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Purpose: To audit and analyse the accuracy of current biometric formulae on refractive outcomes following cataract surgery in patients with axial length less than 22 mm. Methods: A total of 84 eyes from 84 patients with axial length Results: The mean axial length was 21.00 ± 0.55 mm. Mean error was greatest for Hoffer Q at −0.57 dioptres. There was no significant difference in mean absolute error between formulae. SRK/T achieved the highest percentage of outcomes within 0.5 dioptres (45.2%) and 1 dioptre (76.2%) of target. Shallower anterior chamber depth was associated with higher mean absolute error for SRK/T (p = 0.028), Hoffer Q (p = 0.003) and Haigis (p = 0.016) but not Holladay (p = 0.111). Conclusion: SRK/T had the highest proportion of patients achieving refractive results close to predicted outcomes. However, there was a significant association between a shallower anterior chamber depth and higher mean absolute error for all formulae except Holladay 1. This suggests that anterior chamber depth with axial length should be considered when counselling patients about refractive outcome.

There have been significant changes in the management of out of hours services in ophthalmology recently. The European Working Time Directive (EWTD) and economic measures have anecdotally reduced the availability of staff and facilities outside normal working hours, and there have been various responses to the provision of emergency surgical care. There are disparate attitudes to the optimum management of the emergency surgical case. We sought to establish a nationwide picture of the management of out of hours surgery. A questionnaire was distributed to every consultant ophthalmologist working in the NHS and registered with the Royal College of Ophthalmologists (n=947). Information was requested regarding departmental and personal policies, local facilities, and personal beliefs regarding emergency surgery. A total of 440 (46.5%) questionnaires were returned from 155 units; 18.7% of the units had no out of hours services or no operating facilities. Sixty-three percent of units reported a local policy regarding a time after which patients should not be taken to theatre. For 57%, this time began between 2100 hours and midnight. The most common reasons for not operating after a certain time were ‘belief that delay does not significantly affect the outcome’ (41.6%), ‘delayed access to theatre due to competition with other surgical specialities’ (40%), and ‘no specialist ophthalmic-theatre nursing input’ (32.7%). We report the first nationwide study on out of hours ophthalmological surgical working practices. This demonstrates variation in work patterns. It is significant to patients and ophthalmologists that there should be units in United Kingdom without full local facilities and staff.

American Journal of Opthalmology - In Press.Proof corrected by the author Available online since lundi 11 janvier 2016

BACKGROUND: To report the clinicopathologic features of a fibrocellular membrane in a pseudophakic eye with retained silicone oil in the absence of any capsular contraction syndrome, necessitating repeat anterior capsulorhexis. METHODS: Clinicopathologic report of a case. RESULTS: Histopathologic study of the membrane showed absence of any true periodic acid Schiff-positive capsule within the specimen. Clinically, there was no evidence of any anterior capsular contraction. The fibrocellular membrane may have occurred as a result of inflammatory and mechanical effects of silicone oil in the anterior chamber or as a result of the intraocular lens design. CONCLUSION: The authors report the clinicopathologic features of a fibrocellular membrane occluding the anterior capsular opening in a pseudophakic eye with retained silicone oil, in the absence of any capsular contraction. The stimulus for its formation may have been the inflammatory and mechanical effects of retained silicone oil in the anterior chamber.

To ascertain whether the Honan intraocular pressure reducer (HIPR) has an effect on the preoperative intraocular pressure (IOP), surgeon's assessment of anesthesia, and patients' analgesic experience when sub-Tenon's anesthesia is used for routine cataract surgery.Princess Alexandra Eye Pavilion, Edinburgh, Scotland.Forty-five eyes of 45 patients having routine phacoemulsification cataract surgery were randomized to receive 10 minutes of ocular compression using the HIPR or no compression after administration of sub-Tenon's anesthesia. The IOP was measured immediately before and immediately and 10 minutes after sub-Tenon's anesthesia administration using a standard technique. One surgeon who was masked to the randomization process performed all injections and completed a questionnaire on aspects of the anesthetic block. Patients scored their level of analgesia during surgery.The mean rise in IOP immediately after administration of sub-Tenon's anesthesia was 1.39 mm Hg +/- 3.91 (SD) (95% confidence interval +0.22 to 2.57; P =.021). In the 22 patients who received compression, there was a mean IOP reduction of 4.20 +/- 2.74 mm Hg at 10 minutes. The mean difference between the compression and no-compression groups at 10 minutes was 4.99 mm Hg (P.0001). There was no difference in the surgeon's scores for any aspect of the sub-Tenon's anesthesia (P.05). All patients reported good levels of analgesia.There was a significant reduction in IOP after compression using the HIPR. However, the rise in IOP after administration of sub-Tenon's anesthesia was small and the use of the HIPR did not make a significant difference in the effectiveness of the anesthesia to the surgeon or patients.

PURPOSE The purpose of this study was to describe a patient with an untreated rhegmatogenous retinal detachment, first diagnosed during pregnancy, that underwent spontaneous resolution after normal labor and childbirth. METHODS Descriptive case report. RESULTS AND DISCUSSION It has been extensively documented that normal labor and childbirth are safe in the context of rhegmatogenous retinal detachment. Although exudative retinal detachment is a well-known complication of preeclampsia, spontaneous reattachment of a rhegmatogenous retinal detachment is a rare phenomenon. In this case, labor-induced physiologic changes may have contributed to the resolution of the detachment.

Objective Argon laser retinopexy has been the primary treatment for retinal breaks for many decades. Prevention of progression to retinal detachment (RD) is the main objective. The benefit of laser retinopexy is well documented, although little has been reported on the risk factors for progression to RD. By addressing this issue, patients at high risk can be identified, and more timely specialist retinal input can be sought. Methods Data over a 6-month period from 45 consecutive patients undergoing laser retinopexy were reviewed. Patients were categorized into complete success (no more than 1 laser treatment), qualified success (no more than 3 laser or cryotherapy treatments), and treatment failure (more than 3 laser or cryotherapy treatments or progression to RD). Results Complete success was observed in 53.5% of patients, a further 34.9% of patients achieved a qualified success, and the remainder of the patients (11.6%) fell into the treatment failure category. About 9.3% of patients required cryotherapy, and 7.0% of patients underwent RD surgery. Patients with a bridging blood vessel and vitreous hemorrhage were significantly more likely to be in the treatment failure category than those without. RD was significantly associated with the presence of vitreous hemorrhage. Conclusions Patients with retinal breaks associated with bridging blood vessels and vitreous hemorrhage are at greater risk for poorer outcome. The area of subretinal fluid was not linked to failure. If complete laser of a tear is not possible or if concerns remain regarding treatment efficacy, prompt referral to a retina specialist for further management is recommended.

PURPOSE To determine the effect of simultaneous phacoemulsification and silicone oil removal via an anterior approach on the endothelial cell density (ECD). METHODS In this prospective study, the authors measured the ECD before and 6 weeks after surgery using an automatic noncontact specular endothelial microscope. Nine patients underwent phacoemulsification and silicone oil removal via an anterior approach using a closed system and separation of irrigation/aspiration function. RESULTS Of nine patients, four (five eyes) were diabetic and five (five eyes) were nondiabetic. The postoperative ECD of the entire population was statistically different (P

Diabetic patients are at significant risk of developing corneal lesions such as superficial punctate keratitis, recurrent corneal erosions, persistent epithelial defects, and microbial keratitis. The aim of this study was to investigate whether diabetes mellitus is correlated with both reduced corneal sensation and reduced tear production.In 25 type II diabetic patients with a history of retinopathy only and in 25 nondiabetic control subjects (age and sex matched), we performed noncontact corneal aesthesiometry and assessed basal tear production using Schirmer's test with topical anesthesia. The noncontact corneal aesthesiometer (NCCA) is a new noninvasive device for quantifying threshold corneal sensitivity.The diabetic patients demonstrated a significantly reduced Schirmer's test result (P.001) and significantly reduced corneal sensitivity (P.01).Our study supports previous reports of reduced basal tear production, lending more support to the theory of a peripheral neuropathy affecting lacrimal gland function in diabetes. We also confirmed reduced threshold corneal sensitivity in diabetic patients using the NCCA.

We describe the usefulness of intracameral injection of trypan blue to highlight vitreous in the anterior chamber. The technique was used in 3 eyes of 3 patients who had vitreous prolapse in the anterior chamber. Trypan blue 0.06% was injected in the anterior chamber under air to visualize and resect the prolapsed vitreous. Trypan blue stained the clear vitreous and improved visualization for a safe and atraumatic vitrectomy. No complications associated with the dye were found.

Background To evaluate the effect of Nd:YAG capsulotomy for posterior capsular opacification (PCO) on visualisation of the peripheral fundus with scleral indentation. Methods Patients undergoing Nd:YAG capsulotomy for PCO were examined pre- and four weeks post- Nd:YAG capsulotomy. In order to give a quantitative measure of visualisation of the peripheral retina, a novel scalar measurement was developed. Changes in the degree of visualisation following Nd:YAG capsulotomy were calculated. Results There was a significant improvement in fundal visualisation of the retinal periphery with scleral indentation following Nd:YAG capsulotomy (p = 0.001). Conclusion Peripheral fundal visualisation with scleral indentation improves following a small central Nd:YAG capsulotomy. This finding is important in relation to the detection of peripheral pseudophakic retinal breaks, particularly in those patients deemed at high risk following Nd:YAG capsulotomy.

Purpose To report an unusual case of recurrent episcleritis secondary to IgA nephropathy. Design Observational case report. Methods A 39-year-old man was seen with recurrent episodes of red and painful left eye suggestive of episcleritis. Results On routine investigations the patient was found to have haematuria and proteinuria. Further investigations led to the diagnosis of IgA nephropathy on kidney biopsy. Conclusion IgA nephropathy may present with various eye signs without any other systemic clues. This case highlights the importance of some of the basic tests in clinical practice such as urine examination. This can be conveniently done with testing strip and should be considered in the routine investigation of patients with inflammatory eye diseases.

Use of pegaptanib in the treatment of vitreous haemorrhage in idiopathic retinal vasculitis

Thank you for your interest in our case and your insightful comments. Reaching a diagnosis of Eale’s disease involves systematic exclusion of known causes of retinal vasculitis. Although baseline investigations are important in all cases, individually tailored diagnostic testing based on patient symptoms and signs is recommended. Furthermore, in cases of diagnostic doubt, infection may be considered more likely if, after an initial improvement with therapy, the patient’s disease rapidly becomes refractory to treatment. Our case did in fact undergo an extensive systemic work-up, which was not emphasised in the study. We also referred our patient to the physicians given the unusual nature of his presenting symptoms. A complete physical examination as well as medical, contact, and travel history did not reveal any abnormalities or risk factors. In addition to routine blood and urine testing, other investigations performed included fasting glucose and lipid profile, thyroid function tests, renal and liver function tests, serum homocysteine levels, coagulation screen, vitamin B12 and folate levels, serum ACE, CRP, ESR, full autoantibody screen, serum protein electrophoresis, and 72-h Mantoux testing. Radiological investigations performed comprised a chest X-ray, abdominal ultrasound, and carotid Doppler. All investigations completed did not reveal any systemic abnormality. We agree that prompt referral to the physicians and a full contact and travel history are important in ruling out other causes of retinal vasculitis, especially in cases with systemic features (eg, fever, weight loss, and altered bowel habit). In our case, the clinical effect of adjunctive treatment with pegaptanib was evidenced by the rapid regression of disc and retinal neovascularisation with no recurrence of vitreous haemorrhage for up to 9 months.

EDITOR—Murray highlights the recent advances in diagnosis and management of multiple sclerosis.1 This is particularly important in managing a clinically isolated episode of optic neuritis. Current …