Ahmed N El‐Amir

Aim: To describe trends over time and geographical variation in rates of vitreo-retinal surgery in England from 1968 to 2004. Methods: Routinely collected hospital statistics were analysed for England, using the Hospital In-patient Enquiry and Hospital Episode Statistics from 1968 to 2004, and for the Oxford National Health Service Region using the Oxford Record Linkage Study from 1963 to 2004. Results: Annual admission rates in England for surgery were about 5 episodes per 100 000 population in the 1960s, rising gradually to about 10 per 100 000 in the early 1990s, and then more sharply to 30 by 2004. The Oxford Record Linkage Study shows that multiple admissions per person were rare, which confirms that the observed increase represents a real increase in the number of people treated. Annual rates in England for buckle procedures declined to about 6 episodes per 100 000 population in 2004, whereas vitrectomy surgery rose to about 26 episodes per 100 000 population in 2004. Conclusion: Vitreo-retinal surgery has developed over the last 40 years in England, rapidly so over the past 15 years. Vitrectomy surgery has become much more common in England and buckle surgery has shown a steady decline. We demonstrate statistically significant geographical variation in the current annual rate of surgery between local authorities in England.

Here the management of a macular fold complicating retinal reattachment surgery is discussed. The macular fold was repaired by a technique similar to that used in retinal translocation surgery. Direct injection into the macular fold was performed, which caused a linear, rather than the intended concentric, detachment of the retina. Permanent flattening of the macula fold was achieved and the best‐corrected Snellen visual acuity was 6/12 at 6 months. The importance of intervention, advantages and disadvantages of this technique and alternative methods of managing such cases are discussed. It may be prudent to consider peripheral, rather than direct, injection into the macular fold to detach the macula in such cases.