Non-arteritic Anterior Ischaemic Optic Neuropathy after Uneventful Cataract Extraction.

We present the case of a 74-year-old Caucasian female who suffered sudden visual loss after routine phacoemulsification cataract surgery. The patient was subsequently diagnosed with non-arteritic anterior ischaemic optic neuropathy. The case is described in detail, and a concise review of the literature is presented together with the authors' view on the subject outlined. This is a very rare complication after cataract surgery even in high-risk patients with associated systemic co-morbidities. We suspect that the previous history of obesity, coronary artery disease, and arteriosclerosis contributed to the development of this serious ocular complication. We suggest appropriate measures to reduce the risk of its occurrence.

Early controlled drainage of massive suprachoroidal hemorrhage with the aid of an expanding gas bubble and risk factors.

PURPOSE: To assess the visual outcome after massive suprachoroidal hemorrhage managed by early controlled drainage using the aid of an intravitreal expanding gas bubble (100% perfluoropropane). The ocular and systemic risk factors were also reviewed. METHODS: Data were obtained retrospectively from patients with massive suprachoroidal hemorrhage who were treated in Worthing and Southlands National Health Service Trust between January 2003 and December 2008. RESULTS: The study included 10 patients (5 women and 5 men) with a mean age of 73.9 years (range, 54-84 years). All patients underwent early controlled drainage of massive suprachoroidal hemorrhage using 100% perfluoropropane as a tamponade. The mean interval of drainage from the onset was 3.5 days (range, 1-10 days). Anatomical restoration of ocular structures was achieved in 7 patients, with good final visual outcome at mean 9 months (range, 6-14 months). The remaining three patients had poor visual outcome because of retinal detachment with proliferative vitreoretinopathy. The most common risk factor in this case series was glaucoma, which was seen in five patients. Arteriosclerosis was the only risk factor in two patients. CONCLUSION: Early controlled drainage of massive suprachoroidal hemorrhage with 100% perfluoropropane tamponade may help in achieving a good visual outcome. The use of 100% perfluoropropane has the advantage of maintaining positive pressure while facilitating controlled drainage of the hemorrhage as the clot lyses. Retinal detachment however is a poor prognostic indicator. Arteriosclerosis and glaucoma were the most common risk factors seen in this case series.

Intraocular beta-radiation for proliferative vitreo-retinopathy.

Proliferative vitreoretinopathy (PVR) is the most common cause of failure in retinal detachment surgery. PVR is a result of an enhanced healing process. Various surgical and pharmacological methods have failed to provide a definite solution to the problem. Radiation has since long been shown to be effective in similar situations like keloids, pterygia, and post trabeculectomy. Externally delivered radiation has also been tried in PVR, but with limited success. We propose that treatment with intraocularly delivered beta-radiation is a viable method to try and reduce the incidence of PVR after retinal detachment. This can improve the safety of the treatment, reduce potential side effects to surrounding tissues and help achieve a targeted treatment. However, the treatment was limited by the absence of a practical method for intraocular delivery of radiation. This is now possible, as we now have a method which has been shown to be safe in the CABERNET trial. If this can be proved, then it will be an important step towards treating PVR and hence reducing blindness after retinal detachment.

Reopening of a macular hole after nd:yag laser capsulotomy in a vitrectomized eye.

PURPOSE: To describe a case of reopening of macular hole in a vitrectomized eye after Nd:YAG laser capsulotomy. METHODS: A 70-year-old man presented with a Stage 3 macula hole 5 years previously with a vision of 6/24. RESULTS: The patient had a vitrectomy with perfluoropropane tamponade. The macula hole closed and vision improved to 6/12. Subsequently, the patient underwent cataract surgery. The patient required Nd:YAG laser capsulotomy 18 months later for posterior capsule opacification. Assessment before laser treatment revealed the macular hole had remained closed. Immediately postlaser, the patient reported noticing a distinct central scotoma and it was later confirmed that the macular hole had reopened. He had a repeat vitrectomy with internal limiting membrane peel and perfluoropropane tamponade. The macular hole closed and vision improved to 6/18. CONCLUSION: To date, this represents the first case reported in the literature of reopening of a macular hole after Nd:YAG laser capsulotomy in a vitrectomized eye. This implicates causes other than changes in the vitreous for reopening of the macular hole.

Visual function following transpupillary thermotherapy with adjusted laser parameters for the treatment of exudative age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) using adjusted laser parameters for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: TTT was performed on patients with CNV using a diode laser (810 nm) for 60 s in a subthreshold manner. Power settings were varied between 460 and 1200 mW, depending on lesion size, presence of pigment epithelial detachment and the amount of fundal pigmentation and subretinal fluid. LogMAR visual acuity, contrast sensitivity (Pelli-Robson) and metamorphopsia (Amsler chart) were assessed prior to and 6 months following treatment. Subjects also self-administered the National Eye Institute 25-Item Visual Function Questionnaire. RESULTS: Thirty occult/minimally classic and eight predominantly classic membranes were treated with TTT. At 6 months, absence or significant reduction of fluorescein leakage was observed in 20 (53%) patients. Stabilization of vision (loss of less than 15 letters) was observed in 25/30 (83%) eyes with occult/minimally classic CNV and 5/8 (63%) eyes with predominantly classic CNV. Improvement of contrast sensitivity was noted in 15 (35%) eyes, in 10 (26%) eyes it remained unchanged and in 13 (34%) eyes it deteriorated. There was no statistically significant effect of TTT on the National Eye Institute 25-Item Visual Function Questionnaire composite or subscale scores. CONCLUSIONS: TTT using adjusted parameters depending on fundal characteristics appears to be effective in stabilizing subjective and objective visual ability in a considerable number of patients with subfoveal CNV due to age-related macular degeneration. Larger-scale studies are required to confirm the benefit of this technique as opposed to the natural history of occult CNV.