OUTCOME OF REVISION PROCEDURES FOR FAILED PRIMARY MACULAR HOLE SURGERY.

PURPOSE: To analyze the outcomes of revision surgery for idiopathic full-thickness macular holes that have failed to close after primary surgery, and also to assess factors predicting success and to review the relative effect of adjunctive surgical techniques. METHODS: A multicenter retrospective study. Anatomical closure rates and visual acuity change between pre and postrevision surgery were assessed. Hole size, age, symptom duration, surgical interval, and reduced hole size were analyzed as predictive factors for success. Effectiveness of adjunctive surgical techniques was reviewed. RESULTS: Seventy-seven eyes were included in the study. Anatomical closure was achieved in 71% (55/77) cases. There was a median gain of 11 Early Treatment of Diabetic Retinopathy Score letters in all holes and 14 letters in closed holes. Full-thickness macular holes that increased in size by more than 10% following primary surgery had a closure rate of 50% compared with 80% in holes that reduced by 10% or stayed the same (P = 0.015). Increasing hole size is associated with a modest reduction in odds of closure (odds ratio = 0.99; P = 0.04). Surgical interval <2 months is not associated with better outcomes compared with >2 months (P = 0.14). CONCLUSION: Revision surgery for full-thickness macular holes that have failed to close after primary surgery is associated with high closure rates and significant visual gains.

Prospective validation of a virtual post-operative clinic in vitreoretinal surgery.

PURPOSE: To evaluate the clinical efficacy and safety of asynchronous virtual post-operative assessments following vitreoretinal surgery and procedures compared to traditional face-to-face assessments in a high-volume tertiary eye centre. METHODS: Prospective comparative clinical series study of patients who had undergone vitreoretinal surgery or post-laser retinopexy. Patients received both virtual and face-to-face assessments. The virtual assessment included clinical questions, visual acuity measurement, and virtual retinal imaging using ultra-wide field (UWF) imaging and macular optical coherence tomography (OCT). Face-to-face assessments involved standard clinical examinations. RESULTS: We included 142 patients undergoing a variety of vitreoretinal procedures. We showed comparable results between virtual and face-to-face assessments in both, post-operative and post-laser treatments. UWF imaging with macular OCT demonstrated potential for effective virtual post-operative assessment. The virtual assessment has a sensitivity of 91% and specificity of 100% for detecting retinal detachments with 100% specificity and 100% sensitivity for detecting new retinal tears or insufficient laser treatment. CONCLUSIONS: The implementation of asynchronous virtual post-operative assessments following a variety of vitreoretinal procedures is a promising alternative to traditional face-to-face assessments. Virtual assessments using UWF imaging and macular OCT showed high sensitivity and specificity. Virtual post-operative clinics offer the potential to improve patient access and decrease the clinical burden, especially with the continuing evolution of telemedicine technologies and imaging modalities.

Outcomes of cataract surgery in patients previously treated with orbital radiotherapy.

PURPOSE: To quantify the risks for cataract surgery in patients who have previously undergone external beam radiotherapy (EBRT). SETTING: Tertiary ophthalmology and oncology hospital. DESIGN: Retrospective case series. METHODS: Patients treated with orbital EBRT at the Beatson West of Scotland Cancer Centre between 2001 and 2019 were identified, and clinical records were reviewed to identify those who had subsequently undergone cataract surgery. Preoperative and postoperative case records, and operation records, were reviewed to identify demographic data and data regarding complications and surgical outcomes. RESULTS: 46 eyes (of 33 patients) were included. The indications for EBRT included thyroid eye disease, lymphoma, choroidal metastases, and other orbital malignancies. Mean corrected preoperative Snellen visual acuity was 20/100 (range 20/30 to 20/2000) improving to 20/25 (20/12 to 20/160, 1-way analysis of variance P < .01). Mean visual gain was 0.5 logMAR (-0.9 to 1.9). There was 1 case of posterior capsule (PC) rupture with vitreous loss (2%). Dense PC plaque was noted intraoperatively in 19.5% (n = 9). 13% (n = 6) required Nd:YAG laser posterior capsulotomy. There were 6 cases (13%) of cystoid macular edema (CME). CONCLUSIONS: Visual outcomes after cataract surgery in this cohort of patients were similar to those obtained in a nationwide cohort. EBRT seemed to be associated with an increased incidence of intraoperative PC plaque, postoperative CME (which in most cases settled with treatment), and need for posterior capsulotomy.

The differences between patient and optometrist experiences of contact lens hygiene education from the perspective of a Scottish university teaching hospital.

BACKGROUND: Contact lens related keratitis is a frequent presentation to acute ophthalmology services. Patients often do not recall being counselled regarding the safe use of contact lenses therefore fail to comply with guidance. This study aimed to identify the content and format of advice given to patients with contact lens keratitis concerning appropriate hygiene practices, determine their compliance with this and finally characterise optometrist practices regarding contact lens advice provided to patients. METHODS: All adult patients presenting with contact lens related keratitis to the acute ophthalmology clinic were asked to complete a survey. Information was collected on lens type, format of advice received and compliance. Community optometrists were asked to complete an electronic survey on their contact lens review practices and routine patient education. RESULTS: All patients surveyed recalled counselling on initiation of contact lenses; however 12% (6/50) were given no advice on return visits. This advice was in written format for 20% (10/50) of patients on initiation increasing to 32% (16/50) on renewal. Many patients slept (22%), showered (44%) or swam (36%) in lenses. 92% cleaned their contact lenses appropriately, but cases were washed infrequently (19% of cases cleaned < monthly) or with tap water (27%). All optometrists surveyed claimed to provide advice to patients in either written or verbal format for new and returning contact lens users. 49% (16/33) of optometrists gave written advice to patients on initial contact lens fitting, but only 1/33 continued with written advice for repeat customers. CONCLUSION: This study identified that although most patients were informed of appropriate hygiene requirements, compliance was poor. Optometrists regularly provide verbal advice but do not routinely offer written support and there is a mismatch between patient recollection and self-reported optometrist practice. It is suggested that patient education needs greater emphasis and both verbal and written information should be regularly provided on initial review and follow up assessments.

Anterior segment optical coherence tomographic characterisation of keratic precipitates.

BACKGROUND/OBJECTIVES: Anterior segment optical coherence tomography (AS-OCT) can be used to visualise keratic precipitates (KPs) on the corneal endothelium. However, there has been no correlation between characteristic clinical appearances of KPs and AS-OCT morphology. We wished to assess the potential diagnostic role of AS-OCT in patients presenting with inflammatory eye disease and KPs. SUBJECTS/METHODS: Six patients with inflammatory KPs were compared to one patient with infective interface keratitis following Descemet Membrane Endothelial Keratoplasty (DMEK) and one patient with endothelial pigment. AS-OCT was performed in each case and morphological features of the KPs were compared. Reflectivity of KPs was also compared numerically by measuring their relative lightness. RESULTS: AS-OCT images in acute and active inflammation generally demonstrated hyperreflective KP variants in comparison to conditions with moderate or longstanding inflammation. In the patient with infective interface keratitis, KPs were evident on the endothelial surface but no changes could be identified at the graft-host interface. There were no significant differences between infective and inflammatory KPs to help distinguish between the two. Endothelial pigment deposits were clearly differentiated from keratic precipitates with smaller, poorly defined deposits on the endothelium surface which were isoreflective to the cornea. CONCLUSION: Hyperreflective KPs could be suggestive of newly deposited KPs and active inflammation; they may also be increased in KPs of herpetic origin. AS-OCT should not be used to differentiate infective infiltrate from inflammatory KPs if a patient were to present with post-operative inflammation and interface infection should still be suspected even if only endothelial deposits are identified on AS-OCT. AS-OCT may be used as a diagnostic and monitoring tool to assess response to treatment in cases where anterior segment inflammation of uncertain aetiology is present.