Alvin K H Kwok

A 73 year old woman with essential hypertension presented with moderate cataract and a chronic stage 4 macular hole of 500 μm in the right eye; and cataract and stage 2 macular hole of 250 μm in the left eye. Best corrected Snellen visual acuity (BCVA) was hand movements and 6/36 in the right and left eye, respectively. Standard pars plana vitrectomy (PPV), induction of posterior hyaloid detachment, and removal of ICG stained ILM around the macular hole up to the temporal arcade vessels and optic disc margin was performed in the left eye. This was followed by a two stage fluid-air exchange and finally 12% perfluoropropane as internal tamponade. The perioperative course was uneventful. On the sixth postoperative day, the patient returned after she had bumped her head gently against a table. Significant vitreous haemorrhage was found in the left eye. The intraocular pressure was normal and ultrasonography revealed no retinal detachment. Two months postoperatively, the vitreous haemorrhage persisted and an uneventful external fluid-air exchange was then performed. Three months postoperatively, her BCVA was 6/36 with a closed macular hole and significant decrease of central scotoma in the left eye.

To evaluate the efficacy and safety of topical 2% lignocaine gel in providing analgesia during outpatient transpupillary or trans-scleral laser treatment of inflamed eyes. A prospective study was carried out of consecutive eligible eyes undergoing laser treatment using 2% lignocaine gel as a topical anaesthetic and a coupling medium. At the conclusion of each procedure, patients were asked to grade a pain score (0 = no discomfort, 1 = mild discomfort, 2 = mild pain, 3 = moderate pain, 4 = severe pain). Twenty eyes in 19 patients received laser treatment. No pain was reported in 95% of cases treated (no discomfort in 75%, mild discomfort in 20%) and only mild pain in 5% (one patient). No adverse reactions were encountered in any of the patients. There were no complications associated with the procedures. Lignocaine 2% gel is safe and effective for outpatient transpupillary and trans-scleral laser treatment in inflamed eyes, providing adequate analgesia and serving as a coupling medium at the same time.

To analyze the role of endolaser around macular hole in managing associated retinal detachment in patients with high myopia. Review of medical records of 25 consecutive eyes of 25 patients with at least 5.00 diopters of myopia who underwent primary pars plana vitrectomy and fluid-gas exchange. In the first half of the study period, one row of contiguous argon green endolaser was routinely applied over the retinal edge of the macular hole (EL group). In the second half of the study period, endolaser was not applied around any macular hole (NEL group). Demographic information, intraoperative and postoperative complications, and final visual acuities and retinal reattachment rates were studied. The mean (+/-SD) refractive error was -11.8 +/- -3.5 diopters (D) for the EL group and -11.6 +/- -5.4 D for the NEL group. The mean axial length was 29.0 +/- 1.8 mm for the EL group and 28.3 +/- 1.7 mm for the NEL group. The primary anatomic success was 62.5% (10/16) and 77.8% (7/9) in the EL and NEL groups, respectively. No statistically significant difference was found in preoperative, postoperative, or change in best-corrected visual acuities between the two groups. Endolaser around the macular hole after pars plana vitrectomy and internal gas tamponade may not affect the anatomic or visual outcome in primary retinal detachment secondary to a highly myopic macular hole.