The incidence and rate of rhegmatogenous retinal detachment seven years after cataract surgery in patients with high myopia.

BACKGROUND: Cataract extraction is the most commonly performed surgery in the National Health Service. Myopia increases the risk of postoperative rhegmatogenous retinal detachment (RRD). The aim of this study was to determine the incidence and rate of RRD seven years after cataract extraction in highly myopic eyes. METHODS: Retrospective review was performed of notes of all high myopes (axial length 26.0 mm or more) who underwent cataract extraction during the study period in one centre. RESULTS: 84 eyes met the study criteria. Follow-up time from surgery was 93 to 147 months (median 127 months). The average axial length was 28.72 mm (sd 1.37). Two eyes developed post-operative RRD; the incidence was 2.4% and the rate one RRD per 441.6 person-years. The results of 15 other studies on the incidence of RRD after cataract extraction in high myopia were pooled and combined with our estimate. CONCLUSION: Both patients in our study who developed RRD had risk factors for this complication as well as high myopia. Risk factors are discussed in the light of our results and the pooled estimate. Our follow-up time is longer than most. Future case series should calculate rates to allow meaningful comparison of case series.

P63 expression in conjunctival proliferative diseases: pterygium and laryngo-onycho-cutaneous (LOC) syndrome.

PURPOSE: Compare expression of p63 in pterygium and laryngo-onycho-cutaneous (LOC) syndrome with normal conjunctiva. METHODS: P63 immunohistochemical detection was carried out in normal, pterygium, and LOC conjunctival tissue. In vitro, growth of normal conjunctival biopsy specimens, pterygium, and LOC in growth tissue was compared. RESULTS: In normal conjunctiva, p63 was poorly expressed in the infranasal quadrant, with 36% of cells stained vs. 55 to 59% in other quadrants (p < 0.05). In pterygium, p63 was overexpressed (59% cells stained) compared to normal supranasal (55%) and normal infranasal conjunctiva (36%, p < 0.05). In LOC, p63 was only expressed in 39% of cells vs. 58% in normal supratemporal conjunctiva (p < 0.05). Cytokeratin 19 was expressed by all cells cultured from normal conjunctival tissue. CONCLUSIONS: This study emphasizes the importance of using control tissue explanted from the correspondent conjunctival quadrant when studying proliferative disorders. Different pathogenesis may account for the differences in p63 expression between pterygium and LOC.

Retrobulbar hemorrhage after sub-Tenon's anesthesia.

We present a case of retrobulbar hemorrhage complicating sub-Tenon's anesthesia in a patient receiving oral anticoagulants. To our knowledge, this has been described only once in the literature.

Surgical removal of subfoveal choroidal neovascular membranes in older patients without age-related macular degeneration.

PURPOSE: To assess visual and anatomical outcomes following the surgical removal of subfoveal choroidal neovascular membranes (CNVMs) in older patients without clinical evidence of diffuse disease of the retinal pigment epithelium (RPE). METHODS: We retrospectively reviewed records of consecutive patients aged 50 years or older who underwent surgical removal of subfoveal CNVMs. Patients with clinical evidence for age-related macular degeneration (AMD) (>5 small drusen), angioid streaks, and myopic degeneration were excluded. RESULTS: Twenty-two patients (8 women) ranged in age from 50 to 85 years (median, 67 years). All membranes were 100% classic, with a mean size of 2.5 MPS disc areas (range, 1 to 6.5). Best postoperative visual acuity (VA), measured a median 12.5 weeks after surgery, improved (>3 Snellen lines) in 10 eyes (45%) and worsened in 0 eyes, with 8 eyes (36%) achieving 20/50 or better. Over a mean follow-up of 37 months (range, 6 to 114 months), CNVM recurrence was seen in 13 eyes (59%), causing loss of VA from best postoperative levels in 5 eyes (23%). On final follow-up, 4 eyes (18%) retained acuity of 20/50 or better, 12 eyes (55%) had disciform scarring, and 5 eyes (23%) had geographic atrophy. Improvement in best postoperative VA occurred in a higher percentage of eyes with focal (58%) compared with idiopathic (30%) disease, but this trend was not statistically significant (p = 0.23, Fisher's exact test). CONCLUSIONS: Surgical removal of subfoveal CNVMs may result in substantial visual improvement in older patients without other clinical evidence for AMD, particularly in eyes with focal diseases of the RPE-Bruch's membrane complex.

An in vitro study of human lens epithelial cell adhesion to intraocular lenses with and without a fibronectin coating.

PURPOSE: To demonstrate differences in human lens epithelial cell adhesion to different intraocular lens biomaterials in vitro and to determine whether these differences can be influenced by coating the intraocular lens surface with commercially available fibronectin. METHODS: A prospective laboratory-based study comparing human lens epithelial cell adhesion to silicone (n=18), polymethylmethacrylate (PMMA; n=18), and acrylic (n=18) intraocular lenses in vitro. The three types of intraocular lenses were then coated with fibronectin: silicone (n=6), PMMA (n=6), and acrylic (n=6). The main outcome measure was the mean number of lens epithelial cells attached to each lens type after 24 hours of incubation. RESULTS: In the uncoated lens group, there was a significantly higher number of lens epithelial cells attached to the acrylic than to the silicone or PMMA lenses (P<0.001). Coating the lenses with fibronectin caused a significant increase in attachment of lens epithelial cells for all three lens types. CONCLUSIONS: There was a significant difference in the degree of lens epithelial cell attachment to the various types of intraocular lenses in vitro. Cell attachment was more prominent in the acrylic lenses, but the fibronectin coating negated differences in lens type and caused a significant increase in cell attachment across all groups.

Diagnosis and treatment of endogenous fungal endophthalmitis.

Endogenous infectious endophthalmitis is rare, and a primary source is usually identified. A case of primary fungal endophthalmitis successfully treated with vitrectomy and systemic antifungal therapy is presented. The aetiology and treatment of the condition are discussed.

Suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy.

Nd:YAG laser posterior capsulotomy is the commonest procedure for posterior capsule thickening following cataract surgery. Complications following this laser surgery are relatively few, and this is ordinarily a safe and effective procedure. Herein a case is described of suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy. To the best of the authors' knowledge, this is the first report of this complication. Patients undergoing this procedure should be warned of this rare but potentially devastating complication.