The effect of ethnicity on anatomic success following macular hole surgery: a multicentre cohort study.

PURPOSE: The purpose is to assess the effect of ethnicity on surgical macular hole closure. METHODS: A retrospective cohort study was undertaken in five UK National Health Service Hospitals. We included all patients with known ethnicity undergoing vitrectomy, internal limiting membrane peel, and gas/oil tamponade for all stages of primary full-thickness macular hole (FTMH). The primary outcome was anatomic success, defined as FTMH closure with one operation. The secondary outcome was mean change in best-corrected visual acuity (BCVA) comparing baseline with final review. RESULTS: Of 334 operations, the ethnicity profile comprised 78.7% White patients, 11.7% Black patients, 8.1% Asian patients, and 1.5% in mixed/other ethnicities. Mean age was 69.7 years with 68.5% females. Overall, 280 (83.8%) had anatomic success. Anatomic failure occurred in 38.5% of Black patients versus 12.6% of White patients (relative risk: 1.788; 95% CI: 1.012 to 3.159; P = 0.045). Overall, baseline logarithm of the minimum angle of resolution BCVA improved by 0.34, from 0.95 (95% CI: 0.894 to 1.008) to 0.62 (95% CI: 0.556 to 0.676). Mean BCVA improved by 0.35 in White patients, 0.37 in Black patients, 0.23 in Asian patients, and 0.38 in mixed/other ethnicity (P = 0.689). Greater FTMH minimum linear diameter was associated with an increased risk of anatomic failure (relative risk: 1.004; 95% CI: 1.002 to 1.005; P < 0.0001), whereas better pre-operative BCVA (F [1,19] = 162.90; P < 0.0001) and anatomic success (F [1,19] = 97.69; P < 0.0001) were associated with greater BCVA improvement. Socio-economic status did not significantly influence anatomic success or BCVA change. CONCLUSIONS: Black ethnicity is associated with an approximately twofold greater risk of failed FTMH surgery. The reasons for this difference warrant further study.

The Risk of Posterior Capsule Rupture during Phacoemulsification Cataract Surgery in Eyes with Previous Intravitreal Anti Vascular Endothelial Growth Factor Injections.

PURPOSE: To investigate if previous intravitreal anti vascular endothelial growth factor (VEGF) injections are a predictor for posterior capsule rupture (PCR) during phacoemulsification cataract surgery. SETTING: National Health Service: Whipps Cross University Hospital Eye Treatment Centre. District General, London, United Kingdom DESIGN:: Single centre, retrospective, electronic medical record (EMR) database study with univariate analysis. METHODS: EMR (Medisoft) was used to extract data for eyes undergoing phacoemulsification surgery between 01.08.16 to 01.01.18. Patient demographics, indication for intravitreal therapy, treatment type, number of previous intravitreal injections (IVI), diabetic status, surgeon grade and operative complications were included as variables for analysis. RESULTS: Data was available for 4047 cataract operations. Of these, 108 had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have pre-operative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that prior anti-VEGF IVI treatment was associated with an increased risk of PCR when compared to the non IVI group (9.26% vs 1.88%, p<0.0001). There is a dose dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. CONCLUSIONS: Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR despite the absence of visible structural damage to the PC pre-operatively.

Risk of posterior capsular rupture during phacoemulsification cataract surgery in eyes with previous intravitreal antivascular endothelial growth factor injections.

PURPOSE: To investigate whether previous intravitreal antivascular endothelial growth factor (VEGF) injections are a predictor for posterior capsular rupture (PCR) during phacoemulsification cataract surgery. SETTING: Whipps Cross University Hospital Eye Treatment Centre, London, United Kingdom. DESIGN: Single-center, retrospective, electronic medical record (EMR) database study with univariate analysis. METHODS: Data were extracted from an EMR system on eyes undergoing phacoemulsification surgery between August 1, 2016, and January 1, 2018. Patient demographics, indication for intravitreal therapy, treatment type, the number of previous intravitreal injections (IVIs), diabetic status, surgeon grade, and operative complications were included as variables for analysis. RESULTS: Data were available for 4047 cataract operations. Of these, 108 (2.7%) had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have preoperative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that previous anti-VEGF IVI treatment was associated with an increased risk of PCR when compared with the non-IVI group (6.67% vs 1.88%, P < .0001). There is a dose-dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. CONCLUSIONS: Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR, despite the absence of visible structural damage to the posterior capsule preoperatively.

Mechanical exposure of ophthalmic surgeons: a quantitative ergonomic evaluation of indirect ophthalmoscopy and slit-lamp biomicroscopy.

OBJECTIVE: Vitreoretinal (VR) surgeons have high rates of spinal pain. The aim of this study was to investigate if VR surgeons adopt more complex postures in indirect ophthalmoscopy procedures compared with procedures involving the slit-lamp or operating microscope. METHODS: Postures of the neck, back, and overall spine were measured by inclinometers on 13 VR surgeons. Each doctor was measured during 3 indirect examinations and 3 slit-lamp examinations (SLE), and then during 1 operating microscope procedure (phacoemulsification/vitrectomy) and 1 indirect procedure (indirect laser or cryotherapy/buckle). RESULTS: The average degree of flexion of neck/back/overall spine was significantly higher in indirect examinations compared with SLE (p < 0.01). SLE involved mainly neutral flexion, whereas indirect examinations involved significant time in moderate flexion of the neck and overall spine (42.2% and 76.2%, respectively), lateral bending of the back and overall spine (62.5% and 38%), and rotation of the neck and overall spine (76.6% and 32.1%). For indirect procedures, the neck was in moderate flexion and rotation approximately half of the time, and the overall spine was moderately flexed in >75% of the time. CONCLUSION: Based on biomechanical concepts, VR surgeons are at risk of developing spinal pain because they adopt postures that are described as ergonomically unacceptable.