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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.

Introduction: The UK Government imposed a COVID19 lockdown (LD) restricting all but essential activities from 24th March 2020. Subsequently, there has been a significant reduction in casualty attendances nationwide including for ophthalmic emergencies. We aim to study the presentation of rhegmatogenous retinal detachments (RRD) and significant vitreous haemorrhage caused by posterior vitreous detachment (PVD-VH) in three tertiary centres covering most of the North West of England in the 6 weeks before and during the lockdown. Methods: A retrospective multicenter non-randomised consecutive case series study was designed to collect information on all cases of RRD and PVD-VH requiring surgery presenting to the vitreoretinal departments of Manchester Royal Eye Hospital, East Lancashire NHS Foundation Trust and the Lancashire NHS Foundation Trust from 11th February to 4th May 2020. Results: A total of 137 eyes of 137 patients were identified between the three centres of which 132 eyes were operated for RRD. Of these, 86 (64.7%) were operated pre-LD compared with 46 eyes (34.8%) during LD. Forty-five out of 86 eyes (52.3%) were macula-off pre-LD compared with 31 out of 46 eyes (67.3%) during LD ( p = 0.06). There was lower proportion of non-PVD related RRD during LD (11 pre-LD to 1 during LD, p = 0.05). PVR was present in four cases during LD compared to 2 before ( p = 0.19). Conclusion: There was a clinically significant reduction in the overall incidence of RRD in our centres with an increase in the proportion of macula-off and proliferative vitreoretinopathy during the LD period compared to a similar period before.

The management of suprachoroidal haemorrhage (SCH) remains a challenge. We aimed to analyse and discuss the safety and efficacy outcomes of SCH drainage surgery over a 10-year period in one of the largest tertiary centres in the UK. Retrospective observational study of consecutive patients who underwent SCH drainage in Manchester Royal Eye Hospital over a 10-year period (from 2008 to 2018). Safety and efficacy were assessed by analysing surgery-related complications and functional and anatomical success. Outcomes of those who underwent external drainage alone versus combined drainage and vitrectomy were compared. Twenty consecutive patients with a mean age of 70 ± 19 years were studied. Age over 70 years, hypertension, cardiovascular disease, and glaucoma were the most common risk factors for SCH. Eleven patients underwent external drainage alone and nine patients had combined vitrectomy and drainage. Overall, mean pre-operative BCVA improved from 2.22 ± 0.26 logMAR (20/3319 Snellen) to 1.42 ± 1.02 LogMAR (20/526 Snellen) at last follow-up visit (p = 0.002). Severe hypotony occurred in 4 patients. Overall anatomical and functional success rates were both 75%. Drainage of SCH with or without vitrectomy is a valuable approach in the management of extensive SCH, a condition generally associated with poor prognosis. Suprachoroidal haemorrhage (SCH) is a sight threatening condition with a guarded visual prognosis. We present the functional and anatomical outcomes together with surgery-related complications of patients who underwent external drainage surgery alone or combined drainage and vitrectomy for SCH.

Background: The COVID-19 pandemic has posed global health care challenges. This paper examines the effect of the pandemic on patient numbers, demographics, type and severity of presentations to the emergency eye department (EED) at one of the largest tertiary referral eye hospitals in the United Kingdom (UK) and discusses the management strategies developed.Methods: Retrospective data was collected to compare a four week time frame during the pre-COVID-19 period (PCP; 6/1/20 to 2/2/20) with the COVID-19 period (CP; 23/3/20 to 19/4/20). Results: 2,664 patients were seen during the PCP and this decreased to 759 patients during the CP. This represented a significant decline in mean±SD daily patient presentations from 74±16 during the PCP to 27±7 during the CP (U=18.7, p2=1.37, p=0.50). There were 73 presentations with sight-threatening conditions during the PCP and 51 during the CP. The mean±SD number of patients who presented with sight-threatening conditions during the PCP (2.6±1.8) was not significantly different from the CP (1.8±1.4) (U=289.5, p=0.09).Conclusion: These findings reassure that current measures at the Manchester Royal Eye Hospital (MREH) are sufficiently robust for patients to access eye care services and ensure patient safety during the CP. Moreover, telemedicine has emerged as an effective tool to meet increasing demand in times of limited resources and may serve an important role in future patient care.

Age-related macular degeneration (AMD) is the leading cause of visual impairment in the western world, causing significant reduction in quality of life. Despite treatment advances, the burden of visual impairment caused by AMD continues to rise. In addition to traditional low vision rehabilitation and support, optical and electronic aids, and strategies to enhance the use of peripheral vision, implantable telescopic devices have been indicated as a surgical means of enhancing vision. Here we examine the literature on commercially available telescopic devices discussing their design, mode of action, surgical procedure and published outcomes on visual acuity, quality of life, surgical complication rates and cost effectiveness data where available. Funding Article processing charges were funded by VisionCare Inc.

The objective of this study was to present the results of combined phacovitrectomy using 1.8 mm microincision cataract surgery (MICS) with special emphasis on the anterior segment complications in this group. Retrospective, single-centre case series involving consecutive patients undergoing phacovitrectomy in a single centre in the United Kingdom during a 6-month period. A total of 52 eyes underwent combined MICS and pars plana vitrectomy. Intraoperative complications included posterior capsule rupture (n=2), minor iris trauma during phacoemulsification (n=1), iatrogenic retinal tears (n=2), and entry site break (n=1). Postoperatively two cases had significant inflammation, one of which resulted in 360° posterior synaechiea, iris bombe, and raised intraocular pressure. Other complications included mild posterior synaechiae (n=2), posterior capsular opacification (n=3), cystoid macular oedema (n=1), and hyphaema (n=1), which spontaneously resolved. There were no cases of intraocular lens decentration. Two patients who underwent surgery for retinal detachment repair subsequently redetached. Among those having surgery for macular hole, non-closure was seen in one patient and one patient developed a retinal detachment. In conclusion, sub-2 mm MICS is a safe and effective technique in dealing with vitreoretinal disorders necessitating cataract surgery at the same time.

The purpose of this study was to compare the incidence of iatrogenic anterior retinal breaks in 20-G vitrectomy (PPV) with transconjunctival 23-G PPV. Retrospective, observational review study involving consecutive patients undergoing PPV in a single center in the UK during a 2-year period. Sclerotomy-related entry-site breaks (ESB) were found in 50/628 (7.9 %) 20-G PPV cases and 5/296 (1.7 %) 23-G PPV eyes (p

We report the case of a 32-year-old Afrocaribbean man with known stage 3 proliferative sickle-cell retinopathy who presented with a mixed picture of tractional and rhegmatogenous macula off detachment. He underwent left primary 25 g vitrectomy with silicone oil, delamination and endolaser photocoagulation under a general anaesthetic. He, however, presented 48 hours postoperatively with gross anterior segment ischaemia. His pain and ocular signs settled over the course of a few days following administration of supplemental oxygen, oral steroids, analgesia and intravenous hydration. Examination showed resolution of his proptosis and orbital signs as well as anterior segment inflammation. He remains under follow-up.

Different surgical approaches have been used for the treatment of optic disc pit associated maculopathy, with increasing emphasis on vitrectomy. Case report We report a case of optic disc pit maculopathy where vitrectomy was combined with subretinal fluid drainage using a 42-gauge subretinal cannula connected to a "back-flush" flute handle. No retinopexy was performed at the site of drainage. This technique resulted in almost complete resolution of subretinal fluid by 6 weeks, with visual acuity improving from 1.00 Log MAR preoperatively to 0.40 at 8 months after surgery. We describe a novel technique for subretinal fluid drainage using a subretinal 42-G cannula connected to a standard "back flush" flute in optic disc pit-associated maculopathy.

Objective: To evaluate the anatomic and functional success of phacovitrectomy and intraocular gas tamponade for macular hole surgery with only first night face down posturing. Methods: This was a nonrandomized observational prospective trial over 9 months, with data collection on 28 eyes of 26 consecutive patients who underwent phacovitrectomy, internal limiting membrane peel, and intraocular gas tamponade (C2F6) for stage 2, 3, and 4 macular holes. Data included sex, age, hole latency and Gass stage, preoperative and postoperative visual acuity and ocular coherence tomography, refractive outcome, ocular comorbidity, first postoperative day gas fill, and intraocular pressure. Postoperatively, all patients were postured face down overnight. Thereafter, patients with more than 70% gas fill (beyond the inferior retinal vascular arcade) were asked to stop posturing, although they were advised not to lie flat on their backs at night for 10 days. Results: The sample was divided into patients who did and did not need to posture postoperatively, depending on first day gas fill. Twenty patients did not need posturing and 8 patients needed postoperative posturing for 10 days. The mean macular hole duration was 10.5 months. A total of 87.5% compared to 100% achieved hole closure in the posture and nonposture group, respectively. The mean postoperative visual acuity was 0.5 ± 0.25 LogMAR. Statistical analysis revealed no significant difference in age, hole duration, preoperative and postoperative visual acuities, intraocular pressure measured 24 hours postoperatively, or refractive error between the two samples. Conclusion: Phacovitrectomy for macular hole surgery without postoperative face down posture is a reasonable approach, as long as the eye has more than 70% gas fill (beyond the inferior retinal vascular arcade) on the first postoperative day. This study showed no statistically significant difference between patients who postured and those who did not posture. The combination of phacoemulsification, pars plana vitrectomy, internal limiting membrane, and gas tamponade in macular hole surgery reduces the difficulty of posturing in elderly patients. This technique saves the patient from exposure to a second intraocular intervention to remove a cataract which will commonly develop after vitrectomy and gas tamponade alone.

Background Ocular damage from radiation treatment is a well established phenomenon. Many factors are now known to influence the incidence of radiation retinopathy, including total dosage and daily fraction size. Patients who are diabetic, hypertensive or received previous chemotherapy are more susceptible to radiation retinopathy. Case Presentation A 55 year old male was referred from the oncology department with epiphora. His medical history included Type 2 Insulin treated Diabetes Mellitus and hypertension. One year prior to presentation he had undergone a total rhinectomy with a 4 week course of post-operative radiotherapy for an aggressive sqaumous cell carcinoma of the nose. On examination the visual acuity was noted to be 6/36 left eye and 6/9 right eye. Posterior segment examination revealed marked retinal ischaemia present in the posterior pole and macular region of both eyes. The appearance was not thought to be typical of diabetic changes, radiation retinopathy being the more likely diagnosis especially in view of his history. Over the next four months the vision in both eyes rapidly deteriorated to 3/60 left eye and 1/60 right eye. Bilateral pan retinal photocoagulation was thought to be appropriate treatment at this point. Conclusion This case highlights the importance for ophthalmologists and oncologists to be aware of the close relationship between diabetes and radiation treatment and the profound rapid impact this combination of factors may have on visual function. Radiation is being used with increasing frequency for ocular and orbital disease, because of this more cases of radiation retinopathy may become prevalent. Factors which may potentiate radiation retinopathy should be well known including, increased radiation dosage, increased fraction size, concomitant systemic vascular disease and use of chemotherapy. Counselling should be offered in all cases at risk of visual loss. As no effective treatment currently exists to restore visual function, monitoring of visual acuity in all cases and early referral to the ophthalmologist as appropriate is warranted.

Neodymium:YAG (Nd:YAG) laser peripheral iridotomy is the procedure of choice to treat and avoid further episodes of angle-closure glaucoma. A patient who developed a visually incapacitating posterior subcapsular lens opacity shortly after Nd:YAG laser peripheral iridotomy is described. The patient underwent cataract surgery and achieved a good level of visual acuity postoperatively. The intraocular pressure remained under control with no medical treatment. This case suggests a possible, albeit rare, potential complication of Nd:YAG laser peripheral iridotomy. [Ophthalmic Surg Lasers Imaging 2006;37:330-332.] AUTHORS From the Manchester Royal Eye Hospital (FED-S), Manchester; and the University Hospital Aintree (DC), Liverpool, United Kingdom. Accepted for publication April 2, 2006. Address reprint requests to Felipe Eduardo Dhawahir-Scala, MRCSEd, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, United Kingdom.

Background A case report to highlight the association between rifabutin and hypopyon Methods A 56 year old male presented with a one day history of blurred vision in his right eye. He had an established diagnosis of Crohn's disease which was in remission following treatment with rifabutin and clarithromycin. A brisk anterior uveitis with hypopyon and a mild vitritis was detected in the right eye. The acute inflammatory episode resolved following treatment with topical corticosteroids and withdrawal of rifabutin. Results The presence of hypopyon is atypical in uveitis associated with inflammatory bowel disease. The association between rifabutin treatment and hypopyon uveitis is well recognised in Mycobacterium avium paratuberculosis. However, use of rifabutin in the management of Crohn's disease is controversial and not widely known to an ophthalmic readership. Conclusion This report highlights the importance of keeping abreast of novel therapeutic developments in systemic conditions likely to be encountered in ophthalmology.