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OCTA is an imaging modality used in the assessment of the retinal vasculature. It operates on the principle of coherence tomography used in standard OCT with the addition of delineating the retinal vascular. This provides a modern non-invasive retinal vascular imaging method compared to conventional dye-based imaging. High quality depth resolution of the superficial and deep capillary networks is possible on OCTA whereas this was not possible prior. OCTA may be limited by image quality degradation from factors such as motion artefact or media opacities, and therefore may not be the investigation of choice for all patient groups. There are multiple potential clinical applications for OCTA in retinal and choroidal vascular disease. Ongoing research is necessary to substantiate the more widespread use of OCTA due to its significant cost burden compared to current modalities.

To assess the proportion of patients with raised intraocular pressure (IOP) (≥ 30 mmHg) on the first postoperative day following pars plana vitrectomy (PPV), encirclement and endotamponade and assess the number requiring alteration in management to address elevated IOP. To establish whether review on day one is required. Retrospective case note review of consecutive patients who underwent 23-gauge PPV, 276-encirclement and endotamponade under the care of a single surgeon. All patients as standard received prophylactic anti-glaucoma medication post-surgery (eye drops) to take home but initiate only after day-one review. Statistical analysis was carried out using student t tests and Fisher’s exact tests. Sixty-six patients were examined over a 2-year period. Mean day-one IOP was 22.2 mmHg (SD 7.3, 95% CI 20.4–24.0). Eleven patients (16.7%) had IOP ≥ 30 mmHg. Five patients (7.6%) had management changing decisions made at the day-one postoperative visit. Lens status, endotamponade, preoperative IOP, surgeon grade, cryopexy versus laser retinopexy or preoperative administration of once only 500 mg dose of intravenous acetazolamide did not influence IOP, with no significant difference between these subgroups. No cases of hypotony occurred. A significant minority of patients had elevation of IOP above 30 mmHg, a number of whom required treatment changes to address this. No preoperative risk factors were identified indicating those at risk of high IOP. It is important to identify these potentially harmful IOP elevations, and therefore day-one review is imperative and should be continued.

To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61, 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.

Purpose To review the clinical features and outcomes of pars plana vitrectomy (PPV) in patients with retained lens fragments after phacoemulsification and compare the results with those in previous studies. Setting Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom. Methods This retrospective chart review comprised 82 consecutive eyes of 82 patients who had vitrectomy for retained lens material after phacoemulsification between January 2000 and June 2006. Data on demographics, preexisting eye conditions, cataract surgery details, findings at presentation, interval between phacoemulsification and vitrectomy, details of vitrectomy, details of follow-up visits, and postoperative complications were collected. Results The incidence of raised intraocular pressure (IOP) was 46.3%. Anterior vitrectomy was associated with a lower incidence of increased IOP (P = .006). There was no association between late vitrectomy and a worse visual outcome. There was a much lower rate of complications than in other studies; the incidence of retinal detachment and of cystoid macular edema was 4.9%, and there were no cases of endophthalmitis. Conclusion The incidence of raised IOP in patients who had anterior vitrectomy at the time of cataract surgery was low. The visual outcomes were good, and the incidence of complications was low irrespective of the timing of the PPV.

Background/aim: A third of elderly people fall each year. Poor vision is associated with increased risk of falls. The authors aimed to determine if first eye cataract surgery reduces the risk of falling, and to measure associated health gain. Methods: 306 women aged over 70, with cataract, were randomised to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow up every 3 months. Health status was measured after 6 months. Results: Visual function improved in the operated group (corrected binocular acuity improved by 0.25 logMAR units; 8% had acuity worse than 6/12 compared with 37% of controls). Over 12 months of follow up, 76 (49%) operated participants fell at least once, and 28 (18%) fell more than once. 69 (45%) unoperated participants fell at least once, 38 (25%) fell more than once. Rate of falling was reduced by 34% in the operated group (rate ratio 0.66, 95% confidence interval 0.45 to 0.96, p = 0.03). Activity, anxiety, depression, confidence, visual disability, and handicap all improved in the operated group compared with the control group. Four participants in the operated group had fractures (3%), compared with 12 (8%) in the control group (p = 0.04). Conclusion: First eye cataract surgery reduces the rate of falling, and risk of fractures and improves visual function and general health status.

PURPOSE To report a case of silicone oil-induced corneal perforation following complex retinal detachment surgery. METHODS Case report. RESULTS Two months following a second retinal detachment repair, the patient presented to eye casualty with a corneal perforation secondary to silicone oil keratopathy. CONCLUSION The pathophysiology of silicone oil-related perforation is not clearly understood. Poor corneal nutrition due to the presence of oil may be an important contributory factor. Close monitoring of patients for early signs of silicone oil keratopathy could preempt perforation.

To evaluate the cost-effectiveness of first eye cataract surgery compared with no surgery from a health service and personal social services perspective.An economic evaluation undertaken alongside a randomised controlled trial of first eye cataract surgery in secondary care ophthalmology clinics. A sample of 306 women over 70 years old with bilateral cataracts was randomised to cataract surgery (expedited, approximately four weeks) or control (routine, 12 months wait); 75% of participants had baseline acuity of 6/12 or better. Outcomes included falls and the EuroQol EQ-5D.The operated group cost a mean pounds sterling 2004 (bootstrapped) more than the control group over one year (95% confidence interval (CI), pounds sterling 1363 to pounds sterling 2833) (p0.001), but experienced on average 0.456 fewer falls, an incremental cost per fall prevented of pounds sterling 4390. The bootstrapped mean gain in quality adjusted life years (QALYs) per patient was 0.056 (95% CI, 0.006 to 0.108) (p0.001). The incremental cost-utility ratio was pounds sterling 35 704, above the currently accepted UK threshold level of willingness to pay per QALY of pounds sterling 30 000. However, in an analysis modelling costs and benefits over patients' expected lifetime, the incremental cost per QALY was pounds sterling 13 172, under conservative assumptions.First eye cataract surgery, while cost-ineffective over the trial period, was probably cost-effective over the participants' remaining lifetime.

We report an unusual case of unilateral spontaneous lens dislocation in a 52-year-old woman with a posterior polar cataract. We postulate that the increasing lens size secondary to nuclear sclerosis may have exerted pressure on a thinned posterior capsule, causing the capsule to rupture spontaneously. The unusual weak posterior capsule in posterior polar cataract is a well-recognized risk factor in phacoemulsification surgery. We believe this is the first report case of spontaneous lens dislocation secondary to posterior capsule rupture in posterior polar cataract.