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Jan Patrick Chu, Jagjit Singh Gilhotra Royal Adelaide Hospital, Adelaide, South Australia, AustraliaCorrespondence: Jan Patrick Chu, Email JanPatrick.Chu@sa.gov.auPurpose: To present a case of bilateral herpes simplex anterior uveitis in an immunocompetent patient.Methods: Case Report.Results: A 42-year-old Kenyan female presented with a 2-year history of intermittent painful eye redness associated with blurring of vision of both eyes. Symptoms started after childbirth. There were no associated systemic symptoms. She presented with a best corrected visual acuity (BCVA) of 6/18 and 6/30 on the right and left eyes, respectively. On examination, conjunctival hyperaemia, large keratic precipitates (KPs), posterior synechiae, poorly dilating pupil, anterior subcapsular cataract and +2 anterior chamber (AC) cells and flare were noted on both eyes. Intraocular pressures (IOP) were within normal limits. Optical coherence tomography (OCT) showed bilateral cystoid macular oedema (CMO). Serum herpes simplex virus (HSV) IgM was detected, whereas autoimmune and other infectious aetiologies were excluded. Aqueous humour samples from both eyes tested negative for HSV. Bilateral 16 mg subtenon triamcinolone injection were done. Dexamethasone 0.1% eye drops and atropine 1.0% eye drops were started. Topical anti-glaucomatous medication was started due to IOP > 30 mmHg on both eyes and Valacyclovir 1g three times a day was initiated. Final visit showed an improvement of BCVA to 6/9 on both eyes. There was complete resolution of AC cells and flare, and CMO on OCT.Conclusion: The diagnosis of bilateral herpetic anterior uveitis was based on the criteria set by The Herpetic Eye Disease Study (HEDS). Although the patient was immunocompetent, she was in a state of transient immunodeficiency that is pregnancy, which could have led to bilateral ocular involvement.Keywords: anterior, bilateral, chronic, herpes simplex virus, immunocompetent

Sutureless vitrectomy has rapidly been accepted as an essential part of a vitreoretinal surgical setup. The size and structure of the wound along with near intact conjunctival covering makes the incision self-sealing and safe. This allows the vitrectomy instruments to be used without creating an initial limited peritomy to expose bare sclera, and obviates the need for sutures at the end of the procedure. Wound construction is the essential step in ensuring postoperative wound stability. Both one-step and two-step wound constructions have been described. Key points include an oblique, tunneled approach to ensure a valve-like effect as well as misalignment of conjunctival and scleral wounds by displacing conjunctiva during construction. Advantages include decreased operative times in certain cases and decreased postoperative inflammation, early postoperative rehabilitation, improved patient comfort, and minimal conjunctival damage. Complications are based around wound competence, hypotony, and its relationship to endophthalmitis rates. Early reports highlighted an increase in endophthalmitis though further studies are required to accurately assess the incidence. Endophthalmitis has not been reported in cases that underwent fluid/air exchange. This review focuses on techniques, benefits, complications, personal experiences, and the safety profiles of sutureless vitrectomy systems. A literature review was undertaken using 'Medline' and 'Pubmed'. Search terms included sutureless vitrectomy, 20 gauge, 23 gauge, 25 gauge, and transconjunctival and small gauge vitrectomy. [ABSTRACT FROM AUTHOR]

A 29-year-old lady receiving repeated blood transfusions for β thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine. [ABSTRACT FROM AUTHOR]

Background: To assess topical dorzolamide as medical therapy for idiopathic full-thickness macular holes (FTMHs)., Methods: Randomised, double-blinded, placebo-controlled, single-centre clinical trial involving 32 patients with idiopathic small FTMHs (<400 μm $$ \upmu \mathrm{m} $$ ). Participants in both arms used topical dorzolamide 2% or saline thrice daily for 8 weeks with monthly OCT. Those with persisting FTMH underwent vitrectomy with ILM peel and gas tamponade. The primary outcome was the rate of FTMH closure at the end of treatment., Results: Between 6 March 2020 and 16 June 2023, 32 eligible patients were enrolled: 16 participants in each arm. All participants in both groups were included in the final analysis. At the final visit, 3 of 16 (18.8%) patients in both the topical dorzolamide and placebo group demonstrated closure. There was no statistically significant difference in the proportion of FTMH closure between the control and treatment group (p = 1.00), nor statistically significant difference in the mean change in best corrected visual acuity (BCVA; p = 0.909). There was no difference in the change in FTMH diameter between groups (p = 0.225). No serious adverse events were reported in either group., Conclusion: Topical dorzolamide was safe but not superior to placebo in the functional and anatomical outcomes of FTMH., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: In bovine retinal pigment epithelium (RPE) cells, increased secretion of vascular endothelial growth factor (VEGF) has a positive linear association with proliferation of RPE. Spectral domain optical coherence tomography (SD-OCT) based improvement in grades of topographic retinal pigment epithelium alterations (RPE-A), were evaluated after intravitreal anti-VEGF therapy, in diabetic macular edema (DME), for the first time., Methods: A tertiary care center-based, prospective study. Forty-four consecutive patients, 40-65 years of age with type 2 diabetes mellitus (DM) with DME, were administered three doses of anti-VEGF therapy at monthly intervals. Pre- and post-intervention SD-OCT was done and central sub field thickness (CST), cube average thickness (CAT) and topographic grades of RPE-A were assessed using single layer RPE map (SL-RPE) as; Grade 0: No alterations, Grade 1: Alteration in two quadrants, Grade 2: Alteration in more than two quadrants., Results: CST decreased from 354.2 ± 16.0 µm pre-intervention to 233.2 ± 7.9 µm post-intervention. CAT reduced from 340.6 ± 6.5 µm pre-intervention to 274.1 ± 5.1 µm post-intervention. Significant improvement in grades of RPE-A pre- v/s post-intervention were observed. (Grade 0: 0 v/s 39; Grade 1: 17 v/s 3; Grade 2: 27 v/s 2) (p < 0.001)., Conclusion: Anti-VEGF therapy is associated with an improvement in grades of RPE-A in DME.The study was registered with the Clinical Trial Registry of India (CTRI/2019/03/018135).

The number of people living with diabetes is expected to rise to 578 million by 2030 and to 700 million by 2045, exacting a severe socioeconomic burden on healthcare systems around the globe. This is also reflected in the increasing numbers of people with ocular complications of diabetes (namely, diabetic macular oedema (DMO) and diabetic retinopathy (DR)). In one study examining the global prevalence of DR, 35% of people with diabetes had some form of DR, 7% had PDR, 7% had DMO, and 10% were affected by these vision-threatening stages. In many regions of the world (Australia included), DR is one of the top three leading causes of vision loss amongst working age adults (20-74 years). In the management of DMO, the landmark ETDRS study demonstrated that moderate visual loss, defined as doubling of the visual angle, can be reduced by 50% or more by focal/grid laser photocoagulation. However, over the last 20 years, antivascular endothelial growth factor (VEGF) and corticosteroid therapies have emerged as alternative options for the management of DMO and provided patients with choices that have higher chances of improving vision than laser alone. In Australia, since the 2008 NHMRC guidelines, there have been significant developments in both the treatment options and treatment schedules for DMO. This working group was therefore assembled to review and address the current management options available in Australia., Competing Interests: YS Yuen is a consultant for Bayer and Roche and has received speaker fees from Bayer, Roche, and Novartis. JS Gilhotra is a consultant for and has received speaker fees from Bayer, Roche, Allergan and Novartis. H Mehta has consulted for Allergan/Abbvie, Bayer, and Roche. F Chen has received speaker fees from Allergan, Novartis, Roche, and Bayer. L Lim has received consultancy fees from Roche and Novotech and speaker fees from Bayer, Allergan, and Novartis, and his institution has received funding from Bayer., (Copyright © 2023 Yew Sen Yuen et al.)

Purpose: To describe our experience using the gyroscopic mouse in digitally assisted vitreoretinal surgery., Methods: We used a commercially available gyroscopic mouse to control the on-screen cursor of the NGENUITY System for digitally assisted vitreoretinal surgery. The gyroscopic mouse is sealed in a clear sterile plastic bag to allow for intraoperative use. This allowed both the surgeon and assistant to be fully scrubbed while retaining full control of the NGENUITY system's functions. The mouse also allowed the mentor to provide detailed instructions through the on-screen cursor by highlighting important landmarks., Conclusion: Using a sterile gyroscopic mouse improved the teaching utility and surgical workflow of digitally assisted vitreoretinal surgery.

Purpose: Cortisol, a steroid hormone, plays an essential role in metabolic processes of diabetes mellitus. This study for the first time evaluated the association of serum cortisol with spectral domain optical coherence tomography (SD-OCT)-based cross-sectional and topographic parameters with severity of diabetic retinopathy (DR)., Methods: A tertiary care center-based preliminary study was undertaken. Fourteen consecutive cases of DR and fifteen healthy controls were included. Cases were graded according to ETDRS classification: non-proliferative DR (NPDR, n = 8) and proliferative DR (PDR, n = 6). All study subjects underwent complete ophthalmological evaluation. Serum cortisol was analyzed using chemiluminescence microparticle assay method. Central subfield thickness (CST), cube average thickness (CAT), cube volume (CV), retinal nerve fiber layer (RNFL) thickness, disorganization of inner retinal layers (DRIL), grade of retinal photoreceptor ellipsoid zone (EZ) disruption and grade of retinal pigment epithelium (RPE) alterations were evaluated using SD-OCT. Statistical analysis was done using ANOVA and Pearson's correlation analysis., Results: Mean serum cortisol levels (µg/dL) were NPDR = 11.59 ± 0.42, PDR = 14.50 ± 0.26 and controls = 8.22 ± 0.77. With increasing severity of DR, mean CST, CAT, CV showed positive correlation, whereas mean RNFL thickness showed negative correlation with serum cortisol levels (p < 0.01). DRIL, EZ disruption and RPE alterations showed positive correlation with serum cortisol levels (p < 0.001)., Conclusion: Serum cortisol levels are significantly associated with severity of DR and correlate positively with CST, CAT, CV, DRIL, EZ disruption and RPE alterations and negatively with RNFL thickness., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To study the correlation between disorganization of inner retinal layer (DRIL) and macular thickness parameters, ellipsoid zone (EZ) disruption and retinal nerve fiber layer (RNFL) thickness on spectral domain optical coherence tomography (SD-OCT) in diabetic retinopathy (DR), for the first time., Methods: A tertiary care center-based cross-sectional study was undertaken. One hundred and four consecutive study subjects of type 2 diabetes mellitus were included: diabetes mellitus with no retinopathy (No DR) (n = 26); non-proliferative DR (NPDR) (n = 26); proliferative DR (PDR) (n = 26) and healthy controls (n = 26). Best Corrected Visual Acuity (BCVA) was measured on the logarithm of the minimum angle of resolution (logMAR) scale. Clinician-friendly, SD-OCT based, grading systems were created for DRIL and EZ disruption, within the macular cube. DRIL was graded as: grade 0, DRIL absent; and grade 1, DRIL present. EZ disruption was graded as; Grade 0: Intact EZ; Grade 1: Focal disruption and Grade 2: Global disruption. Every study subject underwent RNFL thickness analysis., Results: DRIL was significantly associated with increase in severity of DR.Pearson correlation analysis showed significant positive correlation between DRIL and CST CAT and grades of EZ disruption . However, a significant negative correlation was found between DRIL and RNFL thickness ., Conclusion: Presence of DRIL correlates with severity of DR, EZ disruption and RNFL thinning., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Although being the second most common sight-threatening retinal vascular disease after diabetic retinopathy, the patient-centred impact of retinal vein occlusion has not been well studied. This study aims to understand the quality of life issues in people with retinal vein occlusion using a qualitative methodology., Methods: In-depth semi-structured interviews were conducted with 17 patients with retinal vein occlusion. All the interviews were digitally recorded and transcribed verbatim. An inductive analytic approach based on the constant comparative method was used for coding, aggregation, and theme development. The qualitative analysis was done using the software NVivo., Results: Participants had a median age of 73 years (range 34-85 years; females, 71 per cent). Six quality of life themes were identified: concerns about the disease progression and treatment outcome (health concerns), emotional responses to the disease (emotional), experiencing a range of symptoms (symptoms), inability to do things as before (activity limitation), adapting to the visual loss (coping), and inconveniences due to the eye condition (convenience). Participants often felt that lasers and injections did not improve their vision. They feared that their eye condition may come back, or the other eye may be affected. They experienced a range of visual symptoms that affected their day-to-day performance, particularly reading small print, and driving at night. Having multiple treatments and frequent eye appointments were major sources of inconvenience. Patients adopted several coping strategies to manage the stress associated with visual loss., Conclusions: This study shows that several aspects of quality of life are compromised in people with retinal vein occlusion. The findings of this study will be used to identify the item content for a vitreoretinal disease-specific quality of life item bank., (© 2019 Optometry Australia.)

Background: To evaluate the association of central subfield thickness (CST) and cube average thickness (CAT) with ellipsoid zone (EZ) disruption on spectral domain optical coherence tomography (SD-OCT) in patients of diabetic retinopathy (DR)., Methods: Cross sectional study including consecutive patients of type 2 diabetes mellitus [without DR (No DR, n = 97); non-proliferative DR (NPDR, n = 91); proliferative DR (PDR, n = 83)] and healthy controls (n = 82) was undertaken. CST and CAT values were measured using SD-OCT. Data was analyzed using Chi square test, ANOVA and multivariate analysis. Discriminant values of CST and CAT for EZ disruption were evaluated using receiver operator characteristic curve. Area under curve (AUC) was computed., Results: Mean CAT and CST values in the study subjects showed an incremental trend. Multivariate ordinal logistic regression analysis showed increase in CST (OR = 1.022, p < 0.001) and CAT (OR = 1.029, p < 0.001) as significant independent predictors of EZ disruption. Area under curve showed excellent predictive results of CST (AUC = 0. 943 ± 0.021, 95% CI, 0.902-0.984, p < 0.05) and CAT (AUC = 0.959 ± 0.012, 95% CI 0.936-0.982, p < 0.05), as bioimaging biomarkers, for EZ disruption., Conclusion: Increase in CST and CAT is associated with increased odds of EZ disruption and these macular parameters serve as bioimaging biomarkers for EZ disruption in DR.

Importance: Visual outcomes following diabetic vitrectomy have not previously been studied in an Australian population., Background: This analysis aimed to determine the rate of, and factors associated with visual success following diabetic vitrectomy performed for Indigenous and non-Indigenous Australians, and investigate factors predisposing to early progression to diabetic retinopathy (DR) requiring vitrectomy., Design: Retrospective, population-based audit., Participants: All patients undergoing vitrectomy for the complications of DR in South Australia (SA) and the Northern Territory (NT) between 2007 and 2011., Methods: Medical records were audited and data collected, including demographics, diabetic history, past treatment for DR, indication for vitrectomy and visual acuity pre and postoperatively., Main Outcome Measures: Visual success (gain of ≥15 ETDRS letters) at 6 and 12 months, postoperatively., Results: A total of 495 diabetic vitrectomies, for 404 eyes of 335 patients were performed in SA and NT between 2007 and 2011. 77 (23%) patients requiring diabetic vitrectomy were Indigenous Australians. 87% of patients undergoing diabetic vitrectomy had stable or improved vision at 1 year, postoperatively. There was no significant difference between indigenous and non-indigenous eyes achieving visual success (P = 0.929). Timely preoperative laser treatment (P = 0.03) and preoperative visual acuity (P = 0.01) were the predominant factors associated with visual success., Conclusions and Relevance: Indigenous patients are just as likely to have improved vision following diabetic vitrectomy as non-Indigenous Australians. However, the small subset of indigenous patients with blind eyes prior to vitrectomy are significantly less likely to improve from surgery. The underlying factors associated with poor outcomes in this group requires further exploration., (© 2017 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To evaluate the role of serum urea and creatinine as surrogate markers for disruption of retinal photoreceptor external limiting membrane (ELM) and inner segment ellipsoid zone (EZ) in Type 2 diabetic retinopathy (DR) using spectral-domain optical coherence tomography, for the first time., Methods: One hundred and seventeen consecutive cases of Type 2 diabetes mellitus (diabetes without retinopathy [No DR; n = 39], nonproliferative diabetic retinopathy [NPDR; n = 39], proliferative diabetic retinopathy [PDR; n = 39]) and 40 healthy control subjects were included. Serum levels of urea and creatinine were assessed using standard protocol. Spectral-domain optical coherence tomography was used to grade the disruption of ELM and EZ as follows: Grade 0, no disruption of ELM and EZ; Grade 1, ELM disrupted, EZ intact; Grade 2, ELM and EZ disrupted. Data were analyzed statistically., Results: Increase in serum levels of urea (F = 22.93) and creatinine (F = 15.82) and increased grades of disruption of ELM and EZ (γ = 116.3) were observed with increased severity of DR (P < 0.001). Increase in serum levels of urea (F = 10.45) and creatinine (F = 6.89) was observed with increased grades of disruption of ELM and EZ (P = 0.001)., Conclusion: Serum levels of urea and creatinine are surrogate markers for disruption of retinal photoreceptor ELM and EZ on spectral-domain optical coherence tomography in DR.

Background: The lack of an appropriate retina-specific patient-reported outcome instrument restricts the understanding of the full impact of hereditary retinal diseases and other less common but potentially blinding acquired retinal diseases such as, vascular occlusions, epiretinal membrane, macular hole, central serous retinopathy and other vitreoretinopathies on quality of life. This study aims to explore the quality of life issues in people with hereditary retinal diseases and acquired retinal diseases to develop disease-specific patient-reported outcome instruments., Methods: A qualitative research methodology to understand the lived experiences of people with retinal diseases was carried out. Data were collected through semistructured interviews. The coding, aggregation and theme development was carried out using the NVivo -10 software., Results: Seventy-nine interviews were conducted with participants with hereditary retinal diseases ( n  = 32; median age = 57 years) and acquired retinal diseases ( n  = 47; median age = 73 years). We identified nine quality of life themes (domains) relevant to people with retinal diseases. Difficulty in performing important day-to-day activities (activity limitation) was the most prominent quality of life issue in the hereditary retinal diseases group whereas concerns about health, disease outcome and personal safety (health concerns) was the most prominent quality of life issue in the acquired retinal diseases group. Participants with hereditary retinal diseases had more issues with social interaction (social well-being), problems with mobility and orientation (mobility), and effect on work and finance (economic) than participants with acquired retinal diseases. On the contrary, participants with acquired retinal diseases reported more inconveniences (conveniences) than participants with hereditary retinal diseases, which were mostly attributed to treatment. Participants with hereditary retinal diseases were coping better compared to participants with acquired retinal diseases., Conclusions: Our study found that participants with both hereditary and acquired retinal diseases are living with myriad of disease-specific quality of life issues. Many of these issues are completely different and unique to each disease group. Hence, these group of diseases would need separate patient-reported outcome instruments to capture the disease-specific quality of life impacts., Competing Interests: MP is an ophthalmologist pursuing her PhD at Optometry and Vision Science, Flinders University, Adelaide. Her research is about understanding the quality of life issues among patients with retinal diseases and developing and validating technologically advanced survey questionnaires to measure quality of life impacts among these patients. JK is a research associate in Optometry and Vision Science, Flinders University. KP is the Foundation Chair of Optometry and Vision Science. The authors JK and KP are internationally recognised experts in PRO development and validation. JK and KP are also optometrists with an extensive clinical experience. JG and SS are retinal specialist at the University of Adelaide.Ethical approval was obtained from the Southern Adelaide Clinical Human Research Ethics Committee and the corresponding ethics committees at health care facilities (469.11) and the study adheres to the Tenets of Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Purpose: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety., Design: Multicenter retrospective case series., Participants: All patients receiving intravitreal injections from 7 retinal specialists., Methods: An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine., Main Outcome Measures: Incidence of endophthalmitis after intravitreal injections., Results: A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used., Conclusions: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Spectral domain optical coherence tomography (SD-OCT) is fast becoming the current standard of care for the detection and assessment of diabetic macular edema. With the application of SD-OCT for imaging of retinal microstructure and measurement of retinal thickness, new information regarding disease characteristics has been gathered, which was unrecognized previously. Retinal thickness measurements on SD-OCT have also been used for deciding the management and monitoring of the disease. Since its development, OCT has enhanced the understanding of retinal anatomical changes in diabetic retinopathy. Several authors have used SD-OCT to classify diabetic macular edema with the purpose of correlating the pathophysiology with disease severity. The classification systems have helped monitor the treatment efficacy and provide prognostic information on the treatment outcome. The following review article summarizes these classifications.

Background: To date, our understanding of the biochemical composition of the living human vitreous relies on extrapolations from animal or human post-mortem studies., Methods: This was a cross-sectional study of vitreous samples from 27 individuals scheduled for retinal surgery within a tertiary hospital. From each vitreous sample, the concentrations of sodium, potassium, chloride, calcium, magnesium, glucose, lactate, β- hydroxybutyrate, copper, zinc, selenium, iron, ferritin and transferrin and osmolality were measured. Perioperative serum samples were also obtained for comparison., Results: The following vitreous mean ± standard deviation (95% confidence interval of the mean) was observed for each analyte: sodium, 146.7 ± 3.3 (145.4-148.0) mmol/L; potassium, 5.73 ± 0.86 (5.39-6.08) mmol/L; chloride, 121.6 ± 2.6 (120.6-122.7) mmol/L; calcium, 1.128 ± 0.518 (0.923-1.333) mmol/L; magnesium, 0.900 ± 0.158 (0.838-0.962) mmol/L; glucose, 2.97 ± 0.98 (2.58-3.36) mmol/L; lactate, 3.97 ± 1.09 (3.54-4.40) mmol/L; osmolality, 289.5 ± 6.9 (286.6-292.5) mOsm/kg; BOHB, 0.0937 ± 0.0472 (0.0750-0.1124) mmol/L; copper, 0.519 ± 0.269 (0.412-0.625) µmol/L; zinc, 1.95 ± 1.09 (1.52-2.38) µmol/L; selenium, 0.1035 ± 0.0276 (0.0923-0.1146) µmol/L; iron, 3.11 ± 1.40 (2.56-3.66) µmol/L; ferritin, 19.5 ± 10.3 (15.5-23.6) µg/L; transferrin, 0.0878 ± 0.0526 (0.0670-0.1086) g/L. Vitreous biochemistry was not significantly different between male and female participants. Vitreous biochemistry was significantly different between non-diabetic and diabetic participants. Vitreous biochemistry was significantly different from the vitreous substitute BSS Plus (Alcon, USA). The vitreous extracted from living humans was markedly different from the commonly reported reference values obtained from animal studies., Conclusions: The current data provide hitherto unavailable information about the biochemical composition of the living human vitreous., (© 2016 Royal Australian and New Zealand College of Ophthalmologists.)

We present a 23-year-old female patient who developed bilateral, multifocal CSCR three months after BMT and two months after developing GvHD. At the time of diagnosis, her medications included cyclosporine and high-dose oral steroid for GvHD. CSCR resolved quickly after the resolution of GvHD, along with rapid tapering of steroids and restoration of emotional wellbeing. Rapid tapering of systemic steroids under close monitoring of a hematologist in the setting of resolved mild GvHD may facilitate prompt resolution of CSCR.

Commotio retinae (CR) is an outer retinal disorder following blunt trauma to the eye. Histologically it is characterized by disruption of the photoreceptor outer segments (OS), typically without injury to other retinal layers. Using spectral-domain optical coherence tomography (OCT) the condition is visible as hyper-reflectivity of the OS. Most cases of CR are associated with transient grey-white discoloration of the retina and are easily diagnosed clinically, but there have been reports of OCT-confirmed CR without retinal discoloration. It is likely that this subclinical variant of CR is under-recognized as the OCT features of CR are subtle. Here, we report a case of OCT-confirmed subclinical CR that demonstrated prominent infrared hypo-reflectance, using the infrared protocol of the SPECTRALIS® OCT, Heidelberg Engineering. This case suggests that infrared reflectance may have a role in diagnosing cases of subclinical CR.

Purpose: The aim of this study was to understand people's experience with age-related macular degeneration (AMD) in light of new treatment successes., Methods: An interpretive qualitative methodology was used to facilitate understanding of the experience of people with AMD. Rich in-depth data were collected using focus groups and individual interviews. Thematic analysis of the data occurred through the processes of line-by-line coding, aggregation, and theme development using the NVivo 10 software., Results: A total of 4 focus groups and 16 individual interviews were conducted with 34 people (median age = 81 years; range = 56 to 102 years; 19 females) with AMD. Four major themes arose from the narratives of the participants: cautious optimism, enduring, adaptation, and profound loss. Cautious optimism resonated for participants who had received successful treatment and stabilization of AMD. Enduring emerged as participants with exudative AMD described an ongoing need for invasive and frequent treatments (anti-vascular endothelial growth factor injections) that maintained their vision. Adaptation was evident in the narratives of all participants and was directly related to the physical and psychological limitations that were a consequence of visual disability. Profound loss encompassed both physical and emotional aspects of deteriorating vision and was most evident in patients for whom treatment had failed or had not been considered appropriate for their disease., Conclusions: The findings of this study shed new light on the influence of underlying pathology, disease trajectory, and success of new treatments on quality of life of people living with AMD. Optimism toward maintaining vision in the presence of exudative AMD was described by participants, moderated by ongoing caution and a need for endurance of frequent and often problematic intravitreal treatments. These findings add a deeper understanding of this complex and life-changing experience.

Unilateral acute idiopathic maculopathy is a rare disease affecting young healthy patients resulting in moderate to severe unilateral visual loss preceded by prodromal flu-like illness. We present a case of delayed presentation of unilateral acute idiopathic maculopathy associated with hand, foot and mouth disease.

Purpose: The authors report a case with early reopening, spontaneous closure, and delayed reopening with optical coherence tomography after successful repair to highlight the dynamic nature of tissue remodeling in surgically repaired macular holes., Method: Observational case report., Result: A 62-year-old woman underwent successful surgery for Grade IV macular hole. Five weeks postoperatively, the macular hole reopened but underwent spontaneous closure at 6 months of follow-up. Nine months later, there was reopening of the macular hole, which was surgically repaired., Conclusion: Successful macular hole repair warrants long-term observation due to the ongoing tissue remodeling.

A 39-year-old female with elevated serum cobalt levels from her bilateral hip prostheses presented with a 3-week history of blurred vision in her left eye. Optical coherence tomography revealed patchy degeneration of the photoreceptor-retinal pigment epithelium (RPE) complex. The lesions were hypofluorescent on indocyanine green angiography. We postulate that this is a case of implant-related chorio-retinal cobalt toxicity.

Purpose: To report a case of intraretinal silicone oil incorporation after anatomically successful detachment surgery., Methods: Retrospective case report., Results: We show a sequence of optical coherence tomography images documenting silicone oil incorporation from the vitreous cavity over a 3-months period. This resulted in foveal cystic spaces filled with a hyperreflective material and best-corrected visual acuity of 30/200., Conclusion: Intraretinal incorporation of silicone oil is rare and mainly occurs via subretinal access in cases with chronically detached retina. However, other mechanisms are possible. Here, we document a case of intraretinal silicone oil incorporation from the vitreous cavity after anatomically successful detachment surgery.

Background:   To assess the efficacy of a new nanopulse laser, retinal regeneration therapy for the treatment of diabetic macular oedema., Design:   Randomized, non-inferiority, trial., Participants:   20 eyes of 17 subjects in the retinal regeneration therapy group and 18 eyes of 14 subjects in the conventional group were analysed., Methods:   The treatment group received retinal regeneration therapy laser, and the control group received photocoagulation., Main Outcome Measures:   The primary outcome was the optical coherence tomography-measured change in central retinal thickness at 6 months. A secondary outcome was the change in logarithm of minimum angle of resolution visual acuity at 6 months. Non-inferiority required the one-sided 95% confidence interval of the mean retinal thickness reduction after retinal regeneration therapy to be within 35 µm of the reduction after control laser., Results:   When outliers were included in the dataset, the difference in retinal thickness reduction by analysis of covariance was 10.9 (standard deviation 17.6) mm in favour of the control laser. The difference between groups in retinal thickness reduction was 40.8 mm. If two extreme outliers were excluded, the difference was 5.6 (standard deviation 14.2) mm in favour of the retinal regeneration therapy laser, and the D optical coherence tomography was 18.5 mm. The visual acuity difference between groups was 0.059, meeting non-inferiority requirements., Conclusions:   Although retinal thickness reduction was not unambiguously non-inferior, in the short-term, retinal regeneration therapy approximates the clinical efficacy of conventional photocoagulation, stabilizing visual acuity and providing motivation for larger trials assessing retinal regeneration therapy., (© 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To report a case with giant retinal tear after pneumatic retinopexy. To our knowledge, this is only the second case of a giant retinal tear after pneumatic retinopexy reported., Methods: This is a descriptive case study., Results: A 43-year-old myopic man underwent pneumatic retinopexy for right eye rhegmatogenous retinal detachment. Postoperative course was complicated by a giant retinal tear, which was treated successfully., Conclusion: Though rare, giant retinal tears can occur after pneumatic retinopexy. The likely mechanism is increased vitreous traction because of expansion of gas in a predisposed myopic eye.

A 62-year-old woman with an autoimmune disease presented with panuveitis and was treated with immune suppression. She subsequently developed herpetic acute retinal necrosis and later died of herpes simplex encephalitis. Acute retinal necrosis usually occurs months to years after herpes simplex encephalitis. In our case, the ocular findings were present for 5 weeks before the encephalitis presented. To our knowledge, this is the first Australian case of acute retinal necrosis preceding herpes simplex encephalitis.

A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.

Purpose: To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age-related macular degeneration (AMD) using an as required dosing regimen., Methods: A retrospective study of 210 patients (231 eyes) with choroidal neovascularization resulting from neovasacular AMD. Patients were treated with 1.25 mg intravitreal bevacizumab at a vitreoretinal practice in Adelaide, South Australia. Patients were followed up at 2-4 weeks and then at 1-month intervals; repeat injections were offered in the event of recurrence. Recurrence was defined as either a decrease of best-corrected visual acuity or an increase in macular oedema, subretinal fluid or intraretinal fluid on optical coherence tomography, after complete or partial resolution in previous follow-up visits. Patient data were collected for 12 months of follow up or until the patient's treatment was changed to ranibizumab., Results: Significant improvement in visual acuity and central retinal thickness was demonstrated at 1 month with an improvement of vision from logMAR equivalent 0.76 to 0.68 (P < 0.001) and a decrease of central retinal thickness from 306 µm to 244 µm (P < 0.001). This overall improvement was continued throughout the 12-month follow-up period; however, follow up was poor with 12-month data available for only a small number of patients (7.8%). Ocular and systemic side-effects were rare at 3.5% and 0.4%, respectively., Conclusion: Eyes with neovascular AMD treated with intravitreal bevacizumab for up to 12 months had significant functional and anatomical improvement. Further studies need to confirm the long-term safety and efficacy of this treatment., (© 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: The objective of the present study was to describe the prevalence of homonymous visual field defects in a defined older urban population and associations with self-reported stroke., Methods: Homonymous visual field defects were assessed from screening automated visual field tests of both eyes in 3654 persons aged > or =49 years who were participating in the Blue Mountains Eye Study. This represented 82.4% of eligible residents from a defined area west of Sydney, Australia. A detailed eye examination was performed, and the medical history was taken. Masked grading of visual fields was used to classify the presence of homonymous visual field defects., Results: Homonymous visual field defects were found in 25 persons (prevalence 0.8%, 95% CI 0.5% to 1.1%). Stroke history was reported by 194 participants (5.3%, 95% CI 4.6% to 6.1%). A strong relationship was found between homonymous visual field defects and history of stroke, age-, and sex-adjusted odds ratio (OR) 23.4 (95% CI 9.9 to 55.7). Homonymous field defects were present in 8.3% of all persons who reported experiencing a stroke. Among those with homonymous field defects, 52% reported a history of stroke. Only 2 of 10 persons (20%) with homonymous field defects without a history of stroke reported having stopped driving, whereas 6 of 9 (67%) reporting stroke had stopped driving (P=0.07). Increasing age (OR 1.4 per decade, 95% CI 1.2 to 1.8) was significantly associated with homonymous visual field defects, with adjustment for sex, whereas a history of hypertension (OR 2.7, 95% CI 1.2 to 6.1), diabetes (OR 2.1, 95% CI 1.4 to 3.2), and renal impairment (OR 2.8, 95% CI 1.0 to 8.1) also was associated, with adjustment for age and sex., Conclusions: This study provides accurate prevalence data for homonymous visual field defects in an older population. About half the participants did not report stroke.

Background: Alloplastic implants have been used to repair orbital wall fractures and correct anophthalmic enophthalmos (or volume deficiency in an anophthalmic socket). Orbital haemorrhage is a rare complication of these implants., Method: A retrospective review of patient files of two consultant oculoplastic surgeons., Results: Four cases of orbital haemorrhage following alloplastic implants were identified. The haemorrhages occurred 5-18 years after surgery, and occurred within the pseudocapsule of the implant. In one case, recurrent haemorrhages were noted., Conclusion: Although rare, orbital haemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery.

The aim of present study was to review vision and other factors associated with the cessation of driving. As part of the Blue Mountains Eye Study, detailed demographic information, driving status and medical history were taken. Visual acuity was measured during a standardized refraction and visual fields documented. Potential risk factors were decided a priori. Among the 3654 Eye Study participants, 2831 (77.5%) had driven a motor vehicle in the past, of whom 2379 (84.0%) were current drivers and 452 (16.0%, 95% CI 14.6-17.4%) said they had stopped driving. Older persons and women were more likely to have stopped driving. After adjusting for age and sex, sensory impairment affecting vision and hearing, plus chronic medical conditions and benzodiazepine use were significantly associated with cessation of driving. The study found that sensory impairment, particularly visual parameters, was associated with the decision to stop driving by older subjects.

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.