Heavy silicone oil tamponade: a multicentre experience.

OBJECTIVE: To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications. METHODS AND ANALYSIS: Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil. RESULTS: 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0-2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes). CONCLUSION: This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies.

The risk of rhegmatogenous retinal detachment following anterior vitrectomy during cataract surgery: with versus without pars plana vitrectomy.

PURPOSE: To compare the rates of rhegmatogenous retinal detachment (RRD) following an anterior vitrectomy (AV) alone during cataract surgery, compared to cases requiring a subsequent pars plana vitrectomy (PPV) for dropped nuclear lens fragments (DNLFs). METHODS: Retrospective electronic note review of consecutive patients with a posterior capsular rupture (PCR) requiring either AV or subsequent PPV for DNLF over a 5-year period. RESULTS: A total of 20,235 cataract operations were performed during the defined period with 199 cases (eyes) of PCR (0.98%). One hundred forty-four of these (72.4%) were managed with AV, and the remaining 55 cases were further complicated by DNLF and thus underwent secondary PPVs. A total of 80.0% of cases in the AV group had a final BCVA of 0.30 logMAR or better, and 77.35% in the DNLF group had a BCVA of 0.30 logMAR or better (p = 0.069). Final BCVA was 0.30 (range-0.18 to 3.0) in the AV group and 0.32 (range-0.18 to 1.8) in the DNLF group (p = 0.82). Final BCVA in those patients who suffered a RRD was poorer than the rest of the cohort in the AV group (p = 0.03). Seven of 144 cases in the AV group went on to develop a RRD with a median time of 11 months (range 1-18 months). None of the cases in the DNLF group went on to develop a RRD (P = 0.048). CONCLUSION: Following an anterior vitrectomy during complicated cataract surgery, the risk of RRD may be lower in patients who require a subsequent PPV for management of DNLF compared to patients who are managed with anterior vitrectomy alone.

Presumed ocular tuberculosis in the United Kingdom: a British Ophthalmological Surveillance Unit (BOSU) study.

INTRODUCTION: Ocular tuberculosis (TB) is an extrapulmonary manifestation of mycobacterium infection that most commonly presents as uveitis. This is the first prospective incidence study of presumed ocular tuberculosis performed in the United Kingdom (UK). METHOD: New cases of ocular tuberculosis presenting to hospitals in the UK were prospectively ascertained between October 2016 and November 2017 with the aid of the British Ophthalmological Surveillance Unit (BOSU). Initial presentation data and 1-year follow-up data was collected using questionnaires. RESULTS: Forty-eight patients were recruited giving an overall incidence for ocular TB of 0.73 per million population per annum. The origin of birth for 71% of the patients was a non-UK country and 87.5% had their initial diagnosis of TB made by an ophthalmologist. The most common first line treatment was isoniazid, rifampicin, ethambutol and pyrazinamide which 71% of patients were treated with 60% of patients were commenced on a reducing course of oral steroids. At 1-year follow-up, 29 patients (83%) had complete resolution of active clinical signs. Mean best corrected visual acuity (BCVA) at presentation was +0.41 LogMAR(SD = 0.62), compared to +0.31 LogMAR (SD = 0.56) at 12-month follow-up. DISCUSSION: It is increasingly the responsibility of the ophthalmologist to diagnose ocular TB and although it remains a rare condition, consensus on diagnostic criteria and treatment is required. Increasing recognition and accessibility to gamma-interferon testing should enable earlier detection. Treatment with quadruple ATT treatment regimens for at least 6 months shows good clinical outcomes. However, it is still unclear whether steroid use is beneficial. Further large studies with longer follow-up would be warranted to answer these questions.

Spontaneous retinal pigment epithelial tear in type 2 choroidal neovascularization: repair mechanisms following anti-VEGF therapy.

BACKGROUND: To report the clinical course and the multimodal retinal imaging of a spontaneous retinal pigment epithelial (RPE) tear in a type 2 choroidal neovascularization (CNV) secondary to age-related macular degeneration treated with anti-vascular endothelial growth factor (VEGF) treatment. CASE PRESENTATION: A 74 year-old man presented with visual acuity deterioration in the right eye. Multimodal retinal imaging showed a predominantly classic (type 2) CNV complicated by a spontaneous RPE tear. The patient received six intravitreal injections of anti-VEGF which resulted in improvement of the vision and stabilization of the neovascular lesion on optical coherence tomography (OCT). Longitudinal changes of the RPE-photoreceptors interface, including RPE splitting, are reported on OCT. CONCLUSION: RPE tears may spontaneously occur in type 2 CNV. Anti-VEGF treatment should be aimed at promoting RPE repair and limiting the extent of the scarring. The mechanisms of RPE repair during treatment may be documented with OCT.