Suprachoroidal hemorrhage during cataract surgery in a vitrectomized eye.

We report a case of surprachoroidal hemorrhage (SCH) that occurred during cataract surgery in a previously vitrectomized eye. The only sign of SCH was a progressive shadow obscuring the red reflex. There was no increase in intraocular pressure (IOP), shallowing of the anterior chamber, or iris prolapse. Postoperatively, the SCH gradually resolved without complications, leaving a series of subretinal pigmentary lines. Surgeons should be aware that the signs normally expected in SCH may not develop in vitrectomized eyes. Obscuration of the red reflex may be the only sign of the hemorrhage, and when this happens, it may be prudent to keep the IOP elevated and suture the incision at the end of the procedure.

Direct referral of posterior capsular opacification by optometrists.

PURPOSE: To study referrals of posterior capsular opacification (PCO) for laser capsulotomy by optometrists and compare direct referral with that via the general practitioner (GP). METHODS: A prospective analysis of optometrist referrals with regard to diagnostic accuracy, appropriateness of referral, quality of letters and patient waiting times. RESULTS: Of 222 referrals, 156 were direct and 66 via the GP. Forty-five (20.3%) letters were of good quality, 141 (63.5%) were average and 36 (16.2%) were poor. Waiting times for direct referrals ranged from 2 to 30 weeks (mean 8.3 weeks, S.D. 4.1); that for referrals via the GP ranged from 4 to 25 weeks (mean 10.3 weeks, S.D. 3.6). Directly referred patients thus waited 2 weeks shorter than patients referred via GPs (95% confidence interval 0.7-3.1, p = 0.002). Diagnostic concurrence was 99% (211/213 patients). The rate of laser capsulotomy was 98.2% (215/219); 103 (46.4%) letters utilised a referral form (GOS18); 146 (65.8%) discussed subjective visual problems and five (2.3%) incorporated patient consent for provision of feedback to the referring optometrist. CONCLUSION: Direct optometrist referral is effective, accurate and reduces patient waiting time and GP workload. Referral letters should be typed or printed to optimise legibility. Patient consent for feedback should be obtained by the referring optometrist.