Brendan Vote

Further evidence for proinflammatory nature of perfluorohexyloctane in the eye

Background: The authors present a clinicopathological report of their initial experience with perfluorohexyloctane (F6H8), a novel semifluorinated liquid fluorocarbon developed as a long‐term vitreous substitute.

Anti-inflammatory fibrosis suppression in threatened trabeculectomy bleb failure produces good long term control of intraocular pressure without risk of sight threatening complications

Aims: To determine the long term outcome of systemic anti-inflammatory fibrosis suppression in cases of threatened trabeculectomy bleb failure in open angle glaucoma. Methods: This prospective non-comparative case series followed 77 eyes of 63 patients which showed signs of threatened early bleb failure and were treated with oral anti-inflammatory fibrosis suppression of prednisone, a non-steroidal anti-inflammatory agent, and colchicine taken for a mean period of 6 weeks, in addition to standard postoperative topical treatment, for a mean follow up of 6 years. Results: Trabeculectomy with anti-inflammatory fibrosis suppression controlled the IOP at ≤21 mm Hg with a probability of 0.91 (95% CI: 0.81 to 1.0) at 8 years and 0.89 (95% CI: 0.56 to 1.1) at 12 years. There were no reported cases of endophthalmitis, hypotonous maculopathy, late bleb leak, or serious systemic side effects. Conclusion: Anti-inflammatory fibrosis suppression provided good control of bleb fibrosis without risk of sight threatening complications in a patient group at high risk of bleb failure.

Trypan blue-assisted vitrectomy.

Purpose: To evaluate the efficacy of trypan blue dye for the staining and removal of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid during pars plana vitrectomy. Methods: The authors retrospectively reviewed a consecutive series of 26 eyes of 26 patients in whom trypan blue 0.15% dye was used to stain intraocular tissues during vitrectomy surgery. Results: The cases reviewed included the following diagnoses: epiretinal membrane (13), macular hole (9), proliferative vitreoretinopathy (2), chronic pseudophakic cystoid macular edema (1), and chronic diabetic macular edema (1). The application of trypan blue resulted in a useful and consistent bluish staining, facilitating the identification, delineation, and removal of the epiretinal membrane, internal limiting membrane, or posterior hyaloid in all patients. Six months after the surgery, visual acuity was better or the same in 21 of the 26 patients. There were no clinical signs of retinal toxicity in any patients. Conclusion: Trypan blue staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal.

Systemic anti-inflammatory fibrosis suppression in threatened trabeculectomy failure.

Purpose: To provide a rationale for the use of systemic anti‐inflammatory fibrosis suppression in the postoperative management of threatened early trabeculectomy bleb failure.

Retinal migraine: caught in the act

A 22 year old male dancer presented via his optometrist following an episode of transient visual loss in his left eye. He described a slow blurring and darkening of the vision of the left eye with a similarly gradual return to normal, the whole episode lasting 10 minutes. He described similar episodes every 2–3 months for the previous 3 years with no associated migrainous aura or headache, and exercise was not a trigger. Figure 1 shows images taken before, during, and 10 minutes after his presenting episode (see figure legend for description). Figure 1 (A) Left eye taken at routine optometrist appointment 1 month before presenting episode; normal appearance of disc, vessels, and macula. (B) During the episode of visual loss, constriction of both arteries and veins is seen with macular pallor and a central cherry red spot and slight disc pallor

Loss of vision caused by expansion of intraocular perfluoropropane (C3F8) gas during nitrous oxide anesthesia

PURPOSE To report visual loss associated with nitrous oxide anesthesia in patients with intraocular perfluoropropane (C(3)F(8)) gas. DESIGN Observational case series. METHODS Three patients are described who lost vision in the eye with intraocular gas after subsequent nitrous oxide general anesthesia. RESULTS Three patients, aged 75, 80, and 73 years, with intraocular C(3)F(8) gas in three eyes underwent nitrous oxide general anesthesia in three different medical centers for conditions unrelated to their ophthalmic surgery, ranging from 10 days to 1 month after their vitreoretinal procedure. All three patients suffered visual loss due to presumed central retinal artery occlusion caused by expansion of the intraocular gas by nitrous oxide during general anesthesia. In two patients, there was no recovery of light perception. In one patient, there was moderate recovery of vision. CONCLUSIONS Identification of patients with intraocular gas is critical when planning nitrous oxide anesthesia. This may be achieved by the use of a simple intraocular gas identification bracelet issued to patients at the time of their vitreoretinal procedure.

Golf‐related ocular injuries

Purpose: To examine patient outcomes from golf‐related ocular injuries.

Changing trends in sympathetic ophthalmia.

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following non‐surgical penetrating injury to one eye. Three patients are presented where sympathetic ophthalmia developed after repeated vitreoretinal surgery. Prompt and effective management with systemic immunosuppressive agents permitted control of their disease and retention of good visual acuity in their remaining eye. Vitreoretinal surgery is an important risk factor in sympathetic ophthalmia. Informed consent for vitreoretinal surgery (especially in the re‐operation setting) should now include the risk of sympathetic ophthalmia (approximately 1 in 800). Diverse clinical presentations are possible in sympathetic ophthalmia and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of sympathetic ophthalmia. Modern immunosuppressive therapy with systemic steroids and steroid‐sparing agents such as cyclosporin A and azathioprine have improved the prognosis. This is particularly so in cases where early diagnosis is made and prompt and suitable immunotherapy is commenced.

Visual loss after use of nitrous oxide gas with general anesthetic in patients with intraocular gas still persistent up to 30 days after vitrectomy.

INTRAOCULAR gas may enter an eye in a variety of ways: penetrating injury, infection, rapid decompression, gas bubble disease, or from therapeutic interventions by ophthalmologists. 1 Therapeutic use of intraocular gas provides internal retinal tamponade for retinal breaks or detachment, macular hole repair, and complicated diabetic vitrectomy. Unfortunately, gases used in intraocular surgery introduce a variety of potential problems. One problem is posed for patients requiring subsequent surgery (not necessarily ophthalmic) in the postoperative period while intraocular gas may still be present in the eye. We report three cases from three different centers where adverse events occurred after nitrous oxide (N 2 O)-induced general anesthesia in patients following recent vitrectomy with use of intraocular gas. A of principles of intraocular gases is provided, including recommendations for prevention and management of N 2 O-induced anesthesia-related intraocular gas complications.

Undergraduate ophthalmology education survey of New Zealand ophthalmologists, general practitioners and optometrists

Aim: To determine what New Zealand ophthalmologists, general practitioners and optometrists consider important ophthalmic topic areas requiring emphasis in the medical undergraduate curriculum.