Surgical management of optic disc pit associated maculopathy.

PURPOSE: To report the surgical outcome in seven cases of optic disc pit associated maculopathy. METHODS: This was a retrospective case-note analysis of presenting features, pre- and postoperative visual acuities, surgical procedures, complications, and follow-up. The principal treatment in all the cases was pars plana vitrectomy, posterior hyaloid peel, endolaser to the papillomacular bundle temporal to the disc, and internal tamponade with gas or silicone oil. RESULTS: Of the four male and three female patients, two were children. All the patients had posterior hyaloid peeling during the vitrectomy and endolaser. Six patients had intraocular gas tamponade and one had silicone oil. Four patients needed a second surgical procedure to obtain a satisfactory anatomic and visual outcome. Postoperatively, four patients had an improvement of 2 or more Snellen lines. One patient with a history of multiple surgeries developed high intraocular pressure postoperatively and cataract. The mean follow-up period was 9.1 months. CONCLUSIONS: Serous retinopathy associated with optic disc pit responds well to early vitrectomy, endolaser, and internal tamponade. Silicone oil was effective in one refractory case. Cumulative data are required to define the management of this condition.

Posterior polar cataract surgery - a posterior segment approach.

PURPOSE: To suggest a surgical approach that would pre-empt uncontrolled posterior capsular rupture and consequent posterior segment complications associated with posterior polar cataract surgery. DESIGN: An interventional case series. METHODS: This was a prospective, interventional study undertaken at a tertiary referral ophthalmic unit. Eleven eyes of eight patients underwent planned pars plana vitrectomy, lensectomy and posterior chamber sulcus fixated intra-ocular lens implantation. Demography, presenting features, pre- and post-operative visual acuities, complications and length of follow-up were recorded. A single surgical technique was performed in all the cases. RESULTS: Five male and three female patients with a mean age of 49.7 years, underwent this procedure. The median-corrected pre-operative visual acuity was 6/12 and the same post-operatively was 6/6. The only major per-operative complication was one case of accidental iridectomy. Post-operatively there were transient choroidal folds in one case, mild posterior segment haemorrhage in another and retinal detachment in one patient. The mean follow-up period was 13 months. CONCLUSIONS: This surgical technique offers a relatively controlled and predictable approach to posterior polar cataract surgery compared to others described in the literature. Although this technique is not without complications, the visual outcome is usually good.

Effectiveness of emergency argon laser retinopexy performed by trainee doctors.

OBJECTIVE: To report the outcomes following treatment of retinal tears with argon laser photocoagulation by trainee doctors as an emergency procedure. METHODS: Retrospective, case note analysis of 100 consecutive patients treated between August 2000 and December 2002 at a tertiary referral hospital. RESULTS: The case notes of 100 consecutive patients (41 male, 59 female) with a mean age of 57.5 years were reviewed. Out of these 90 were symptomatic. The follow-up period ranged from 1 week to 8 months. All patients had argon laser retinopexy in the Emergency department. The on-call Registrar performed the procedure on 94 patients, and Senior House Officers performed the other six. A total of 98 procedures were performed on the slit lamp and two by laser indirect ophthalmoscope. In all, 24 patients needed further treatment with either indirect laser, cryotherapy, or surgery. At the last follow-up, all the patients had anatomically attached retinas. CONCLUSION: A significant proportion of patients (24%) undergoing laser retinopexy in the emergency department needed further treatment. The relative inexperience in using the indirect laser, together with its unavailability in the Emergency department, may be the contributory factors. There seems to be scope for supervised training in using the laser indirect ophthalmoscope for the trainees in the Ophthalmic Emergency department.

Surgical treatment and outcome of patients with giant retinal tears.

OBJECTIVE: To report the management and outcome in retinal detachments associated with giant retinal tears (GRTs). METHODS: Retrospective, case note analysis of patients treated between November 1991 and June 2002 at a tertiary referral hospital. RESULTS: The case notes of 29 patients (24 males, 5 females) with a follow-up ranging from five months to 7 years were reviewed. In all, 25 eyes had retinal detachments with macular involvement and 10 patients had myopia more than 6 D. All patients underwent vitrectomy. A total of 23 patients had heavy liquid and 16 had scleral explants; 28 patients had silicone oil and one had C3F8 tamponade. Intraoperative complications included lens trauma and iatrogenic GRT. Six eyes had recurrent retinal detachment and needed multiple surgical procedures. At the last follow-up, 25 patients had anatomically attached retinas. In all, 18 fellow eyes were treated prophylactically. Three patients had total retinal detachment and marked PVR. The visual acuity improved in 20 eyes. CONCLUSION: GRTs are more common in patients with high myopia. With newer techniques of surgical treatment of GRTs, the anatomical and visual outcomes are more favourable.

Nature of linkage between the cationic headgroup and cholesteryl skeleton controls gene transfection efficiency.

Three novel cationic cholesterol derivatives with different modes of linkage between the cationic headgroup and the cholesteryl backbone have been synthesized and used as mixtures with 1, 2-dioleoyl-L-alpha-glycero-3-phosphatidyl ethanolamine (DOPE) for liposome-mediated gene transfection. A pronounced improvement in gene transfer efficiency was observed when the cationic center was appended to the cholesteryl backbone using an ether linkage as opposed to when the linkages were based on either ester or urethane groups. Amphiphiles with ether links such as cholest-5-en-3beta-oxyethane-N,N,N-trimethyl ammonium bromide (2) and cholest-5-en-3beta-oxyethane-N,N-dimethyl-N-2-hydroxyethyl ammonium bromide (3) showed transfection efficiencies considerably greater than commercially available gene transfer reagents. Notably, the transfection ability of 2 with DOPE in the presence of serum was significantly greater than Lipofectamine((R)) and Lipofectin((R)). Interestingly, 3 did not require the helper lipid DOPE for transfection. This suggests that these newly described cholesterol-based amphiphiles should be very promising in liposome-mediated gene transfection. The advantage that the ether linkage possesses would be important in the design of newer, more efficient cholesterol-based delivery reagents.