Sui Chien Wong

Purpose: Combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) is traditionally described as arising from hamartomatous proliferation. We hypothesize that posterior hyaloid membrane (PHM) traction is the primary driver with secondary retinal/RPE changes, supported by imaging and surgical outcomes. Methods: Dual-center retrospective series of 64 eyes with ‘CHRRPE’ and OCT imaging. Results: Mean age was 16.2±16.9 years. The PHM was adherent and thickened on OCT in 97%, with broad (>1500µm) attachment in 76%. Traction was present in all eyes (mini-peaks 69%, maxi-peaks in 73%). Thirty-six eyes had follow-up (mean 6.3±5.7 years). Those undergoing surgery (n=15) were younger (6.6 vs 15.0 years, p=0.010), more likely to have macular phenotype (80% vs 50%, p=0.008), and had worse baseline visual acuity (1.01±0.62logMAR [20/200] vs 0.52±0.38logMAR [20/66], p=0.024) versus observation. Surgery resulted in greater reduction in CST (-183±168µm vs -47.4±179µm, p=0.007), reduction in clinically apparent pigmentary change (100% vs 15%, p<0.001), and visual acuity improvement (-0.26±0.46logMAR [13 letter gain] vs +0.29±0.67logMAR [15 letter loss], p=0.045) versus observation, including after adjustment for follow-up. Traction features resolved postoperatively in all cases. Conclusion: Traction appears to be a defining feature of CHRRPE. We propose the term ‘Traction-Induced Retinal and Retinal Pigment Epithelium Lesion’ (TRIPEL) to reflect the pathophysiology.

Objectives To evaluate the efficacy of inner retinal fenestration as a surgical technique for the treatment of optic disc pit maculopathy (ODPM) in the paediatric population. Methods This is a retrospective, interventional case series of paediatric patients with ODPM treated at two tertiary hospitals in London by a single surgeon (SCW). All patients underwent pars plana vitrectomy with the creation of two inner retinal fenestrations and endogas tamponade. The partial-thickness retinotomies were made radial to the optic disc pit using a 25-gauge MVR blade. Anatomic and visual outcomes were determined by optical coherence tomography central retinal thickness and best-corrected visual acuity (BCVA), respectively. Results A total of six eyes were included. Average patient age was 12.0 ± 3.5 years. Preoperatively all eyes demonstrated intraretinal fluid and/or serous detachment of the central macula. Patients were followed for a mean of 22.7 ± 16.1 months after surgery. Mean preoperative BCVA was logMAR 0.71 ± 0.29 (20/100). Mean postoperative BCVA was 0.49 ± 0.30 (20/63) at 2 weeks, 0.35 ± 0.33 (20/45) at 3 months and 0.16 ± 0.29 (20/32) at 1 year. Progressive resolution of intraretinal and subretinal fluid (SRF) was observed in all eyes, with central retinal thickness significantly improved by 2 weeks postoperatively (637.83 ± 209.09 µm preoperatively and 465.40 ± 169.86 µm postoperatively, p = 0.04). Recurrence of subretinal or intraretinal fluid was not observed. Conclusion Dual inner retinal fenestration is an effective technique that resolves fluid and restores vision in paediatric patients with ODPM. These results support the hypothesis that enabling egress of fluid into the vitreous cavity can achieve long-lasting amelioration of ODPM.

Objectives To audit the structural and functional outcomes of surgery for acute tractional retinal detachment due to retinopathy or prematurity between 2004 and 2014 in Oxford UK. Methods Consecutive operations were identified from a surgical log. Clinical data including demography, perioperative data, and retinal outcomes were extracted into a spreadsheet and compared against two international data sets referenced in the method section. Nonparametric tests (Fisher’s exact, and the Mann–Whitney U-tests) were used for statistical analysis with a p-value < 0.05 considered significant. Results Twenty-nine eyes of 19 babies underwent surgery. The mean age (SD) at final follow-up was 6.4 (3.7) years of age and comparable to the reference data sets. The mean birth weight and gestational age of babies matched the ETROP data set referenced in the method section. Anatomical success was obtained in 16/29 (55.2%) of eyes and more likely with stage 4 ROP than stage 5 disease (p < 0.05). Thirteen of 29 eyes (44.8%) obtained form vision post-operatively. All instances of macular retinal reattachment during follow up were verified with post-operative OCT. Conclusions Surgery for stage 5 ROP is not worthwhile. For stage 4 ROP it yielded better visual outcomes than ETROP but registration for visual impairment was not prevented. Innovation such as endoscopic vitrectomy could yield better outcomes. Earlier detection of vitreoretinal fibrosis could result in timelier referral. A formally funded national service is needed to ring-fence resource to avoid delays in access to surgery, which has a narrow surgical window.

Background/aims: To investigate the effect of hydroxypropylmethylcellulose (HPMC) on the physical interaction (contact angle) between silicone oil and a silicone intraocular lens (IOL). Methods: In vitro experiments were performed, to determine the effect of HPMC (0.5%, 1% or 2%), with or without an additional simple mechanical manoeuvre, on the contact angle of silicone oil at the surface of both silicone and acrylic (control) IOLs. A balanced salt solution chamber was used. The study group comprised 21 silicone and nine acrylic IOLs. Results: The median contact angle of silicone oil on silicone IOL was 99°. The addition of HPMC 2% alone did not significantly alter the contact angle. HPMC 2% combined with an additional single mechanical manoeuvre increased the contact angle to 180° (greater non-wetting), with complete separation of silicone oil from silicone IOL within 1 min. The manoeuvre alone, or in conjunction with a lower concentration of HPMC (0.5 or 1%), was ineffective in increasing the contact angle. Conclusion: We present a novel, non-toxic technique of using hydroxypropylmethylcellulose 2% combined with a simple mechanical manoeuvre, for the removal of adherent silicone oil droplets from silicone intraocular lenses.