Outcomes of suprachoroidal haemorrhage drainage with and without vitrectomy: a 10-year study.

PURPOSE: The management of suprachoroidal haemorrhage (SCH) remains a challenge. We aimed to analyse and discuss the safety and efficacy outcomes of SCH drainage surgery over a 10-year period in one of the largest tertiary centres in the UK. METHODS: Retrospective observational study of consecutive patients who underwent SCH drainage in Manchester Royal Eye Hospital over a 10-year period (from 2008 to 2018). Safety and efficacy were assessed by analysing surgery-related complications and functional and anatomical success. Outcomes of those who underwent external drainage alone versus combined drainage and vitrectomy were compared. RESULTS: Twenty consecutive patients with a mean age of 70 ± 19 years were studied. Age over 70 years, hypertension, cardiovascular disease, and glaucoma were the most common risk factors for SCH. Eleven patients underwent external drainage alone and nine patients had combined vitrectomy and drainage. Overall, mean pre-operative BCVA improved from 2.22 ± 0.26 logMAR (20/3319 Snellen) to 1.42 ± 1.02 LogMAR (20/526 Snellen) at last follow-up visit (p = 0.002). Severe hypotony occurred in 4 patients. Overall anatomical and functional success rates were both 75%. CONCLUSIONS: Drainage of SCH with or without vitrectomy is a valuable approach in the management of extensive SCH, a condition generally associated with poor prognosis.

Favourable outcome in paediatric endogenous endophthalmitis secondary to Neisseria meningitidis following pars plana vitrectomy.

Paediatric endogenous endophthalmitis is an uncommon but potentially devastating intraocular infection which should not be missed. Often cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight and life. We present one such case and how it was surgically managed.

Management of penetrating injury with retained intraocular lead foreign body from a writing instrument: surgical video with implications for paediatric public health and safety.

Penetrating ocular injuries from writing instruments that are thrown, especially by children, in the community can result in significant ocular morbidity. Often these cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight. We present a case of one such injury and how it was surgically managed.

Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent.

PRECIS: The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required. PURPOSE: The purpose of this study was to report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis. METHODS: Retrospective observational case series of 37 eyes, with medically uncontrolled glaucoma in uveitis using Xen-45 implantation. All patients had at least 12 months follow-up. Primary outcome measures included visual acuity, intraocular pressure (IOP), degree of inflammation and ocular hypotensive medications. In addition, the time taken from the decision to surgery was recorded. Data were collected preoperatively and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. Postoperative complications included hypotony and decompressive retinopathy. The requirement for further glaucoma surgery, including bleb needling, and failure were documented. RESULTS: The mean follow-up time was 16.7 months (range: 12 to 32 mo). Preoperatively all patients were on >3 ocular hypotensive medications and 75.7% were on oral acetazolamide. Systemic immunosuppression was used in 62.2% and all were on topical steroids. Mean preoperative IOP was 36.1 mm Hg (±SD 9.6) on an average 3.69 (±SD 0.47) drops. The median time from decision to operate to surgery was 5.5 days (range: 1 to 120 d). Mean postoperative IOP was 12.6 mm Hg (±SD 4.1) with an average 0.62 (±SD 1.1) drops at 1 year representing a 65% drop in IOP and 83% reduction in IOP-lowering medication. Bleb needling with 5-fluorouracil was performed on 5 eyes (13.5%). Symptomatic hypotony occurred in 7 eyes requiring further interventions. No decompressive retinopathy was found at last follow-up. Five eyes (13.5%) failed, needing drainage tube surgery or trabeculectomy. CONCLUSIONS: The Xen-45 implant is an effective treatment for hypertensive crises in glaucoma in uveitis, offering dramatic IOP lowering without significant uveitis flare-up. In this group of patients with uveitis, needling rates are lower than reported in primary open-angle glaucoma. However, complications including hypotony can still occur.