Vitreoretinal management of the complications of sickle cell retinopathy by observation or pars plana vitrectomy.

PURPOSE: To describe the management of vitreoretinal complications of sickle cell retinopathy. DESIGN: A retrospective interventional case series. METHODS: Review of an electronic patient record and clinical notes of 27 patients with vitreoretinal complications of sickle retinopathy. RESULTS: Six male patients and 21 female patients presented with a mean age of 41 years (range 28-67), 12 left eyes and 16 right eyes. The mean follow-up was 15.5 months (range: 3-60). Two patients were SS, and the remainders were doubly heterozygous (SC). In all, 10 were observed without surgery- three with vitreous haemorrhage, four tractional retinal detachments (TRD), and three rhegmatogenous retinal detachments (RRD). Two patients demonstrated spontaneous flattening of the retina- one RRD and one TRD. Eighteen eyes had pars plana vitrectomies (PPVs)- seven with vitreous haemorrhage, three RRD, three TRD, three ERM (one bilateral), and two macular holes. In all, 15 patients (83%) had improved vision postoperatively. The mean logMar preoperative visual acuity was 1.07 (Snellen equivalent 6/70), SD 0.62 was significantly improved postoperatively (mean 0.42 (6/15), SD 0.48, P=0.001). CONCLUSIONS: Sickle retinopathy occasionally presents with vitreoretinal complications. These can often be observed and may spontaneously regress. If surgery is required eyes respond to vitrectomy procedures with segmentation of sea fan proliferation.

Severe folding of the inferior retina after relaxing retinectomy for proliferative vitreoretinopathy.

PURPOSE: Proliferative vitreoretinopathy (PVR) is a severe complication of retinal detachment, which can be treated surgically by relaxing retinectomy. In this study, we describe patients with severe inferior retinal folding after this surgical intervention (SIRF). METHODS: A retrospective review of the electronic patient records of 254 patients who received relaxing retinectomies was performed to identify patients with SIRF. RESULTS: Five patients (1.97% of those with retinectomy) were identified with SIRF, mean age, 51.4 years; mean follow-up, 36 months. Three patients had rhegmatogenous retinal detachment (RRD) with PVR, one had a dropped nucleus with RRD and PVR and one with giant retinal dialysis from ocular trauma. SIRF was noted from a mean 4.2 months after the retinectomy. All involved the macula and visions were hand movements or perception of light. CONCLUSIONS: SIRF is an uncommon but devastating complication of relaxing retinectomy with a poor visual outcome. This is the first description of this condition that we are aware of.

Comparison of standard eyelid margin closure using silk with a modified repair using 7/0 vicryl and a buried knot.

AIMS: To assess the efficacy and complications of eyelid margin closure with 7/0 Vicryl or Vicryl Rapide suture with a buried knot at the grey line and to compare this with standard closure using silk with an external knot. METHODS: Analysis of a prospective, non-comparative, interventional case series using 7/0 Vicryl or Vicryl Rapide with a buried grey-line knot (modified lid margin closure). Detailed assessment during the healing period was directed to (1) the lid margin profile, (2) the grey line suture and (3) the tissue reaction. Patients were seen for assessment within two days following surgery, at 14 days and at two months. A retrospective, comparative series of silk with an external knot (standard lid margin closure) and 7/0 Vicryl or Vicryl Rapide (modified lid margin closure) was also studied. An analysis was made of the hospital records of patients who had undergone direct lid margin closure with 7/0 Vicryl, Vicryl Rapide or silk. Short- and long-term complications were noted. RESULTS: The prospective series included 24 patients whose lid margin closure had been performed with the modified technique with 7/0 Vicryl or 7/0 Vicryl Rapide. All lids healed well and there was no difference between these two sutures. The retrospective series included 123 patients. Seventy-one patients had the modified technique using 7/0 Vicryl or Vicryl Rapide. Fifty-two patients had lid margin closure with the standard technique using 6/0 silk. All lids healed well. In summary, in both the prospective and retrospective groups, no significant complications were encountered and the healing was excellent. CONCLUSIONS: 7/0 Vicryl and Vicryl Rapide with a buried knot at the grey line allows excellent lid margin healing comparable with standard closure using silk. Vicryl sutures do not need to be removed.