including on prophylactic intervention, the occurrence of retinal detachment and the presence/type of retinal breaks.113 eyes from 63 patients with Stickler syndrome were studied; 72.6% (82/113) of these eyes received 360° laser prophylaxis. Of these 9% had a retinal detachment, but no GRTs occurred. Among the 27.4% (31/113) of eyes that had no prophylactic treatment, 23% suffered a retinal detachment and 42.9% of these were associated with a GRT.Patients who underwent laser prophylaxis had fewer retinal detachments and no GRTs during an average of 6.1 years follow-up (median 5 years), suggesting that this is a safe and effective approach for individuals with Stickler syndrome.

PURPOSE To evaluate the efficacy of repeat pars plana vitrectomy and gas tamponade for persistent macular holes (MHs), especially looking at a predictive value of optical coherence tomography parameters in revisional surgery. METHODS Retrospective, nonrandomized interventional case series of consecutive patients with a persistent MH that underwent revisional pars plana vitrectomy and gas tamponade. The primary outcome measure was anatomical closure of the MH after revisional surgery. The secondary outcome measure was a functional outcome of the MH closure based on the best-corrected visual acuity. The changes of minimum linear diameter and MH index after the primary surgery were evaluated to see if they were prognostic markers of success for the revisional surgery. RESULTS A total of 27 patients with a persistent MH after primary MH surgery were identified, all of whom underwent a second operation with pars plana vitrectomy and gas tamponade with an internal limiting membrane peel extension in 20 cases. The MH closure rate after revisional surgery was 89% (24/27). Twenty-two cases were included in the optical coherence tomography analysis, of which 14 MHs that showed both a reduction of the minimum linear diameter and an increase in the MH index after the primary repair closed after revisional surgery. The mean best-corrected visual acuity before revisional surgery was 0.86 logMAR (20/145 Snellen) but increased significantly postoperatively to 0.69 (±0.15) logMAR (20/98 Snellen) at 3 months and to 0.49 logMAR (20/62 Snellen) at 12 months. CONCLUSION For a persistent idiopathic MH, simple repeat pars plana vitrectomy with gas tamponade has a good anatomical and functional success rate in selected cases. The minimum linear diameter and MH index can be useful optical coherence tomography markers for prognostic guidance.

Purpose To evaluate a sequential approach of pneumatic displacement followed by vitrectomy (PPV) in failed cases to deal with submacular haemorrhage (SMH) of various aetiologies. Methods Retrospective, non-randomised interventional case series of consecutive patients with SMH of up to 2-weeks' duration, who were treated with a stepwise approach. Step 1 involved intravitreal injection of 0.3ml 100% C3F8 and rt-PA 50mcg/0.1ml. If unsuccessful, a prompt PPV with subretinal rt-PA 50mcg/0.1ml and 20% SF6 gas tamponade was carried out as a second attempt to displace the SMH. Results Thirty-one patients with SMH underwent pneumatic displacement; 24 (77.4%) had a successful outcome without further intervention. The mean presenting visual acuity (VA) of the 'successful cohort' was 1.34 logMAR (20/440 snellen), improving to 0.83 logMAR (20/135 snellen) 1-month after treatment. Five out of the 7 patients with failed pneumatic displacement underwent PPV with subretinal rt-PA at an average of 5 days post-step 1, with successful SMH displacement in 3 patients, giving an overall success of 87.1% for this treatment protocol. Conclusion A sequential approach of expansile gas injection followed by prompt PPV, aided by rt-PA at both steps, is a coherent, logical pathway to treat submacular haemorrhage with high anatomical and functional success.