Heavy silicone oil tamponade: a multicentre experience.

OBJECTIVE: To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications. METHODS AND ANALYSIS: Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil. RESULTS: 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0-2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes). CONCLUSION: This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies.

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens.

PURPOSE: To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL). METHODS: Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2-4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery. RESULTS: A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%. CONCLUSIONS: The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism.

Intravitreal gas injection for the treatment of diabetic macular edema.

PURPOSE: This study investigates the efficacy of an intravitreal gas injection in inducing a posterior vitreous detachment (PVD) in patients with clinically significant diabetic macular edema refractory to laser therapy. METHODS: A local ethics committee-approved technique of an intravitreal injection of pure perfluoropropane gas (C(3)F(8)) was performed for all participants. After a period of prone positioning, the patients underwent regular and detailed clinical review. MAIN OUTCOME MEASURES: The induction of a PVD, change in macular thickness, change in visual acuity. RESULTS: A PVD was induced in all five eyes with subsequent signs of reduction in macular thickness and resolution of exudates. Mean visual improvement was 11 ETDRS (Early Treatment Diabetic Retinopathy Study) letters (range 4-21). Apart from a transient vitreous hemorrhage in one eye, there were no significant treatment-related complications. CONCLUSION: The induction of a PVD by pneumatic retinopexy appears to have a significant influence on diabetic macular edema in eyes which have not successfully responded to macular laser therapy. A randomized clinical trial is justified on the basis of the initial promising data.

Hyoscine skin patches for drooling dilate pupils and impair accommodation: spectacle correction for photophobia and blurred vision may be warranted.

Hyoscine skin patches diminish salivation by their anticholinergic action. The aim of reporting this case series is to present the ophthalmic side effects in children, and to highlight the precautions to take. Five children (two males, three females; age range 8-18y) with quadraplegic cerebral palsy (Gross Motor Function Classification System Level V) and profound intellectual impairment, wearing hyoscine skin patches to control excessive salivation, were examined. Binocular visual acuity, pupil reaction, pupil diameter, and dynamic retinoscopy were recorded before and after instilling guttae cyclopentolate 1%. The accommodative responses were compared with the expected norms. Spectacle correction was provided for refractive error and to compensate for lack of accommodation. Tinted lenses were provided for photophobia. Visual assessment was repeated 6 months later. All children had dilated pupils with a mean diameter of 7.8mm (range 7-9mm) before instilling guttae cyclopentolate. Mean pupil constriction to bright light was only 1.8mm (range 1-2mm). Mean resting accommodation was 0.45 dioptres (D; range 0-1D) and no accommodative responses were detected on dynamic retinoscopy. Three children were photophobic. Visual behaviour was seen to improve after the use of appropriate spectacles. Photophobia was relieved by tinted lenses. The anticholinergic effects of hyoscine skin patches can cause photophobia and impair vision due to pupil dilatation and paralysis of accommodation. Appropriate spectacles are recommended.

PaCE: a technique to avoid subretinal fluid drainage in retinal detachment surgery.

PURPOSE: Subretinal fluid (SRF) drainage and thus the potential complications of this procedure during scleral buckling can be avoided by inducing SRF absorption preoperatively. The technique described in this series is named PaCE (Pneumatic Cryo Explant). METHODS: A total of 22 eyes of 22 patients with primary bullous rhegmatogenous retinal detachment (RRD) were included in this prospective non-comparative case trial. All satisfied specific inclusion criteria similar to those used in previous pneumatic retinopexy (PR) studies. Under direct visualization, 0.3 ml C3F8 100% was injected into the vitreous cavity through the pars plana. Postoperative posturing was encouraged. Retinopexy with either cryotherapy or laser was performed, combined with scleral buckling (SB) when the SRF was absorbed. Avoidance of SRF drainage and persistent reattachment of the retina at the end of the 12-month follow-up was considered a successful outcome. A change in vision by one line (logMAR) was considered significant. RESULTS: Resolution of SRF before retinopexy and the SB procedure was achieved in 20 of 22 eyes (90.9%) and hence SRF drainage was not required. Visual improvement was achieved in 95% of cases. One eye (4.5%) lost vision due to a total RD after gas injection (further surgery was not carried out). CONCLUSION: PaCE should be considered in any suitable case of primary RRD where SRF drainage is deemed necessary. The potential complications associated with this procedure are relatively less serious and it does not compromise the viability of subsequent procedures.

Choroidal neovascularization after laser in situ keratomileusis in a patient with low myopia.

We report a case of choroidal neovascularization after laser in situ keratomileusis in a 37-year-old man with low myopia.