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Aims: To examine the role of early vitrectomy in the management of endophthalmitis from all causes., Methods: Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200)., Results: Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes., Conclusions: Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Endogenous endophthalmitis is rare and associated with significant morbidity and mortality. The primary objective was to identify causative organisms. Secondary objectives included the determination of systemic risk factors and visual prognostic factors., Design: Retrospective review., Methods: 78 eyes from 62 subjects over a 21-year period from 1999 to 2020 in Auckland, New Zealand. Parameters assessed included pathologic microbial organism, clinical presentation, treatment, complications, prognostic factors, and visual outcomes., Methods: Information was collected on microbiology, treatment, visual outcomes, and complications., Results: Median age was 61.6 years and 32 subjects (51.6%) were male. Diabetes was the most common risk factor seen in 24 (38.7%) subjects. 17 subjects (27.4%) presented directly to ophthalmology and 17.4% had an initial misdiagnosis. 49 subjects (79.0%) presented with reduced vision and only 27 (43.5%) presented with pain. Hypopyon was present in 13 eyes (16.7%). Gram-positive bacteria were the most common causative organism seen in 40 (51.3%) eyes, followed by yeast and fungi in 21 (26.9%) eyes, then gram-negative bacteria seen in 17 (21.8%) eyes. Median final BCVA was 6/18. Severe vision loss occurred in 33 (42.3%) eyes and 7 (9.0%) eyes required evisceration or enucleation. Presenting visual acuity was a significant predictor of visual outcome., Conclusion: Endogenous endophthalmitis occurred at 1.9 cases per million per year. Ophthalmologists require a high index of suspicion for underlying systemic infection in any subject presenting with ocular inflammation, and need to be aware that endogenous endophthalmitis may present without pain and frequently without hypopyon.

Purpose: To compare functional and anatomical outcomes, rates of culture positivity and number of procedures in eyes with endophthalmitis following phacoemulsification surgery, treated with either primary vitrectomy and intravitreal antibiotics or vitreous tap and antibiotic injection (T&I)., Methods: Patients developing endophthalmitis after phacoemulsification surgery between 2007 and 2016 were identified, and outcomes were compared between the two treatment groups., Results: 19 patients underwent a primary vitrectomy and 22 underwent a T&I. There was a significant improvement in visual acuity after T&I (p=.003) and primary vitrectomy (p=.00005). The median improvement in visual acuity was significantly greater for the primary vitrectomy group than the T&I group (p=.024). 64% of eyes were culture positive with the initial T&I, and 63% with primary vitrectomy (p=1.00). Two eyes initially culture negative with a T&I, and three eyes that were culture positive with a T&I were subsequently culture positive with a vitrectomy 24-72 hours later. 68% of patients who underwent a T&I required an additional procedure, compared to 26% of the vitrectomy group (p=.01). The T&I group underwent a mean of 2.3 procedures each, and the primary vitrectomy group underwent 1.5 (p=.03)., Conclusions: Eyes with endophthalmitis treated with a primary vitrectomy demonstrated greater visual improvement and needed fewer procedures than those initially treated with a T&I. Viable bacteria were only seen in subsequent procedures in the T&I group, indicating that primary vitrectomy was superior at sterilizing the eye.

The COL9A3 gene encodes one of the three alpha chains of Type IX collagen, with heterozygous variants reported to cause multiple epiphyseal dysplasia, and suggested as contributory in some cases of sensorineural hearing loss. Patients with homozygous variants have midface hypoplasia, myopia, sensorineural hearing loss, epiphyseal changes and carry a diagnosis of Stickler syndrome. Variants in COL9A3 have not previously been reported to cause vitreoretinal degeneration and/or retinal detachments. This report describes two families with autosomal dominant inheritance and predominant features of peripheral vitreoretinal lattice degeneration and retinal detachment. Genomic sequencing revealed a heterozygous splice variant in COL9A3 [NG_016353.1(NM_001853.4):c.1107 + 1G>C, NC_000020.10(NM_001853.4):c.1107 + 1G>C, LRG1253t1] in Family 1, and a heterozygous missense variant [NG_016353.1(NM_001853.4):c.388G>A p.(Gly130Ser)] in Family 2, each segregating with disease. cDNA studies of the splice variant demonstrated an in-frame deletion in the COL2 domain, and the missense variant occurred in the COL3 domain, both indicating the critical role of Type IX collagen in the vitreous base of the eye.

Importance: To determine if endophthalmitis following cataract surgery is linked to increased mortality., Background: Increased mortality has been linked to patients with cataract and cataract surgery. We tested the hypothesis that post-cataract endophthalmitis has a greater risk of death than pseudophakes who do not develop this complication., Design: Case-control study conducted in a tertiary public hospital., Participants: The study group comprised 50 consecutive patients with post-cataract endophthalmitis, and these were matched with selected controls., Methods: Patients with endophthalmitis following cataract surgery were identified from a prospective electronic surgical database. Subsequently, it was determined if the patient was deceased at the time of sequestration (September 2015), and the date of death was recorded. A previously described population who had undergone cataract surgery in the same facility was selected as a control group, and the population was case-matched in terms age, gender, presence or absence of diabetes and/or hypertension., Main Outcome Measures: The median survival rates were determined for the control group and the patients with post-cataract endophthalmitis., Results: Fifty patients were identified as undergoing endophthalmitis post-cataract surgery, and 48 (n = 48) met inclusion criteria (mean age 72 years ±12 SD with 30:18 F:M); 17% were diabetic, and 50% had systemic hypertension. No statistically significant difference in median survival between the study and control cases was identified (100 months (95% confidence interval 86-114) vs. 106 months (95% confidence interval 66-146), respectively, P = 0.756)., Conclusions and Relevance: Post-cataract endophthalmitis was not associated with an increased rate of mortality in this study., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

Importance: To compare the safety and outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in post-vitrectomy eyes., Background: To compare visual outcomes and adverse outcomes of FLACS and conventional phacoemulsification in vitrectomized eyes., Design: Single surgeon, retrospective study set in a private clinic in Auckland, New Zealand. Patients selected in a chronological manner, without masking or randomization., Participants: Only patients undergoing cataract extraction following vitrectomy were included., Methods: The last 25 surgeries performed prior to acquisition of the femtosecond laser and the first 25 surgeries performed following acquisition of the femtosecond laser were included. Patient demographic data, preoperative and postoperative visual acuities were collected. Intraoperative and postoperative complications were compared. Follow-up ranged from 1 to 74 months., Main Outcome Measures: The main outcome measures are postoperative visual outcomes and intra- and postoperative complications for both groups., Results: Results of FLACS compared to conventional phacoemulsification are as follows: preoperative logMAR best corrected visual acuity (BCVA) (0.63 vs. 0.69), postoperative logMAR BCVA (0.17 vs. 0.19), posterior capsule complications (0% vs. 12%, P = 0.235), cystoid macular oedema (CMO) (12% vs. 20%, P = 0.705) and postoperative neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy (16% vs. 48%, P = 0.032)., Conclusions and Relevance: FLACS demonstrates comparable visual outcomes to conventional phacoemulsification. Whilst outcomes measured were not statistically significant, except postoperative YAG capsulotomy, FLACS showed a trend towards a better intraoperative and postoperative safety profile. Femtosecond laser offers a theoretical advantage in reducing complication rates in post-vitrectomy eyes, further larger studies are needed., (© 2017 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To report and evaluate the clinical and optical coherence tomography (OCT) features of optic nerve hemorrhages (ONH) associated with spontaneous posterior vitreous detachment (PVD)., Design: A prospective case series conducted at a private ophthalmic practice in Auckland, New Zealand., Methods: A consecutive series of patients presenting at a private multispecialty practice in Auckland, New Zealand, with symptoms of PVD with ONH underwent imaging of the optic nerve with digital retinal photography and OCT. The number and location of each hemorrhage were recorded, together with relevant ophthalmic and demographic data., Results: Twenty of 30 eyes with ONH had evidence of persistent vitreopapillary adhesion. Three patterns of adhesion were identified: central, peripheral, and combined. In all, 52 hemorrhages were identified, of which the majority were flame-shaped, although other types were seen including dot and blot hemorrhages. One subretinal hemorrhage occurred in a patient with a central vitreopapillary adhesion., Conclusions: ONH hemorrhages associated with PVD are commonly found with persistent vitreopapillary adhesions as evidenced on OCT. The clinical features of ONH together with OCT imaging may help to distinguish ONH associated with PVD from other hemorrhages found on or adjacent to the optic nerve., (Copyright 2017 Asia-Pacific Academy of Ophthalmology.)

Purpose: This study aimed to determine if the lens protein aquaporin 0 (AQP0) is present in the vitreous of pseudophakic eyes of patients presenting with chronic cystoid macular edema (CME)., Design: A case-control study was conducted., Methods: Ten patients undergoing therapeutic vitrectomy for chronic CME after uncomplicated cataract surgery were enrolled in this study. Fourteen patients with pseudophakia undergoing vitrectomy surgery for indications other than CME acted as the comparison group.The vitreous fluid from the 2 groups was analyzed for the presence of the lens protein AQP0 and type II collagen (used as a positive control)., Results: Type II collagen was detected in all the vitreous samples, whereas AQP0 was documented in 50% of eyes with chronic CME but was not found in the vitreous of any eyes without a documented history of CME., Conclusions: Aquaporin 0 is found in some eyes with chronic CME after uncomplicated cataract surgery, suggesting contamination of the vitreous by lens protein may have a role in the pathogenesis of this disorder.

A wide range of ocular abnormalities have been documented to occur in patients with myotonic dystrophy type 1. The objectives of this study were to investigate the macular and optic nerve morphology using optical coherence tomography in patients with myotonic dystrophy type 1. A total of 30 myotonic dystrophy type 1 patients and 28 controls were recruited for participation. All participants underwent a thorough ophthalmologic examination, including spectral-domain optical coherence tomography of the macula and retinal nerve fibre layer. Images were reviewed by a retinal specialist ophthalmologist, masked to the diagnosis of the participants. Average macular thickness was significantly greater in the myotonic dystrophy group compared to controls [327.3 μm vs. 308.5 μm (p < 0.001)]. Macular thickness was significantly greater (p < 0.005) in five of the nine macular regions. The increase in macular thickness was due to the increased prevalence of epiretinal membranes in the myotonic dystrophy patient group (p = 0.0002): 48.2 % of myotonic dystrophy patient eyes had evidence of epiretinal membrane, compared with 12.5 % of control eyes. Examination revealed that 56.7 % of myotonic dystrophy patients had an epiretinal membrane in at least one eye. Visual acuity was reduced due to the presence of epiretinal membrane in six patient eyes and none of the control eyes. The presence of an epiretinal membrane was significantly correlated with increasing age in the patient group. We report an increased prevalence of epiretinal membrane in the myotonic dystrophy type 1 group. This may be a previously under-recognised form of visual impairment in this group. Epiretinal membranes can be treated surgically. We suggest that, in addition to a comprehensive clinical examination, optical coherence tomography examination is implemented as part of an ophthalmological assessment for the myotonic dystrophy type 1 patient with reduced visual acuity.

We localised amino acids in the mid-peripheral aged human retina and a retina that had undergone radiation treatment 10 years earlier. The distribution pattern of glutamate, γ-amino butyric acid (GABA), glycine, glutamine and taurine, reflected patterns established in the primate retina. The retina that had undergone radiation exposure displayed both anatomical and neurochemical remodelling. The proximal retina comprised around 40 to 45 per cent of the total retina and neuronal kinesis and aberrant neuronal projections were also present. Amino acid neurochemistry was strikingly different with Müller cells displaying GABA loading, glycinergic neurons displaced and displaying a very high level of glycine labelling. We conclude that radiation exposure triggered these changes in the human retina and likely reflects general remodelling of structure and function following ischaemic damage to endothelial cells., (© 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.)

Purpose: To identify the distribution of creatine transporter (CRT) in the aged human retina and how this expression pattern is modified after retinal detachment., Methods: An affinity-purified antibody raised against the CRT was used in the immunohistochemical investigation. The anti-CRT antibody was colocalized with neuronal markers (calbindin, parvalbumin, Islet-1, calretinin, GAD₆₇, Go-alpha), glia markers (glutamine synthetase, glial fibrillary acid protein), and a blood vessel basal membrane marker (laminin). Confocal microscopy was used to visualize the labeling patterns in retinal sections. The level of CRT expression was determined in the retina using a semiquantification method., Results: Immunohistochemical assessment of CRT expression in the normal aged retina revealed strong labeling in photoreceptor synaptic terminals and in inner and outer segments. Labeling was also observed on subpopulations of amacrine cells and ganglion cells as well as in the outer and inner plexiform layers. CRT labeling was observed in blood vessels, although was absent in glial cells. In retinal detachment, the CRT labeling pattern was maintained, although there was an apparent decrease in labeling in inner retina and an increase in CRT expression in photoreceptors., Conclusions: CRT is expressed in areas of intense metabolic activity, such as photoreceptors, selected cells in the inner retina, and sites of creatine transport into the retina (inner retinal blood vessels and retinal pigment epithelium). The absence of CRT to Müller cells harmonizes with the concept that glial cells are a biosynthetic source of creatine but not a source of creatine to other retinal neurons. The increased immunolabeling of CRT localized to the outer retina in retinal detachment suggests a regional metabolic remodeling occurring in photoreceptor cells.

Rhegmatogenous retinal detachment is by far the most common indication for retinal surgery and a major cause of severe vision loss. Increased levels of glutamate found in the vitreous of human patients and persistent remodeling, even after reattachment, suggest substantial neurochemical, functional and anatomical changes have occurred in the detached retina. Therefore, this study was designed to characterize the morphological changes and glutamate receptor functionality in human rhegmatogenous retinal detachment. A cation channel permeating probe, agmatine (1-amino-4-guanidobutane; AGB), was employed to track endogenous and kainate (KA) driven channel functionality combined with immunocytochemical characterization of cellular remodeling. In the detached retina increased AGB permeability was identified in the outer retina while there was a decrease in the inner retina in basal conditions. KA receptors exhibited increased AGB permeability in ON bipolar cells and decreased permeability in calbindin labeled inner retinal cells. All retinal detachment samples demonstrated ectopic synaptic protein expression, photoreceptor processes extending toward the inner retina, and other remodeling features of retinal degeneration. These anatomical changes have been demonstrated in animal studies and are novel features unreported in primary cases of human retinal detachment. We conclude that deafferentation in retinal detachment leads to alteration of the glutamatergic pathway., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Glutamate is the major neurotransmitter in the vertebrate retina. Neurons involved in the glutamate pathway express α-amino-3-hydroxyl-5-methylisoxazole-4-propionic acid (AMPA), kainic acid (KA) and N-methyl-D-aspartate (NMDA) receptors. Functional characterization of these ionotropic glutamate receptors can be achieved by using a cation channel permeating probe named agmatine (1-amino-4-guanidobutane; AGB). Retinal mapping using this guanidinium analog has certain advantages including the immunocytochemical identification of a whole population of neurons expressing functional glutamate gated receptor channels. We have extended AGB studies into the functionality of ionotropic receptors in peripheral aged human retina to serve as a comparison for functional analysis of retinopathies such as retinal detachment. We probed the human retina with AGB after activation with AMPA, KA and NMDA. The results showed patterns of AGB entry into neurons consistent with those previously observed in subunit localization studies in adult mammalian retinae including primates. Application of 30 μM AMPA activated receptors in virtually all calretinin immunoreactive AII amacrine cells in the mid-peripheral human retina. About half of the AII amacrine cells showed AGB permeation after incubation with 50 μM KA. Some bipolar cells including DB3 OFF bipolar cells displayed functional KA receptors. Colocalization of AGB with parvalbumin labeled horizontal cells revealed functional KA and AMPA receptors with no responsiveness to NMDA activation. NMDA activation resulted in AGB labeling of ganglion cells and amacrine cells. The present study provides a description of functional ionotropic glutamate receptors in the aged mid-peripheral human retina., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To determine the incidence of posterior vitreous detachment (PVD) in a series of patients who have undergone cataract surgery by phacoemulsification., Design: Comparative case series., Participants: A consecutive series of 149 patients who underwent cataract surgery aged between 50 and 60 years were evaluated in this study., Methods: Patients identified as being eligible for this study were recalled for an ophthalmic assessment, which included a dilated retinal examination., Main Outcome Measures: The status of the vitreous was recorded following an evaluation by slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and B-scan ultrasonography., Results: A PVD was documented in 50.8% of the pseudophakic eyes as compared to 20.8% in the phakic fellow eyes. This difference was statistically significant. Furthermore, the incidence of PVD was greater in pseudophakic eyes with an axial length of 25 mm or greater compared to those eyes with an axial length of <25 mm. Neodymium: yttrium garnet (Nd:YAG) capsulotomy did not influence the prevalence of PVD.In this series of eyes, with a median follow-up interval of 77 months the incidence of pseudophakic retinal detachment (PRD) was 4%., Conclusions: The incidence of PVD in pseudophakic eyes in the 6th decade is higher than those phakic eyes, and is likely to be associated with the increased risk of PRD observed in this age group.

Aim: To identify the clinical features and outcomes of infectious endophthalmitis in New Zealand., Methods: A retrospective review was performed on all patients presenting at Auckland Public Hospital with presumed infectious endophthalmitis between 1996 and 2004., Results: One hundred and six patients were diagnosed with infectious endophthalmitis over the 9-year study period. More than half the infections occurred in the perioperative setting (58.5%), with the next most common group being patients with a history of ocular trauma (18.9%). Endogenous endophthalmitis accounted for 16.0% of the cases while a small percentage arose from other causes. The mean interval between the onset of symptoms and presentation was 4.2 +/- 7.9 days. There was no significant difference in outcomes between clinical settings (P = 0.616) or between gram-positive, gram-negative and fungal infections (P = 0.090). Evisceration/enucleation was more likely in Pacific peoples and those with poor presenting visual acuity., Conclusions: The most common clinical scenario for patients presenting with presumed infectious endophthalmitis in this series was in the perioperative setting. We did not find that the prognosis was influenced by the microbiological isolate or clinical setting. However, those patients presenting with poor acuities typically had the worst outcomes. Pacific ethnicity was also associated with increased rate of complications.

Purpose: To report on the functional outcome of surgery on patients with concurrent cataract and breakthrough vitreous haemorrhage from age-related macular degeneration (ARMD)., Methods: Retrospective case series., Results: Five eyes were included in the study. The post operative follow-up interval ranged from 9 to 12 months. Preoperative visual acuity ranged from hand motion to perception of light. Two surgeries were complicated by iatrogenic breaks, and a further surgery was required to re-attach the retina in one of these eyes. Only one of the five eyes experienced an improvement in visual functioning., Conclusion: In this series, the outcome of surgery for combined cataract and breakthrough vitreous haemorrhage, secondary to ARMD was poor. The functional outcome of surgery for combined cataract and vitreous haemorrhage secondary to ARMD in this series was poor.

Purpose: To determine the risk for rhegmatogenous retinal detachment (RRD) after phacoemulsification., Setting: Private and public facility, Auckland, New Zealand., Methods: A retrospective study of 1793 consecutive patients having cataract surgery by phacoemulsification was performed. Patients younger than 40 years were excluded, as were patients who had cataract surgery after ocular trauma. Patients having cataract surgery combined with other ocular procedures such as keratoplasty, glaucoma drainage surgery, or posterior segment surgery were similarly excluded., Results: Rhegmatogenous retinal detachment occurred in 1.17% of the patients having cataract surgery. The risk was greater in patients younger than 50 years (5.17%) and less in those older than 70 years (0.64%). The median interval between cataract surgery and development of the retinal detachment was 39 months. The rate of retinal detachment was greater with complicated cataract surgery, but there was no increased risk for those eyes requiring neodymium:YAG laser capsulotomy., Conclusions: The overall risk for RRD after cataract surgery by phacoemulsification was small. However, in the younger patient, the risk for pseudophakic detachment was higher. In light of this finding, the requirement for cataract surgery in this group should be reassessed.

Purpose: To describe the clinical course and estimate the incidence of endophthalmitis after pars plana vitrectomy in New Zealand., Methods: A retrospective analysis was performed on all cases of culture-positive endophthalmitis after vitreoretinal surgery over a 10-year period., Results: Five cases of culture-positive endophthalmitis were identified between 1993 and 2002. During this interval, 10,397 vitrectomies were performed, equating to an overall incidence of 0.048%. All patients presented within 7 days of surgery., Conclusions: Endophthalmitis after pars plana vitrectomy is uncommon but is associated with a poor functional outcome.

The history of retinal surgery in New Zealand is relatively short but covers a period of transition from caustic cautery to laser retinopexy, from scleral shortening to 25 gauge vitrectomy. The practitioners of this craft include some of the notable figures in medicine in New Zealand, and in their own way each contributed to the welfare of those patients with surgical retinal disease.

Aim: To study the feasibility of humidifying air during vitreoretinal surgery and measure the water content of air before and after intraocular transit., Methods: The absolute water content of air was measured in a series of six eyes undergoing fluid-air exchange during macular hole surgery. Infrared absorption spectroscopy was used to determine the water content of the air infusing and exiting each eye. After baseline measurements for each eye were recorded, a second fluid-air exchange was performed and the effect of humidifying the air infusion was documented. The humidifying device used in this study was a prototype adapted from a commercially available respiratory humidifier and enables humidified air to be delivered at a controlled temperature., Results: The water content of air increased following intraocular transit, implying dehydration occurs from the intraocular surfaces. For a standard airline infusion the mean increase in water content of air egressing from an eye was 13.4 mg/l. Humidifying the air reduced the rate of water loss by nearly 90%., Conclusions: Significant water losses can occur from eyes undergoing fluid-air exchange. Humidifying the infused air can substantially reduce the dehydrating effect during an air exchange. This outcome may have a beneficial effect in reducing cataract formation and visual field defects associated with macular hole surgery.

Aim: The symptoms associated with rhegmatogenous retinal detachments are variable and can be associated with other vitreoretinal and neuro-ophthalmic entities. The present study sought to determine the frequency and type of symptoms associated with rhegmatogenous retinal detachment (RRD), and analyse any relationships with the premorbid state., Methods: An observational case series was undertaken. A patient questionnaire together with clinical data was collected for patients presenting with RRD., Results: The data on 141 patients presenting with RRD were evaluated prospectively. More than 90% of patients reported a variety of symptoms including visual loss, floaters and flashes. The speed of visual loss was not associated with the extent of retinal break. Rather unexpectedly, patients with a history of retinal pathology were not any more likely to be symptomatic either in their presenting or fellow eye. The absence of symptoms was not associated with age, high myopia or previous cataract surgery., Conclusion: Both patients and physicians need to be aware of the importance of the symptoms associated with RRD.

Background: To review medical and ophthalmic findings of primary diabetic vitrectomy patients to examine indices important in progression to fellow eye surgery., Methods: A retrospective analysis was undertaken of all diabetic patients undergoing vitreoretinal surgery at Auckland Public Hospital between January 1992 and July 1996. Kaplan-Meier survival analysis was performed along with univariate and multivariate (Cox Proportional Hazards) data analysis., Results: One hundred and fourteen primary diabetic vitrectomy cases were reviewed with mean follow-up duration of 4 years. Thirty-eight per cent (n = 43) of the study group underwent fellow eye surgery at a mean time of 1.6 years after first eye surgery. Fourteen patients were already blind in the fellow eye at baseline, and five patients refused second eye surgery on intention to treat. Thus there were 62 (54%) patients with severe (surgical threshold) fellow eye disease diagnosed within the follow-up period. The presence of either tractional retinal detachment or combined rhegmatogenous/tractional retinal detachment but without vitreous haemorrhage in the presenting eye was, in this series, a risk factor for fellow eye surgery (OR 5.56; 95% CI 1.96-15.8). Maori and Pacific Islander ethnicity was significantly associated with traction retinal detachment (OR 2.23; 95% CI 1.05-4.7). At data analysis 57% (n = 60) of the study patients had died. The mean time to death was 4.3 years, with 84% of these patients having evidence of renal disease at the time of their first eye surgery. Good visual function in at least one eye was maintained in many patients., Conclusions: A substantial proportion of diabetic vitrectomy patients require fellow eye surgery. Absence of vitreous haemorrhage in the presenting eye (i.e. tractional or combined rhegmatogenous/tractional retinal detachments but without vitreous haemorrhage) was predictive of need for fellow eye surgery. The need for diabetic vitrectomy correlates with poor survival in this study population.

Background: The incidence of retinal detachment in New Zealand is not currently documented in the literature. This study sought to determine the annual incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors in northern New Zealand., Methods: Epidemiological and clinical data were collected for all patients presenting with a RRD in a 12-month interval in a confined geographical area of New Zealand., Results: One hundred and forty-one patients presented between May 1997 and April 1998 with a RRD. Five patients presented with bilateral RRD. The mean age at presentation was 53.9 years and the annual incidence for RRD was 11.8 cases per 100,000 people. RRD was more common in males than in females (1.3:1). Ocular trauma, high myopia and cataract extraction were found to be significant risk factors in the development of RRD., Conclusions: The annual incidence of RRD in northern New Zealand is comparable to values reported for other parts of the world and, consistent with previous studies, the incidence of RRD was found to increase with age, and in association with trauma, high myopia and cataract surgery.

Purpose: To assess a humidity device used in vitreoretinal surgery., Methods: Infrared absorption spectroscopy analysis of absolute water content (absolute humidity) was determined for a typical vitreoretinal air infusion line with and without the humidifying device. A variety of experimental laboratory conditions were utilized and designed to mimic those found in the operating room. The effect on physical parameters, such as flow rates and resistance to flow, were also determined., Results: While large bore infusion (LBI) lines had a negligible effect on flow rate and resistance to flow (reduction in infusion pressure), the standard 20 G infusion line (SI) reduced flow rate and infusion pressure by approximately 25%. When used together, the humidifying device and SI reduced flow rate and infusion pressure by one third. The humidifying device was found to add 6.5 mg/L water content to the air infusion line system. Typical operating room (OR) air contains 9.5 mg/L water content, and 43.876 mg/L water content is required to saturate air at body temperature., Conclusion: To eliminate dehydration as a cause of intraocular morbidity, one must first saturate the infused air. If the visual field defects and other complications are eliminated, this would be good evidence for saturating infused air. As infusion pressure (flow rate) influences dehydration rate, unless saturated air is used, infusion pressure cannot be considered an independent variable in the analysis of field defects.

Purpose: This retrospective study was undertaken to review the clinical signs and management of patients with perforating eye injuries associated with regional anaesthesia for ophthalmic surgery., Methods: Fifteen consecutive patients presenting with inadvertent perforation of the globe were evaluated. Eleven required vitreoretinal surgery. The indications were retinal detachment (six eyes), vitreous haemorrhage (four) and an epiretinal membrane (one eye)., Results: Those eyes with retinal detachments generally had a poor functional outcome in spite of the retinae being attached in five of the six eyes. The operative findings of those eyes with vitreous haemorrhage but attached retina demonstrated varying retinal tear configurations., Conclusions: Eyes with perforating injuries following intraorbital anaesthesia are at risk of developing a retinal detachment. In those eyes presenting with dense vitreous but attached retina, consideration of vitrectomy and laser photocoagulation is advised.

In 34 asymptomatic patients from three families at 50% risk of developing Sorsby's fundus dystrophy, colour contrast sensitivity was measured. In 16 the thresholds--mainly of the tritan axis--were raised above the normal values. It is concluded that testing of colour vision is useful in detecting the abnormal genotype. Raised colour contrast sensitivity was not observed before the first fundus or fluorescein angiographic changes in two of the families, while the colour defect occurred in the absence of ophthalmoscopic abnormality in the third family. Therefore, our results support the clinical suggestion that Sorsby's fundus dystrophy is more than one disease.

A presumptive clinical diagnosis of cytomegalovirus (CMV) retinitis was made in two patients presenting with atypical ophthalmologic findings. The diagnosis was confirmed by finding specific CMV DNA sequences in sampled vitreous fluid using a polymerase chain reaction (PCR) based assay. Neither of these patients yielded CMV on culture or PCR of peripheral blood leucocytes, nor was CMV present in tears or urine of either patient. Serum antibody titres were stable and did not help in establishing the diagnosis. This report suggests that CMV retinitis can occur in the absence of disseminated CMV disease.

Thirteen young diabetic patients with peripheral capillary non perfusion who presented with symptoms of mild maculopathy were reviewed retrospectively. In this group, peripheral retinal ischaemia was often overlooked and a rapidly progressive proliferative retinopathy developed. Fluorescein angiography of the peripheral retina showed capillary closure, but with preservation of arterioles and venules. In this series, half of the eyes lost vision. In seven eyes where the peripheral ischaemia was treated by pan retinal photocoagulation, the maculopathy resolved without any specific laser treatment to the macula. In young diabetics presenting with maculopathy, the peripheral retina should be examined for ischaemia, and if present, pan retinal laser photocoagulation should be performed. Focal treatment for the macular disease can be delayed until after the peripheral photocoagulation, as the maculopathy may remit.

Bilateral pigmented fundus lesions were found in 65 out of 72 patients with familial adenomatous polyposis, an additional five patients having unilateral lesions. With a family history of familial adenomatous polyposis, the occurrence of multiple bilateral fundus lesions indicates the presence of the abnormal gene, as does the occurrence of oval pigmented lesions with surrounding pale haloes. The absence of pigmented fundus lesions does not exclude the abnormal genotype, while the presence of occasional pigmented spots can be found in an appreciable percentage of the population. Ocular examination would, however, appear to be valuable in screening those at risk, with a positive yield in most carriers of the gene for familial adenomatous polyposis.

Costly low vision aids are rented to patients by the Otago Hospital Board. Occupational therapists see the patients in the Low Vision Clinic and then as necessary in their homes. As a consequence accurate follow-up and analysis of the help provided by these aids is available. Patients with senile macular degeneration use telescopic reading aids for an average of 27 months after they are prescribed.

A survey was undertaken of a family known to have Sorsby's fundus dystrophy. Fifty members were reviewed, and 14 were found to be affected. Many of Sorsby's original conclusions were confirmed, including the pattern of inheritance and age of visual loss. Yellow material was present at the level of Bruch's membrane early in the course of the disease. However, the earliest phenotypic marker was delayed filling of the choriocapillaris. Abnormalities of choroidal perfusion became more profound and extended centrifugally with time. The loss of central vision was commonly due to atrophy of the outer retina and choroid. Subretinal neovascularization was a rare occurrence. The homology between this dystrophy and age-related macular disease underlines the importance of the clinical findings in this family.

The findings are presented on the updated Kempster pedigree with Sorsby's fundus dystrophy. The study confirms the features described in other families: autosomal dominant inheritance with complete penetrance, loss of central vision due to subfoveal ingrowth of new vessels, and progressive peripheral chorioretinal atrophy. By contrast to other reports the family in the current study have peripheral retinal dysfunction, a deposit of a subretinal yellow material throughout the fundus and a tritan colour defect, all prior to the loss of central vision; in some patients there was loss of central vision from atrophic disease, rather than from ingrowth of subretinal new vessels; and, there was a different temporal progression of the central subretinal neovascular complex. These features suggest the possibility of genetic heterogeneity.