Reticular Pseudodrusen Voids after Rhegmatogenous Retinal Detachment.

We present a case of reticular pseudodrusen (RPD) regression on multimodal retinal imaging following a rhegmatogenous retinal detachment. Two mechanisms of action can be postulated. The subretinal deposits dissolve due to voluminous subretinal fluid during retinal separation from the retinal pigment epithelium and are in turn mechanically cleared during retinal re-attachment surgery. Alternatively, an RPD clearance is facilitated by enhanced phagocytic activity of macrophages and microglial cells as a response to acute retinal stress.

Twenty years of endophthalmitis: Incidence, aetiology and clinical outcome.

PURPOSE: To review the incidence, aetiology and outcomes of endophthalmitis during a 20-year period in a Norwegian university hospital. METHODS: Single-centre retrospective review. Medical records of all patients admitted to Stavanger University Hospital with suspected endophthalmitis between January 1999 and December 2018 were reviewed. RESULTS: We identified 84 eyes of 81 patients. Postoperative endophthalmitis (PE) was seen in 64 eyes (76%), endogenous endophthalmitis in thirteen eyes (15%), trauma in four eyes (5%) and three eyes (4%) had keratitis-associated endophthalmitis. Administration of intravitreal injections (IVI) was the most common cause (30%), followed by cataract surgery (CS) (21%). Of 40238 IVI, 23 PE cases were identified (incidence, 0.057%; 95% confidence interval [CI] 0.036-0.086%). Of 39697 CS, 12 PE cases were identified (incidence, 0.030%; 95%CI 0.016-0.053%). After introduction of intracameral cefuroxime PE incidence after CS decreased from 0.10% in 1999-2003 to 0.015% in 2004-2018 (p = 0.003). Eighty-four per cent of organisms were Gram-positive. Coagulase-negative staphylococci accounted for 54% of culture-proven cases, and 89% of post-IVI culture-proven cases. Thirty eyes (36%) either regained their previous vision or lost ≤1 Early Treatment Diabetic Retinopathy Study line. One third of endophthalmitis cases had a favourable visual outcome of logMAR 0.2 or better. CONCLUSION: PE after IVI occurred in 1 in 1750 procedures, and was the most common cause of PE. The incidence of PE after CS has decreased >sixfold since 2003, to 1 in 6700 surgeries. A high proportion of low-virulence bacterial species may have contributed to the favourable visual outcome.

POSTOPERATIVE POSITIONING IN MACULAR HOLE SURGERY: An Objective Evaluation of Nonsupine Positioning and the Effect of the "Tennis Ball Technique".

PURPOSE: To objectively evaluate patients' compliance with a nonsupine positioning (NSP) regimen after macular hole surgery and to investigate whether supine positioning time during the first postoperative nights is reduced when a tennis ball is mounted onto the back of the nightshirt. METHODS: A "position monitoring device" capable of recording the time the head is kept in a supine position was attached to the patient's forehead. In a randomized, controlled, crossover study, the accumulated time each patient spent in a supine position was recorded during two consecutive postoperative nights, both when the "tennis ball technique" (TBT) was used and when it was not, respectively. RESULTS: The study included 40 participants. A mean supine time of 14 minutes and 47 seconds was registered with the NSP regimen. When applying the TBT, the mean supine time was significantly reduced to 4 minutes and 24 seconds (P = 0.01). Seven "noncompliant" participants with >30 minutes supine time without TBT had the most marked reduction in supine time from a mean of 63 minutes and 2 seconds, to 3 minutes and 46 seconds, with TBT (P = 0.02). CONCLUSION: During an NSP regimen, patients generally maintain a high level of compliance after macular hole surgery. The TBT further improves their compliance significantly.

Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery.

PURPOSE: The purpose of this study was to compare the efficacy of short-term non-supine positioning (NSP) and strict face-down positioning (FDP) in the repair of macular hole (MH). METHODS: We retrospectively reviewed all MH repairs over a 27-month period (2008-2010). Inclusion criteria were idiopathic full thickness stage 2-4 MH treated by a single surgeon with 23-gauge pars plana vitrectomy, internal limiting membrane peeling and gas tamponade, followed by postoperative short-term NSP (for 5 days) or strict FDP (for 3-4 days). NSP was achieved by fastening a tennis ball to the back of the nightshirt. Outcome measures were anatomical MH closure verified by optical coherence tomography and postoperative visual acuity. RESULTS: A total of 67 eyes (64 patients) met the inclusion criteria. The median follow-up period was 6.6 months (range, 4.7-19.8 months). The closure rates following a single operation were 30/33 (90.9%) in the FDP group, and 31/34 (91.2%) in the NSP group, respectively (p = 0.97). The FDP group improved 2.9 ETDRS lines, and 23 eyes (69.7%) gained two or more ETDRS lines. The NSP group improved 2.7 ETDRS lines (p = 1.00), and 25 eyes (73.5%) gained two or more ETDRS lines. The closure rates in the MH subgroup with diameters larger than 400 µm were 20/23 (87.0%) and 15/17 (88.2%) in the FDP group and the NSP group, respectively (p = 0.96). CONCLUSION: The study indicates that short-term NSP is equally effective as strict FDP in the repair of MH. Contrary to previous reports, even large MH did not seem to benefit from FDP.