An unusual maculopathy after routine cataract surgery.

AIMS: To report the presentation of apparent acute and transient vitreomacular traction causing reduction in visual acuity following routine cataract surgery. METHODS: A case series describing three patients that developed acute and transient vitreomacular traction following routine cataract surgery by experienced surgeons. No patients had any significant past medical or ophthalmic history. The patients presented shortly after surgery with reduction in visual acuity and dramatic optical coherence tomography (OCT) images suggesting vitreomacular traction. RESULTS: All three patients experienced spontaneous resolution of symptoms and clinical signs within the first few weeks after surgery. Two patients experienced continued mild metamorphopsia. CONCLUSION: To our knowledge, this is the first documented report of such cases with associated confirmation by OCT imaging.

Expanding role of local anaesthesia in vitreoretinal surgery.

PURPOSE: Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA). We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19-month period. METHODS: A total of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit. RESULTS: In total, 920/1003 (91.7%) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs 35.7%, P<0.001). In 920/920 (100%) of cases, LA was administered via intraconal injection, compared to 164/1221 (13.4%) of procedures previously. Significantly more patients under the age of 35 years required sedation (35.9%) than did older patients (19.2%). Overall, use of sedation was significantly increased since our previous study (20.2 vs 7.8%). Anaesthesia and surgery were well tolerated by patients. There were no cases of orbital haemorrhage or ocular perforation. Complications included bradycardia requiring atropine 1/920 (0.1%) and chemosis 88/920 (9.6%). CONCLUSIONS: LA is well tolerated and effective even in younger patients. Sedation may well be required in younger patients and for procedures involving scleral buckling. The main indication for GA was patient preference. Despite this, such patients accounted for only 5.2% of the total.

Effect of video display on the grading of diabetic retinopathy.

PURPOSE: Digital images are increasingly being used in ophthalmology. These may be viewed either on thin-film transistor (TFT) or on cathode-ray tube (CRT) displays. However, there is little data showing which is superior. In this study, we compared the performance of CRT and TFT displays for grading of both compressed and uncompressed images of diabetic retinopathy. METHODS: A total of 49 35 mm transparencies of diabetic retinopathy were scanned and compressed. The images comprised 17 with no retinopathy, eight with background, five with preproliferative, and 19 with proliferative retinopathy. Four levels of compression were used: 0, 70, 80, and 90%. A total of 196 randomised images were presented to two masked graders using both TFT and CRT displays under uniform lighting conditions, 2 months apart. The grade of retinopathy was assessed. Statistical analysis of grading accuracy was performed using receiver operator characteristic curves of sensitivity and specificity and the Stuart-Maxwell test for paired, nonparametric data. RESULTS: Both displays showed high sensitivity and specificity for the detection of any retinopathy. For the specific grade of retinopathy, the CRT performed slightly better with a sensitivity of 0.80 for uncompressed images, compared with 0.75 using the TFT. Compression reduced these sensitivities to 0.73 on the CRT and 0.63 on the TFT. Grading of uncompressed images magnified to four times their original size was more accurate on the TFT. CONCLUSIONS: Grading on both displays met sensitivity and specificity criteria proposed by Diabetes UK (formerly British Diabetic Association) for screening of diabetic retinopathy. The CRT generally performed slightly better than the TFT in relation to the detection of the specific grade of retinopathy.