Surgery for idiopathic full-thickness macular holes within four months of symptom onset yields superior visual outcomes: Results from an Irish patient cohort.

PURPOSE: To describe the anatomical, visual, and safety results of full-thickness macular hole (FTMH) repair surgery and determine factors influencing outcomes. PATIENTS AND METHODS: A retrospective chart review was performed on all patients who underwent primary FTMH repair surgery by a single surgeon over a 3-year period. For comparisons, Snellen visual acuity (VA) was converted to logMAR equivalent. Anatomical hole closure, visual improvement, and final VA of ≤ 0.30 logMAR were the primary outcome measures. RESULTS: Twenty eyes of 19 patients were included. Mean patient age was 69 years (range 55 to 80 years) and 74% were female. Mean minimum linear diameter (MLD) was 440 µm (range 170 µm to 1200 µm). Mean duration of symptoms before surgery was 16 weeks (range 3 to 39 weeks). 100% of eyes achieved successful anatomical FTMH closure. Mean VA improved from 1.03 ± 0.43 logMAR (Snellen 6/60) preoperatively to 0.35 ± 0.22 logMAR (Snellen 6/15) postoperatively (p = 0.0001). Patients with worse preoperative VA gained more vision than those with better preoperative VA (p = 0.01). Eyes operated on within 4 months of symptom onset were more than twice as likely to achieve a postoperative VA of ≤ 0.30 logMAR (Snellen 6/12 or better) compared to eyes with a longer duration of symptoms (p = 0.03). CONCLUSION: FTMH repair surgery was safe and effective, with outcomes comparing favourably with published international studies. All patients benefited from surgery regardless of symptom duration, presenting VA or FTMH size. However, surgery performed within 4 months of symptom-onset was particularly beneficial, highlighting the need for prompt referral and surgery.

Presentations to eye emergency departments with flashes and floaters differ dependent on incident solar radiation.

AIM: The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye emergency department of a tertiary referral hospital (the Mater Misericordiae University Hospital) over a 3-year period. The diagnostic and clinical outcomes of F/F presentations were also analysed. METHODS: This retrospective study assessed eye casualty attendances between January 2018 and December 2020. Solar irradiation (j/cm2) at ground level was retrieved from the records of Met Eireann (Irish National Meteorological Service) via their open access records. A review of electronic patient medical records using the in-house database patient centre was carried out of all patients who attended EED of during the study timeline on the 5 'brightest' and 5 'darkest' days of each year. RESULTS: Seven hundred forty patient presentations were analysed in total. Overall, 16% (n = 119) of all patients that attended EED during the timeframe of the study presented with F/F. One hundred six patients (89%) presented with floaters, 40 patients (34%) presented with flashing lights/photopsia, and 35 patients (29%) presented with both F/F. More patients presented to EED with F/F on bright days when compared with dark days (74 vs 45, p < 0.05). Eighty-nine percent of all patients with F/F presented with monocular floaters. There were more floater presentations during bright when compared with dark days (70 vs 36, p < 0.05). More patients were diagnosed with PVD on bright days when compared with those diagnosed with PVD on dark days (43vs 15, p < 0.05). More RDs were diagnosed on dark days compared with bright days (7 vs 3, p < 0.05). CONCLUSION: This study established that F/F presentations were more likely to present during bright days when compared with dark days. The diagnosis of PVD was more common during bright days, and RDs were diagnosed significantly more frequently on dark days. Although incident solar radiation was correlated with greater floaters/PVD presentation, causation is unlikely, and the duration of PVD may have been longer in patients presenting on bright days (i.e. pseudo-sudden symptoms).

Is Pterygium Morphology Related to Loss of Corneal Endothelial Cells? A Cross-Sectional Study.

PURPOSE: To determine the difference in mean corneal endothelial cell density (CECD) between the healthy and diseased eyes of the patients with unilateral pterygium with different morphology patterns by using a non-contact specular microscope (SP2000: Topcon Corporation, Japan) and to find out any relationship between severity of pterygium and daily sunlight exposure with the CECD loss. METHODS: A descriptive cross-sectional prospective study was carried out at Al-Shifa Trust Eye Hospital (ASTEH), Rawalpindi, Pakistan from 21st January 2019 to 22nd January 2020. Two hundred eyes (n= 100 patients) of age range18 -68 years with unilateral pterygium were selected. Necessary demographic data and essential variables like age, smoking status, occupation, and daily direct sunlight exposure were determined. The severity of pterygium (grading) based on its morphology was determined by slit-lamp examination. CECD of each patient was carried out using a non-contact Specular Microscope. The healthy eye (without pterygium) of a patient was considered as control. RESULTS: The age range in this study was 18-68 years, with a mean age of 43.80 ± 24.37 years with a male to female ratio of 1.6:1 (62.00% males vs 38% females). Out of six occupations, the most common occupation was labour/construction work (n=31) followed by farming (n=27). The study reported a mean corneal endothelial cell density (CECD) of 2411.61±143.64 vs 2751.41 ± 123.674 cells/mm2 in diseased and normal eyes, respectively (p-value = 0.0001). CECD was lower in grade 3 pterygium compared to less severe pterygium { grade 3 (Fleshy) =2261 cells/mm2 vs grade 2 (Intermediate)= 2413 cells/mm2 vs grade 1 (Atrophic)=2459 cells/mm2} although this difference between the groups was not found to be significant (p=0.065). No significant association between sunlight exposure and CECD loss was observed (p=0.065). CONCLUSION: This study concluded that the mean corneal endothelial cell density in patients with unilateral pterygium using a non-contact specular microscope were 2411.61±143.64 cells/mm2.