ABSTRACT
PURPOSE: To describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection. METHODS: Retrospective, multi-centre, observational case series with case note review. RESULTS: Eight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3-131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40-20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines. CONCLUSIONS: RRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.
Subject(s)
Fibrinolysin/adverse effects , Peptide Fragments/adverse effects , Retina/pathology , Retinal Detachment/chemically induced , Visual Acuity , Aged , Female , Fibrinolysin/administration & dosage , Follow-Up Studies , Humans , Intravitreal Injections , Male , Middle Aged , Peptide Fragments/administration & dosage , Prognosis , Retina/drug effects , Retinal Detachment/diagnosis , Retinal Perforations/diagnosis , Retinal Perforations/drug therapy , Retrospective Studies , Tomography, Optical Coherence/methods , Vitreous Detachment/diagnosis , Vitreous Detachment/drug therapyABSTRACT
BACKGROUND: Visual loss in the wilderness setting is at best disabling and at worst potentially fatal. However many physicians have a poor knowledge of ophthalmology and the basic skills that could be applied in situations away from definitive care. METHOD: This paper is intended for physicians, interested non-medical people and expedition operators as a practical guide to the treatment and prevention of eye problems on expeditions. RESULTS: Some of the eye conditions described in this paper are unique to the high altitude setting, such as high altitude retinopathy and some could happen in any environment, such as trauma, dry eyes and contact lens problems. As with any aspect of an expedition, preparation is vital to prevent and avoid eye problems. It is therefore important that pre-existing ocular conditions are known about and appropriate drugs and equipment are available in expedition first aid kits. CONCLUSIONS: In the event of a visual problem, it is always better to be cautious and evacuate a patient rather than a risk a sight-threatening complication. However this paper should provide a non-ophthalmologist with the skills to treat the eye conditions described.
