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Aim The use of adjunctive scleral buckling during vitrectomy for retinal detachment associated with inferior breaks has been the recent focus of some debate. It has been suggested that any benefit might be outweighed by potential complications associated with buckling surgery. The purpose of this study was to compare the success rate of vitrectomy, gas, and supplementary scleral buckling with the results of two recently published case series suggesting that acceptable results in inferior break detachments can be achieved with vitrectomy and gas alone. Methods A retrospective analysis of 60 consecutive patients with inferior break retinal detachments was conducted. All patients underwent vitrectomy, gas, and scleral buckling. In all cases, fellow eyes were examined under anaesthesia for retinal breaks if posterior vitreous detachment (PVD) had occurred at the time of presentation. Demographics, preoperative, and postoperative complications and outcome were recorded. Results Primary retinal attachment at 3 months was achieved in 95% of patients. This exceeds success rates of published data of patients who underwent vitrectomy and gas without buckling (81-89%). In patients with PVD in the fellow eye, 53% had horseshoe tears and all were treated with cryopexy. No sight-threatening complications occurred, but five patients developed minor buckle-related complications postoperatively. ConclusionSupplementary scleral buckling is a safe procedure that improves and enhances primary success rates in inferior break detachments over vitrectomy and gas without buckling. There is a high rate of PVDrelated breaks requiring treatment in the fellow eyes.

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Stickler syndrome is a genetically heterogeneous disorder that affects the ocular, skeletal, and auditory systems. To date three genes, COL2A1, COL11A1, and COL11A2, encoding the heterotypic type II/XI collagen fibrils present in vitreous and cartilage have been shown to have mutations that result in Stickler syndrome. As systemic features in this disorder are variable we have used an ophthalmic examination to differentiate those patients with a membranous vitreous phenotype associated with mutations in COL2A1, from other patients who may have mutations in other genes. Gene amplification and exon sequencing was used to screen 50 families or sporadic cases with this membranous phenotype, for mutations in COL2A1. Mutations were detected in 47 (94%) cases consisting of 166 affected and 78 unaffected individuals. We also demonstrate that the predominantly ocular form of type 1 Stickler syndrome is not confined to mutations in the alternatively spliced exon 2. Using splicing reporter constructs we demonstrate that a mutant GC donor splice site in intron 51 can be spliced normally; this contributed to the predominantly ocular phenotype in the family in which it occurred.

Aims The majority of rhegmatogenous retinal detachments result from pathological posterior vitreous detachment (PVD) and secondary horseshoe or giant retinal tears. Retinal detachment without PVD is usually associated with either retinal dialysis or round retinal holes. This study characterises the features, surgical outcome, and incidence of bilateral involvement of detachment associated with round retinal holes Methods In all, 110 retinal detachments from 96 consecutive patients with retinal detachment secondary to round retinal holes were studied. Analysis of patient age, sex, refraction, preoperative visual acuity, presented symptoms, position and extent of detachment, number and distribution of holes present, posterior hyaloid membrane status, surgical management, outcome of surgery, and postoperative visual acuity were studied. Results The mean age for patients was 34 years with a marked female preponderance (64%) and myopia (83%). The posterior hyaloid membrane remained attached in 95 eyes (86%). In all, 45% patients had bilateral pathology, of which 33% had 'mirror image' distribution. Detachments were predominantly shallow (93%) and slow in progression (17%). A total of 100 detachments were repaired with cryotherapy and scleral buckling, eight with cryotherapy alone, and one with laser retinopexy. In all, 99% detachments were successfully reattached with a single procedure. The mean follow-up period was 2 years. There were no instances of redetachment. Conclusions Round hole detachments are slowly evolving detachments with attached vitreous gel in young, predominantly female myopes. Examination of the fellow eye should be mandatory as there is a high incidence of bilateral pathology. Scleral buckling procedures remained highly effective in this selected group of patients.

Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing.

Aim: To determine the long term effect of latanoprost on the intraocular pressure (IOP) of patients with normal tension glaucoma (NTG). Methods: Newly diagnosed patients with NTG were recruited into the study and had their baseline IOPs measured hourly between 8 am and 5 pm using a handheld electronic Tonopen. Patients with fixation threatening field defects were placed immediately into the treatment group while those with non-fixation threatening field defects were randomised into either the treatment group or the control group (no treatment). Treatment consisted of once daily topical latanoprost 0.005%. After a minimum period of 6 months, the patients underwent a second period of IOP phasing. Results: 76 newly diagnosed patients with NTG were recruited-26 had fixation threatening disease, 25 were randomised to treatment, and 25 randomised to the control group. The average duration of treatment was 11 months. The average and maximum diurnal IOP for the patients randomised to treatment were statistically significantly lower than for the control patients at follow up (p,0.05). The treated group as a whole demonstrated a 17% decrease in the average diurnal IOP and a 19% decrease in the maximum diurnal IOP when compared to baseline IOP. 41% of those treated achieved a decrease of at least 20%, but only 10% of patients achieved a decrease of at least 30%. Conclusion: Latanoprost had a sustained hypotensive effect in eyes with NTG and 41% of treated patients achieved a reasonable response. However, in the majority of eyes with NTG, latanoprost monotherapy may be insufficient in producing a desirable 30% reduction in IOP.

There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.