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Suprachoroidal haemorrhage occurs most commonly as an intraoperative or a postoperative complication of ocular surgery. Spontaneous suprachoroidal haemorrhage is rare. Herein a case is described of spontaneous suprachoroidal haemorrhage in a patient who received recombinant tissue plasminogen activator for the treatment of a myocardial infarction. Systemic thrombolysis may induce spontaneous suprachoroidal haemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favourable visual outcome. To the authors' knowledge, there have been only three previous reports in the literature of spontaneous suprachoroidal haemorrhage secondary to thrombolysis.

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A 78-year-old man with a traumatic giant retinal tear and phacodonesis had 3-port pars plana vitrectomy (3PPPV), lensectomy, and sutured posterior chamber intraocular lens (IOL) implantation. Two years after surgery, a filtration bleb was noted at 1 of the suture sites. In another case, a 32-year-old man with lens subluxation secondary to Marfan's syndrome had 3PPPV, lensectomy, and sutured posterior chamber IOL implantation. Two months after surgery, a filtration bleb was noted at 1 of the suture sites. Sutured posterior chamber IOL implantation is 1 of the few instances in which there is virtually a full-thickness suture through the sclera. We presume the filtering bleb formed as a direct result of the permanent passage created from the posterior chamber to the subconjunctiva due to presence of the suture. Presence of a filtering bleb can lead to complications including endophthalmitis.

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been used in combination with the transpupillary approach to compensate for the lack of solidity. There is also the fact that the quality of the CCD camera is not yet satisfactory. However, if surgeons recognize these weak points and adapt the intraocular endoscopic system appropriately, this instrument could surpass expectations and provide more safe and useful techniques for surgery. Our presenting techniques will also be helpful, especially in RRD and/or PVR patients with anterior segment problems, which are frequently occuring in severe cases. References

In a recent issue of this journal, Simmons and associates described 5 cases of polyneuropathy associated with IgA monoclonal gammopathy of undetermined significance (MGUS) and reviewed 6 similar cases from the literature.' These authors do not mention the setting of nonmalignant IgA gammopathies associated with peripheral neuropathy and systemic signs, such as papilledema, thrombocytosis, and multicentric Castleman's disease. 1--3,5,6,8 In these patients, systemic manifestations are those of the POEMS (Polyneuroputhy, Orgunomegaly, Endocrinoputhy, M protein, Skin changes) ~y n d r o m e ,~ but malignant B-cell proliferation, including osteosclerotic or osteolytic myeloma, extramedullary plasmocytoma, and lymphoma, cannot be detected by appropriate investigations. We describe a patient with IgAh monoclonal gammopathy, polyneuropathy, systemic symptoms, and multicentric Castleman's disease without evidence of immunocytic malignancy.A 68-year-old man came to medical attention because of severe arteriopathy in the lower limbs necessitating bilateral aortofemoral bypass. Subsequently, chronic diarrhea, weight loss (32 kg), and a sensorimotor polyneuropathy with generalized tendinous areflexia developed. Extraneurologic symptoms included moderate skin thickening and hirsutism, finger clubbing, white nails, facial telangectasias, and pitting edema. Hepatosplenomegaly and diffuse lymphadenopathy were noted. CSF contained 150 mg/dL protein and no cell. Nerve conduction velocities were initially normal and subsequently dropped in the range of demyelinating disorders. Nerve biopsy showed marked myelinated fiber loss, endoneurial edema, and perivascular mononuclear cuffs. Endocrine screenings showed an increasing thyroid dysfunction with low free T,, normal free T,, and increased TSH, low serum testosterone, normal serum oestradiol, high LH, and normal FSH.

SUMMARYWe report a case of a 77-year-old Caucasian woman, treated with ocriplasmin injection for vitreomacular traction (VMT) and full-thickness macular hole (FTMH), who had a persistence outer retinal defect on her 28-day review, without VMT resolution, then presented 3 months later with complete macular hole closure, with persistence of vitreomacular adhesion. This case raises the question on the validity of the 28-day fixed date to assess final outcome of ocriplasmin injection for FTMH associated with VMT, and sheds new lights on the behaviour of the posterior hyaloid in cases of vitreolysis by a chemical agent such as ocriplasmin. BACKGROUND