Referrals for proliferative diabetic retinopathy from two UK diabetic retinopathy screening services: a 10-year analysis of visual outcomes, requirement for vitrectomy, and mortality

\ua9 The Author(s) 2024. Background/objectives: To determine long-term outcomes of patients referred with proliferative diabetic retinopathy (PDR) from diabetic eye screening programmes (DESP) to tertiary care centres in the United Kingdom (UK). Methods: Retrospective multicentre study of patients referred from two DESPs in the UK over a 36-month period (2007–9) and followed-up for 10 years. Critical outcomes included severe vision loss (SVL) and the need for vitrectomy. Other outcomes assessed included moderate vision loss (MVL), and patient survival time. Univariate and multiple variable Cox proportional hazards regressions were used to analyse survival outcomes. Results: 212 eyes of 150 patients were referred with a diagnosis of PDR. 109 eyes of 72 patients were confirmed to have active PDR and included in the study. 61% of patients had low-risk PDR, while 39% exhibited high-risk features in at least one eye. Eight (7.3%) eyes developed SVL and 16 (14.7%) MVL during follow up. Vitrectomy was required in 24% (95% CI: 15 to 31%) of all PDR eyes and was most commonly performed for vitreous haemorrhage (65%). The 10-year survival in all PDR patients was 76% (95% CI: 63 to 85%) with the mean time to death for all deceased patients being 5.4 \ub1 3.6 years. On multivariable analysis, only age was found to have a significant association with the survival of patients with PDR. Conclusions: During the 10 year follow up SVL was uncommon, but MVL occurred in almost one-fifth of the eyes. Approximately 1 in 4 eyes required vitrectomy, highlighting its significance in patient management

Outcomes of delayed vitrectomy in open-globe injuries in young patients

PURPOSE: The timing of vitrectomy for severe penetrating eye injury to the posterior segment remains controversial; this is particularly pertinent if patients are children and young adults. We present our results of the surgical procedure in young patients after penetrating eye injury using a delayed approach. METHODS: Noncomparative interventional study of patients up to 29 years of age who had vitreoretinal surgery for penetrating eye injury. Surgical procedure was performed in seven eyes of six patients. Posterior vitrectomy was performed because of hemophthalmos after waiting for a mean of 49 days (range, 17-90 days) after posterior vitreous detachment was confirmed on ultrasound examination. RESULTS: The mean postoperative follow-up period was 22 months (range, 9-35 months). Of the 7 patients, 6 (85.7%) achieved visual acuity (Snellen acuity) of 6/12 or better and 4 eyes (57.1%) reached 6/6. At the last follow-up, all patients were pseudophakic, 2 required secondary lens implants, and retinal detachment developed in 1 patient. CONCLUSION: This consecutive case series underlines the fact that a delayed approach is compatible with good visual prognosis in relatively young patients.link_to_subscribed_fulltex

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Maria T Sandinha,1 Ajay K Kotagiri,1 Rona I Owen,1 Caspar Geenen,1 David HW Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK Purpose: To assess the accuracy of B-scan ultrasound (U/S) in diagnosing cases of acute fundus obscuring vitreous hemorrhage (FOVH) using a standardized scan protocol and dedicated ophthalmic ultrasonographer.Methods: Consecutive patients presenting with acute FOVH of unknown cause, between January 2013 and December 2014, were prospectively recruited. Patients underwent a scan performed by a dedicated ultrasonographer, utilizing a systematic scan sequence and using an ocular specific U/S device. The U/S findings were compared to the findings during vitrectomy or after spontaneous hemorrhage clearance.Results: Fifty-eight eyes (58 patients) were included. An underlying rhegmatogenous retinal detachment (RRD) and retinal tears without RRD were reported in nine and 14 patients, respectively. Nineteen of these patients underwent vitrectomy, and the other four underwent laser retinopexy or cryopexy alone. An additional six patients with suspected but uncertain retinal tears underwent vitrectomy, during which tears were confirmed in three, two had retinal vessel avulsions, and one had retinal new vessels. There was “complete” agreement between the B-scan findings and clinical findings in 78% of patients, “partial” agreement in 19%, and agreement was not tested in 3%. When the agreement was “partial”, the disagreements did not affect patient management. The sensitivity was 100% for the detection of RRD, and for the detection of new retinal tears in patients without retinal detachment.Conclusion: B-scan U/S scan was highly sensitive in identifying the pathology in acute FOVH. Our results show an improvement from previously reported results, likely related to the standardized scan protocol and dedicated ophthalmic ultrasonographer. Keywords: diagnosis, ultrasonography, ultrasound B-scan, rhegmatogenous retinal detachment, retinal tear, retinal brea