Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis.

OBJECTIVE: Ocular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: All adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. METHODS: The primary outcomes were baseline and final visual acuity. RESULTS: A total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001). CONCLUSION: A quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.

Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy.

OBJECTIVE: To compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU). DESIGN: Retrospective cohort study. PARTICIPANTS: All consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021. METHODS: Clinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity. RESULTS: A total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both). CONCLUSIONS: NIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.

Anatomical and functional outcomes of short-term DensironXTRA heavy silicone oil for rhegmatogenous retinal detachments: a comparative case series.

To assess the safety and efficacy of short-term DensironXTRA tamponade for repair of complicated rhegmatogenous retinal detachments (RRD). This is a retrospective consecutive case series of patients undergoing pars plana vitrectomy (PPV) with intravitreal DensironXTRA and a comparator group with gas (sulfur hexafluoride (SF6) or perfluoropropane (C3F8)) tamponades by a single surgeon between January 2017 and November 2020 at a tertiary care centre. A total of 121 eyes with DensironXTRA and 81 comparator eyes with a gas tamponade were included. The DensironXTRA group had a significantly higher number of cases with inferior breaks (82% vs. 48%; p < 0.0001) and a history of previous PPV for RRD (64% vs. 12%; p < 0.0001). DensironXTRA was removed after a median period of 70 (IQR: 48.5-105.5) days. There was similar anatomical success in both the comparator gas tamponade and DensironXTRA groups (98.8% vs. 97.5%, p = 0.6506). Although both groups experienced a significant improvement in visual acuity, this change was significantly higher in the comparator gas tamponade group versus DensironXTRA group (p = 0.0017). There was no significant change in IOP in the DensironXTRA group (mean difference - 0.7; 95% CI - 1.753 to 0.331, p = 0.1785). The rates of complications were low and not significantly different between the two groups. There was no evidence for central macular thinning with DensironXTRA compared to the contralateral eye without RRD as well as with DensironXTRA in situ versus after its removal. DensironXTRA is a promising short-term tamponade agent with good anatomical and functional outcomes and low rates of complications for the repair of complicated RRDs.

Prophylactic intraocular pressure lowering measures in anti-vascular endothelial growth factor therapy: A systematic review and meta-analysis.

Acute intraocular pressure (IOP) elevation following repeat intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVI) may pose a risk to the integrity of the retinal nerve fiber (RNFL). This meta-analysis investigates the role of IOP-lowering interventions such as an anterior chamber paracentesis (ACP) and IOP-lowering medications on the IOP in patients undergoing IVIs. MEDLINE, EMBASE, and the Cochrane Library were searched up to February, 2021. Studies investigating IOP-lowering interventions in patients undergoing IVI versus controls were included. The primary outcome was the IOP in the short- and long-term post-IVI. Secondary outcomes were changes in the RNFL thickness and best corrected visual acuity (BCVA). ACP at time of anti-VEGF injection significantly lowered IOP immediately post anti-VEGF (WMD: -27.98 mm Hg, P < 0.001). Patients in the ACP group also had significantly thicker RNFL compared to control (WMD: 2.07 um, P < 0.00001) at median follow-up of 16.5 months. IOP-lowering medications (on the day of injection or in the long-term) significantly reduced IOP up to 30 minutes after injection (WMD: -3.31 mm Hg, P = 0.003). This effect was statistically significant between the 2 arms up to 1 month follow-up. There was no difference in BCVA in intervention versus controls. ACP reduces immediate IOP spikes post-IVI and preserves the RNFL in the short- and longterms IOP-lowering medications also reduce IOP spike, with limited data on RNFL thickness.

Prognostic Features of Preoperative OCT in Retinal Detachments: A Systematic Review and Meta-analysis.

TOPIC: To evaluate the prognostic association between preoperative features seen on OCT imaging and postoperative visual acuity (VA) outcomes in rhegmatogenous retinal detachments (RRDs). CLINICAL RELEVANCE: Currently, there is limited literature on the prognostic value of preoperative RRD OCT features. METHODS: A literature search was conducted on Ovid MEDLINE, Ovid Embase, and Cochrane CENTRAL from inception to September 15, 2022. A meta-analysis was performed using a random-effects model. Quality of studies and evidence were assessed using the Joanna Briggs Institute tools and the Grading of Recommendations, Assessment, Development and Evaluation framework, respectively. RESULTS: A total of 1671 eyes of 1670 patients from 29 observational studies were included. Of these, 89% of eyes had a macula-off RRD at presentation. The mean average duration of detachment was 15 ± 10 days. Most eyes (62%) underwent pars plana vitrectomy. Six preoperative OCT features were analyzed: height of retinal detachment (HRD) at the fovea, central macular thickness (CMT), disruption of the ellipsoid zone (EZ) and/or external limiting membrane (ELM), intraretinal cystic cavities (ICCs), outer retinal corrugations (ORCs), and macular detachment. A greater HRD was weakly associated with postoperative VA (Pearson correlation r = 0.35; 95% confidence interval [CI], 0.20-0.48; P < 0.01), and there was no change in this association throughout the postoperative follow-up period. The CMT was not associated with postoperative VA. Eyes with disruption of the EZ and/or ELM had a postoperative VA worse by 0.35 logarithm of the minimum angle of resolution (logMAR) (95% CI, 0.15-0.54; P < 0.01) or 3 Snellen lines. Eyes with ICCs had a postoperative VA worse by 0.14 logMAR (95% CI, 0.01-0.26; P < 0.01) or 2 Snellen lines. Eyes with ORCs did not have a significantly different postoperative VA than eyes without ORCs. Eyes with macular detachment had a postoperative VA worse by 0.15 logMAR (95% CI, -0.31 to 0.00; P = 0.02) or 2 Snellen lines. Overall, the quality of studies ranged from moderate to good (73%-100%). All associations had a low quality of evidence, with CMT being of very low quality. CONCLUSION: Despite the low quality of evidence, a greater HRD, disruption of the EZ and/or ELM, presence of ICCs, and macular detachment were associated with a poor postoperative VA. We propose a standardized nomenclature for consistency and accuracy in reporting preoperative RRD OCT features for future studies. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Applications of the Guarded-Needle External Drainage Technique in Vitreoretinal Surgery.

PURPOSE: To describe the surgical technique using the guarded-needle external drainage for a wide variety of applications in vitreoretinal surgery. METHODS: A step-by-step procedure and a surgical video using the guarded-needle external drainage technique are presented. In addition, a series of representative cases with wide-ranging diagnoses who underwent the technique is reviewed. DESCRIPTION AND TECHNIQUE: The guarded-needle using a 27-gauge thin-walled TSK needle (TSK Laboratory International) and a trimmed 70 buckle sleeve are connected to the active extrusion tubing of the vitrectomy machine. External drainage is performed by actively aspirating subretinal fluid using low active vacuum. The guarded-needle external drainage technique is used in cases with bullous detachments, and small and anterior breaks, when performing scleral buckle, for prevention of underfill when using oil tamponade in cases with choroidal effusion, addressing subretinal gas/air, lysing a subretinal band, draining a suprachoroidal hemorrhage, for diabetic tractional retinal detachments, detachments with no definitive break, and subretinal biopsy in exudative detachments. CONCLUSION: The guarded-needle external drainage has a wide range of applications in vitreoretinal surgery.

PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS.

PURPOSE: To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD). METHODS: This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF 6 ) or perfluoropropane (C 3 F 8 ) 1-2 weeks before PPV between 2016 and 2020 at a tertiary care center. RESULTS: A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105-526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%. CONCLUSION: PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.

Human Amniotic Membrane Plug for Chronic or Persistent Macular Holes.

PURPOSE: To report on the use of human amniotic membrane for macular holes at 2 Canadian tertiary care centers. DESIGN: Retrospective cohort study. SUBJECTS: Twenty-two patients with persistent or chronic macular holes. METHODS: Macular hole surgery was performed by 3 vitreoretinal surgeons. MAIN OUTCOME MEASURES: Macular hole closure with complete plugging by human amniotic membrane on spectral-domain OCT. RESULTS: The closure rate was 91% (20 of 22; median follow-up, 7 months), with no statistically significant visual acuity change overall. Complications included subretinal silicone oil (5%), choroidal neovascularization (5%), atrophy (5%), and cystoid macular edema (9%). CONCLUSIONS: Anatomical success with limited visual recovery was observed.

A prospective randomized clinical trial comparing nepafenac, intravitreal triamcinolone and no adjuvant therapy for epiretinal membrane.

PURPOSE: To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA). METHODS: Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation. RESULTS: Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 µm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively). CONCLUSION: Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.

DENSIRON 68 HEAVY SILICONE OIL AS A SHORT-TERM INTRAOCULAR TAMPONADE FOR MACULA-ON INFERIOR RETINAL DETACHMENTS-A CASE SERIES.

PURPOSE: To describe our experience using short-term heavy silicone oil (Densiron 68) for macula-on inferior rhegmatogenous retinal detachments with inferior retinal breaks. METHODS: Retrospective, consecutive, observational case series. Data were retrospectively collected from the medical records of patients who underwent pars plana vitrectomy and Densiron 68 endotamponade for macula-on rhegmatogenous retinal detachment repair. RESULTS: Eight patients were included in the study. The mean patient age was 57.1 ± 12.3 (±SD) years. The mean time to Densiron 68 removal was 57.8 ± 17.8 (±SD) days (ranging from 24 to 83 days). One patient (12.5%) detached three weeks after Densiron 68 removal and required further surgery. All patients were attached at last follow-up with a mean follow-up of 192 days. The mean final best-corrected visual acuity was 20 of 40 (0.29 logarithm of the minimum angle of resolution) similar to the 20 of 45 preoperative best-corrected visual acuity (0.35 logarithm of the minimum angle of resolution, P = 0.501). No significant emulsification was noted before or during the removal of the Densiron 68. Two patients developed an increase in intraocular pressure before Densiron 68 removal that resolved after removal. One patient developed cystoid macular edema that resolved with a short course of topical medications, and one patient had persistent CME that required an intravitreal triamcinolone acetate 1% injection. CONCLUSION: The high anatomic success rate, good visual outcomes, and minimal complications suggest that Densiron 68 can be considered as a short-term tamponade for macula-on retinal detachments with inferior pathology.

Long-Term Safety and Efficacy of Siluron2000 with Pars Plana Vitrectomy in the Treatment of Patients with Severe Vitreoretinopathy and Chronic Macular Holes.

PURPOSE: Silicone oil intraocular retinal tamponade is a useful adjunct to pars plana vitrectomy (PPV) in the treatment of complex vitreoretinal conditions. Siluron2000, a modified silicone oil product containing an additional small, high molecular weight and low viscosity, very-long-chain silicone molecule, was developed to reduce post-operative silicone oil emulsification, a non-infrequent complication that occurs with low molecular weight silicone oil. This study was designed to assess the safety and efficacy of long-term Siluron2000. PATIENTS AND METHODS: This was a single-center, retrospective, observational study. All consecutive patients undergoing PPV with intravitreal Siluron2000 injection between January 2017 and September 2019 with at least 6-month follow-up were identified based on billing codes. RESULTS: A total of 57 eyes of 57 consecutive patients comprising 51 cases of proliferative vitreoretinopathy and 6 cases of recurrent full thickness macular hole were included. Median follow-up was 18 months. Emulsification occurred in 9 patients (15%). Retinal re-attachment was achieved in 47 patients (82%). The median time without silicone oil emulsification was 17 months. Of the cases with residual retinal detachment (RD) despite intravitreal Siluron2000, 4 (7%) were total RDs and 6 (10%) were inferior RDs with attached macula. The most common complications were glaucoma 12 (21%), cataract 11 (19%), and epiretinal membrane 2 (3.5%). There was no association between the duration of Siluron2000 and visual outcomes. CONCLUSION: Siluron2000 is an effective long-term tamponade agent in the treatment of complex vitreoretinopathy. Visual and anatomical outcomes are similar to those reported with higher mw silicone oil tamponade agents but with a lower emulsification rate.

Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks.

PURPOSE: To describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. PATIENTS AND METHODS: This is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020. RESULTS: A total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period. CONCLUSION: The combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.

Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography.

BACKGROUND AND OBJECTIVE: To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS: This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021. RESULTS: Among 406 eyes, baseline visual acuity (ß = 0.184, P = .001) and time to surgery (ß = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment. CONCLUSION: Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].

Transient Macular Thinning during the Use of Heavy Silicone Oil, Densiron 68.

BACKGROUND: To evaluate the effect of short-term Densiron tamponade on macular thickness. METHODS: Retrospective case series. Data were collected from charts of patients who received short-term (less than 90 days) Densiron tamponade. The OCT parameters were compared between Densiron in situ and after Densiron removal and to the fellow eye. RESULTS: Twenty eyes were included in the analysis. Although there was a trend toward thinner CRT with Densiron in situ in situ the operated eye when compared to the fellow eye (248 and 264 microns, respectively, p = .066), this difference disappeared after DR. At the final OCT there was a statistically significant recovery in the CRT (from 248 to 277 microns, P = .001) and no statistical difference between operated and the fellow eye (p = .265) with no evidence of ERM or CME. CONCLUSIONS: We found transient macular thinning that resolved after Densiron removal with no evidence of long-term macular thinning in eyes treated with Densiron tamponade for retinal detachment.

Secondary Posterior Chamber Intraocular Lens Fixation Using Flanged Prolene Sutures as an Alternative to an Anterior Chamber Intraocular Lens Implantation.

PURPOSE: To describe and evaluate the clinical outcomes of the Flanged Prolene Suture intraocular lens fixation (PIF) technique and compare it to anterior chamber IOL (ACIOL) implantation. DESIGN: A retrospective comparative review. METHODS: A retrospective comparative review of consecutive patients undergoing secondary IOL implantation was performed. A comparison between patients that had ACIOL and PIF technique was conducted. The main outcome measures were changes in best-corrected visual acuity (VA), IOL position and complications. RESULTS: In the study period, fourteen eyes had ACIOL implantation and ten eyes had PIF surgery. VA acuity for both groups combined improved from 1.27 ± 0.65 logMAR preoperatively to 0.84 ± 0.65 logMAR (P<0.0001). Seventeen patients had VA measurements in the year before the IOL dislocation. In those seventeen patients, VA changed from a baseline of 0.90 ± 0.68 to 0.97 ± 0.61 logMAR in the PIF group (p=0.334) and from 0.54 ± 0.27 to 0.85 ± 0.65 logMAR in the ACIOL group (p=0.145). No intraoperative or early postoperative complications were documented in either group. Two (20%) patients in the PIF group developed CME and one patient developed corneal edema. In the ACIOL group, one patient developed significant CME and two patients developed visual significant corneal edema. CONCLUSION: The PIF technique seems to offer a simple, fast and safe way to fixate an IOL posteriorly. In our experience, the learning curve of the technique is short with a low complication rate and good visual outcomes.

Orbital Magnetic Resonance Imaging Demonstrates Better Contact between the Gas and Anterior Inferior Retina in Side versus Face-Down Position.

PURPOSE: To demonstrate the relationship between an intraocular gas bubble, the retina, and the residual intraocular fluid in different head positions using orbital magnetic resonance imaging (MRI) in 3 patients who underwent pars plana vitrectomy (PPV) with gas tamponade. DESIGN: Novel study. PARTICIPANTS: Patients undergoing PPV with gas-fluid exchange (sulfurhexafluoride [SF6] or perfluoropropane [C3F8]). METHODS: Magnetic resonance imaging scans were obtained in 3 patients undergoing PPV with gas-fluid exchange (SF6 or C3F8). All surgeries were performed by a single surgeon (E.D.M.). On the first postoperative day, the volume of intraocular gas fill was estimated separately by 2 surgeons (A.H. and E.D.M). Four orbital MRI scans were obtained from different head positions, including face up (supine), face down (prone on a massage pillow), flat on the right side, and flat on the left side. MAIN OUTCOME MEASURE: Relationship between the gas bubble and residual vitreous fluid. RESULTS: The MRI images demonstrated, with excellent contrast, the gas and fluid locations in the vitreous cavity in all scans. The relationship between the gas bubble and residual vitreous fluid showed a rapid shift when the patient's head position changed. The MRI images demonstrated that with both 70% gas fill and 95% gas fill, lying on the side can give better support to the inferior retina than face-down positioning. The images demonstrated the importance of accurate head positioning, because a slight change in head position resulted in inadequate contact between the anterior inferior retina and the gas bubble. CONCLUSIONS: To our knowledge, this is the first time that the relationship between an intraocular gas bubble and contact with the retina has been evaluated in different head positions in vivo using MRI imaging. The MRI images demonstrated that side positioning gives better contact between the gas bubble and the inferior and anterior retina than prone positioning even when the gas fill is only 70% of the vitreous cavity.

Screening for obstructive sleep apnea amongst patients with retinal vein occlusion.

OBJECTIVE: To evaluate the prevalence and varying severity of obstructive sleep apnea (OSA) amongst those newly diagnosed with retinal vein occlusion (RVO), and screen patients with the use of 2 in-office-administered questionnaires validated against polysomnography. DESIGN: Prospective cross-sectional study. PARTICIPANTS: Consecutive adult patients (≥18 years of age) with a new diagnosis of RVO confirmed with intravenous fluorescein angiography were enrolled. METHODS: The study was conducted at a tertiary academic centre between March 22, 2017, and April 7, 2018. Patients completed the Berlin and STOP-BANG questionnaires screening for OSA at presentation. Diagnostic test properties of the 2 questionnaires compared with polysomnography at a certified sleep laboratory centre as the gold standard for detection of OSA were calculated. RESULTS: A total of 27 patients (37% females) with a mean (standard deviation) age of 69.6 (11.5) years completed the study. The diagnosis of OSA based on polysomnography was made in 96% (41% severe OSA) of patients with RVO. The Berlin questionnaire had a sensitivity of 43% (confidence interval [CI]: 22%-66%) and specificity of 67% (CI: 22%-96%). The STOP-BANG questionnaire had a sensitivity of 86% (CI: 64%-97%) and specificity of 50% (CI: 12%-88%). CONCLUSIONS: Given the high prevalence of severe OSA amongst those with a new diagnosis of RVO, all patients should be strongly considered for polysomnography. The use of in-office questionnaires may aid in triaging urgency of referrals.

SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE.

PURPOSE: To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery. METHODS: A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed. RESULTS: A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period. CONCLUSION: The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.