Post-septal upper eyelid loading for treatment of exposure keratopathy secondary to non-cicatricial lagophthalmos.

Exposure keratopathy may result in ocular surface dryness, pain, corneal ulceration and loss of vision. Upper eyelid loading is an effective surgical treatment for paralytic lagophthalmos but has been criticised for complications of implant exposure and poor cosmesis. We therefore reviewed the safety and efficacy of our technique of upper eyelid post-septal loading for exposure keratopathy in this context. A retrospective case notes analysis was undertaken of 38 patients who had upper eyelid loading, all with post-septal weight placement, for correction of lagophthalmos. Patient demographics, indications for surgery, outcomes and complications were analysed. The mean age of all patients was 59.6 years. Exposure keratopathy was secondary to facial nerve paralysis in all but two patients, with tumor excision being the commonest underlying aetiology (63.8%). The mean implant weight used was 1.4 grams. Pre-operatively, all 38 patients had ocular discomfort despite maximal use of lubricating eye drops but post-operatively, 29 patients (76.3%) were comfortable without any such drops. Mean lagophthalmos on blink and gentle closure improved from 7.42mm and 5.47mm pre-operatively to 2.18mm and 1.18mm post-operatively (p < 0.001). Similarly, before surgery all patients had some corneal staining but after surgery 37 patients (97.4%) had none. The gold weight was removed in four patients (10.5%), due to chronic inflammation in three and due to mild astigmatism in one. No patient had exposure of the weight and one patient had a ptosis repair 6 months after surgery. Upper eyelid loading was effective in reducing both signs and symptoms of exposure keratopathy related to lagophthalmos in our series. Patients were very satisfied with the surgical outcome and complications related to exposure and cosmesis were very rare.

Surgically induced necrotising scleritis following three-port pars plana vitrectomy without scleral buckling: a series of three cases.

AIM: To document the presentation, management, and prognosis of three cases of surgically induced necrotising scleritis (SINS) following three-port-pars plana vitrectomy (PPV) without scleral buckling. To discuss potential pathogeneses and treatments. METHODS: An interventional case series of three patients presenting to a tertiary referral unit over a 6-month period. RESULTS: All cases were male, presenting within 6 weeks of PPV, with scleral necrosis around a sclerotomy site. Wound microbiology and systemic vasculitis screens were negative. Two cases had underlying systemic disease and had undergone previous ocular surgery. The necrosis resolved in all with aggressive immunosuppression. CONCLUSIONS: SINS following PPV is a rare occurrence requiring prompt and aggressive immunosuppression. Differentiation from an infective postoperative process is essential. The pathogenesis is poorly understood but may share features with classic SINS including hypersensitivity and ischaemia.

The future of glaucoma clinics.

The number of patients seen with glaucoma related pathologies is predicted to increase significantly over the next few years as a result of an ageing population, increased optometric screening, and raised public awareness. In addition, the recent glaucoma literature proposes more aggressive management of ocular hypertension, open angle glaucoma, and narrow angle pathologies. This will overburden many glaucoma services and demands a reappraisal of current management strategies. Using a database of patients compiled from their tertiary referral glaucoma service as an example, the authors discuss the current controversies relating to each glaucoma subtype, encompassing issues relating to disease prognosis, efficacy of treatment, and resource management. They also suggest a range of strategies aimed at streamlining glaucoma clinics. Examples include shared care schemes, multidisciplinary teams, clinic guidelines/protocols, and alteration of clinic review times. The predicted effect of such schemes on clinic workloads is discussed, together with any existing validation.