Comparison of the use of internal limiting membrane flaps versus conventional ILM peeling on post-operative anatomical and visual outcomes in large macular holes.

BACKGROUND: Idiopathic full-thickness macular hole (iFTMH) closure rates following conventional vitrectomy, gas tamponade and internal limiting membrane (ILM) peeling decrease when the minimum linear diameter (MLD) ≥ 500 microns. ILM flap creation has been proposed to improve closure in larger holes. This study evaluated the anatomical and functional impact of ILM flap introduction to routine practice in iFTMH ≥500 microns. METHODS: Retrospective, interventional analysis of prospectively collected data of 191 eyes from consecutive surgeries for primary iFTMH ≥500 microns performed by two surgeons between June 2018 and June 2022, during which both surgeons replaced ILM peeling with ILM flap creation. Post-operative best-corrected visual acuity (BCVA) and anatomical closure were compared between Group 1 (ILM peel) and Group 2 (ILM flap) in an intention-to-treat analysis. RESULTS: Rates of iFTMH closure were greater in the ILM flap group (77/80; 96.3%) than the ILM peel group (94/110; 85.5%) (OR = 4.37, 95% CI = 1.23-15.55, p = 0.023). A non-significant increase in post-operative BCVA improvement was observed in the ILM flap group (p = 0.084). There was no statistically significant difference in final BCVA (p = 0.83). Multivariate logistic regression found only MLD (OR = 0.993, 95% CI = 0.989-0.997, p = 0.001) and ILM flap group (OR = 5.795, 95% CI = 1.313-25.570, p = 0.020) predicted primary closure. CONCLUSION: ILM flap creation improves closure rates in larger holes and should be considered routinely in iFTMH ≥500 microns. Whether ILM flaps affect post-operative visual function remains uncertain.

Expansile gas kinetics for pneumatic retinopexy.

PURPOSE: To study the behaviour of expansile intravitreal gases and air used in treating rhegmatogenous retinal detachment. METHODS: A validated mathematical model of gas expansion and absorption in human eyes was used to simulate the effect of varying volumes of pure air, SF6, C2F6 and C3F8 injected into the vitreous cavity. Variation in axial length was accounted for by using three different vitreous cavity volumes to represent hypermetropic, emmetropic and myopic eyes. RESULTS: The time course of varying volumes of pure air and fluorinated gases injected into the vitreous cavity were tabulated, with calculated parameters including volume of gas, percentage gas fills and corresponding retinal contact angles at different time points. CONCLUSION: We produced a comprehensive compilation of expansive gas kinetics aiming to facilitate surgeon selection of the most suitable choice of gas and volume to use, tailored to an individual patient's clinical need.

Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology.

PURPOSE: Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology. METHODS: This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion. RESULTS: Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study. CONCLUSION: This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.

Bilateral subfoveal serous detachment following Cisplatin chemotherapy.

A 74-year-old gentleman with a background of metastatic pancreatic neuroendocrine tumour on combination chemotherapy of Cisplatin and Etoposide presented with a 3-week history of bilateral visual loss. Snellen visual acuity was right 6/9 and left 6/60. Fundus examination revealed clear media with isolated macular oedema in both eyes. Optical coherence tomography of the maculae showed localised bilateral subfoveal serous detachments. Cisplatin was thought to be the causative agent and was withheld following discussion with the treating Oncology team. Eight weeks after withholding Cisplatin, his vision improved with complete resolution of the subretinal fluid. To the authors' knowledge, this is the first report to have illustrated bilateral subfoveal serous detachment caused by Cisplatin which resolved completely with cessation of offending drug.

Optimizing cataract surgery in patients with age-related macular degeneration.

Age-related macular degeneration (AMD) is one of the leading causes of visual impairment. The development of cataract in AMD patients poses challenges in assessing timing of surgery, predicting potential benefit to the patient of surgery, and predicting short- and long-term effects of surgery on progression of their AMD. Although traditional cataract surgery remains the mainstay of treatment, recently several devices have been developed to address the specific needs of AMD patients with cataract. We look at the associations between cataract and AMD and outline the treatment approaches to cataract surgery in AMD, looking at the potential benefits and risks of both traditional approaches and newer devices. We provide clinicians treating patients with AMD and cataract with a framework for choosing the appropriate management.