Pars plana vitrectomy with gas tamponade is an effective method of treating this form of retinal detachment. Some macular holes close after this surgery.

The results indicate that longer axial length and higher pre-operative intraocular pressure are associated with increased risk of AISH. Poor visual results are more likely following spontaneous nuclear expression, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The results also suggest that AISH complicating a phacoemulsification procedure has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.

A relatively high level of return to driving can be achieved post-stroke with a pro-active approach to driver assessment and rehabilitation. A structured assessment and referral programme should be offered where appropriate.

The final part of a prospective, controlled study of elastic polypropylene suture for cataract surgery was undertaken. The aim was to determine the change in induced astigmatism at 30 months after extracapsular cataract surgery and to assess the long-term safety of the suture material. Thirty-two of 44 patients were reexamined for changes in astigmatism. The results of all examinations were subjected to vector analysis. Both the elastic polypropylene group and the nylon control group continued to show an increase in the against-the-rule component of astigmatism. There was no statistical difference (p < 0.5) between the two groups at 30 months post-operatively, though the shift was greater in the polypropylene group. Wound security was similar for both groups but the polypropylene group had a higher incidence of giant papillary conjunctivitis (24%) due to exposed suture ends. The nylon suture was hydrolysed in 89% of that group and all patients were asymptomatic.

A prospective, randomised study was performed on 52 patients undergoing routine limbal extracapsular cataract surgery to compare the effect of 10/0 nylon and 9/0 elastic polypropylene sutures on post-operative astigmatism. Both the magnitude and the axis of the astigmatism were measured by keratometry and refraction pre-operatively and at regular intervals for 3 months post-operatively. Both groups showed an increase in the magnitude of astigmatism immediately post-operatively. The polypropylene group showed a more rapid decrease in astigmatism over the first 7 days and subsequent stabilisation, although the only significant (p < 0.05) difference in astigmatism between the two groups was at 1 week post-operatively. Both groups showed 'with-the-rule' astigmatism immediately post-operatively, although more of the polypropylene group developed 'against-the-rule' astigmatism by the end of the study. Despite an early reduction in post-operative astigmatism in the polypropylene group, early spectacle prescribing would not be recommended because of the shift in the axis of astigmatism. In addition, the polypropylene group had a 4 times greater incidence of iris prolapse compared with the nylon group.

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