Long-term survival rates of patients undergoing vitrectomy for diabetic retinopathy in an Australian population: a population-based audit.

IMPORTANCE: Five-year survival rates in patients undergoing vitrectomy for diabetic retinopathy (DR) vary from 68% to 95%. No study has been conducted in an Australian population. BACKGROUND: We aimed to determine the survival rates of patients undergoing diabetic vitrectomy in an Australian population. DESIGN: Retrospective audit, tertiary centre hospitals and private practices. PARTICIPANTS: All individuals in South Australia and the Northern Territory who underwent their first vitrectomy for diabetic complications between January 1, 2007 and December 31, 2011. METHODS: An audit of all eligible participants has been completed previously. Survival status as of July 6, 2018 and cause of death were obtained using SA/NT DataLink. Kaplan-Meier survival curves and multivariate cox-regressions were used to analyse survival rates and identify risk factors for mortality. MAIN OUTCOME MEASURES: Five-, seven- and nine-year survival rates. RESULTS: The 5-, 7- and 9-year survival rates were 84.4%, 77.9% and 74.7%, respectively. The most common cause of death was cardiovascular disease. Associated with increased mortality independent of age were Indigenous ethnicity (HR = 2.04, 95% confidence interval [CI]: 1.17-3.57, P = 0.012), chronic renal failure (HR = 1.76, 95% CI: 1.07-2.89, P = 0.026) and renal failure requiring dialysis (HR = 2.32, 95% CI: 1.25-4.32, P = 0.008). CONCLUSIONS AND RELEVANCE: Long-term survival rates after diabetic vitrectomy in Australia are similar to rates reported in other populations. Indigenous ethnicity and chronic renal failure were the most significant factors associated with long-term mortality. This information can guide allocation of future resources to improve the prognosis of these high risk groups.

Visual outcomes following vitrectomy for diabetic retinopathy amongst Indigenous and non-Indigenous Australians in South Australia and the Northern Territory.

IMPORTANCE: Visual outcomes following diabetic vitrectomy have not previously been studied in an Australian population. BACKGROUND: This analysis aimed to determine the rate of, and factors associated with visual success following diabetic vitrectomy performed for Indigenous and non-Indigenous Australians, and investigate factors predisposing to early progression to diabetic retinopathy (DR) requiring vitrectomy. DESIGN: Retrospective, population-based audit. PARTICIPANTS: All patients undergoing vitrectomy for the complications of DR in South Australia (SA) and the Northern Territory (NT) between 2007 and 2011. METHODS: Medical records were audited and data collected, including demographics, diabetic history, past treatment for DR, indication for vitrectomy and visual acuity pre and postoperatively. MAIN OUTCOME MEASURES: Visual success (gain of ≥15 ETDRS letters) at 6 and 12 months, postoperatively. RESULTS: A total of 495 diabetic vitrectomies, for 404 eyes of 335 patients were performed in SA and NT between 2007 and 2011. 77 (23%) patients requiring diabetic vitrectomy were Indigenous Australians. 87% of patients undergoing diabetic vitrectomy had stable or improved vision at 1 year, postoperatively. There was no significant difference between indigenous and non-indigenous eyes achieving visual success (P = 0.929). Timely preoperative laser treatment (P = 0.03) and preoperative visual acuity (P = 0.01) were the predominant factors associated with visual success. CONCLUSIONS AND RELEVANCE: Indigenous patients are just as likely to have improved vision following diabetic vitrectomy as non-Indigenous Australians. However, the small subset of indigenous patients with blind eyes prior to vitrectomy are significantly less likely to improve from surgery. The underlying factors associated with poor outcomes in this group requires further exploration.

Desferrioxamine-related ocular toxicity: a case report.

A 29-year-old lady receiving repeated blood transfusions for ß thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine.

Pilot randomized trial of a nanopulse retinal laser versus conventional photocoagulation for the treatment of diabetic macular oedema.

BACKGROUND: To assess the efficacy of a new nanopulse laser, retinal regeneration therapy for the treatment of diabetic macular oedema. DESIGN: Randomized, non-inferiority, trial. PARTICIPANTS: 20 eyes of 17 subjects in the retinal regeneration therapy group and 18 eyes of 14 subjects in the conventional group were analysed. METHODS: The treatment group received retinal regeneration therapy laser, and the control group received photocoagulation. MAIN OUTCOME MEASURES: The primary outcome was the optical coherence tomography-measured change in central retinal thickness at 6 months. A secondary outcome was the change in logarithm of minimum angle of resolution visual acuity at 6 months. Non-inferiority required the one-sided 95% confidence interval of the mean retinal thickness reduction after retinal regeneration therapy to be within 35 µm of the reduction after control laser. RESULTS: When outliers were included in the dataset, the difference in retinal thickness reduction by analysis of covariance was 10.9 (standard deviation 17.6) mm in favour of the control laser. The difference between groups in retinal thickness reduction was 40.8 mm. If two extreme outliers were excluded, the difference was 5.6 (standard deviation 14.2) mm in favour of the retinal regeneration therapy laser, and the D optical coherence tomography was 18.5 mm. The visual acuity difference between groups was 0.059, meeting non-inferiority requirements. CONCLUSIONS: Although retinal thickness reduction was not unambiguously non-inferior, in the short-term, retinal regeneration therapy approximates the clinical efficacy of conventional photocoagulation, stabilizing visual acuity and providing motivation for larger trials assessing retinal regeneration therapy.

Pulsed intravenous cyclophosphamide for sle retinal vasculitis.

PURPOSE: To report a case of systemic lupus erythematosus vaso-occlusive retinopathy with severe visual loss treated with intravenous pulsed cyclophosphamide. METHODS: Retrospective interventional case report. RESULTS: A 20-year-old Cambodian woman with newly diagnosed systemic lupus erythematosus presented with acute visual loss. Fluorescein fundus angiography demonstrated occlusive retinal vasculitis. Treatment with pulsed intravenous cyclophosphamide, intravenous methylprednisolone, and anticoagulation resulted in recovery of vision from count fingers to 6/6 in both eyes. CONCLUSION: Early aggressive immunosuppression and anticoagulation for systemic lupus erythematosus retinal vasculitis can be beneficial in preventing disease progression and restoring vision. Further studies are needed to compare dosage regimens.

Choroidal neovascularization secondary to sorsby fundus dystrophy treated with intravitreal bevacizumab.

PURPOSE: To report a case of extrafoveal choroidal neovascularization secondary to Sorsby fundus dystrophy that maintained 20/20 visual acuity over 14 months with intravitreal bevacizumab therapy. METHODS: Interventional case report of as-needed treatment with intravitreal bevacizumab of a 38-year-old lady with choroidal neovascularization from Sorsby fundus dystrophy. RESULTS: Three injections of intravitreal bevacizumab were given over 14.5 months, maintaining visual acuity at 20/20. CONCLUSION: Intravitreal bevacizumab therapy appears to maintain vision in patients with choroidal neovascularization from Sorsby fundus dystrophy.

Atrial fibrillation following subconjunctival injection of mydricaine number 02.

Mydricaine is a mydriatic agent used as a subconjunctival injection to maintain perioperative mydriasis. The drug consists of a mixture of 1.3 mg atropine sulphate, 0.12 mg adrenaline and 8.4 mg procaine hydrochloride in a single vial of 0.4 mL. It is common practice to use mydricaine injections during vitreoretinal surgery in the Royal Adelaide Hospital. Even though the drug is used widely in many vitreoretinal centres, mydricaine is not listed in the British National Formulary nor Monthly Index of Medical Specialities. Therefore, case reports provide the main forum for reporting side-effects.

Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia.

This retrospective report presents a series of patients with endogenous endophthalmitis treated over a 13-y period in a tertiary care centre in South Australia. 16 eyes of 13 patients (8 M, 5 F) with a mean age 62 y were included. Systemic predisposing risk factors were mainly diabetes mellitus (30.7%), chronic obstructive airway disease (23.1%) and end-stage renal disease (15.4%). Isolated organisms included fungal species in 11 eyes (7 eyes with Candida albicans and 4 with Aspergillus fumigatus), Gram-positive isolates in 4 eyes, and Pseudomonas aeruginosa in 1 eyes. Presenting visual acuity was 20/200 or lower in 8 patients (61.5%). Final visual improvement of more than 2 lines was noted in 5 patients, it was stable or worse in 6 patients and in 2 patients the eye was either enucleated or eviscerated. Systemic aspergillosis resulted in death of both patients. In conclusion, the clinical course and microbiological profile of pathogens in patients with endogenous endophthalmitis in our series are similar to other recent western reports. Candida species are the leading isolates, with an overall poor visual prognosis, especially in Aspergillus infections. Close monitoring of immune-compromised patients with systemic infections may enable early diagnosis and treatment and improve prognosis.