Purpose: To determine the safety, efficacy, and quality of life improvement following sutureless 25-gauge pars plana vitrectomy for symptomatic floaters.Methods: Patients with symptomatic vitreous floaters who underwent sutureless vitrectomy between January 2008 and January 2011 were included. Data were collected regarding baseline preoperative characteristics, postoperative outcomes, complications, and a nine-item quality-of-life survey completed by each patient.Results: One hundred and sixty-eight eyes (143 patients) underwent sutureless 25gauge pars plana vitrectomy for symptomatic vitreous floaters. Mean Snellen visual acuity was 20/40 preoperatively and improved to 20/25 postoperatively (P , 0.0001). Iatrogenic retinal breaks occurred in 12 of 168 eyes (7.1%). Intraoperative posterior vitreous detachment induction was not found to increase the risk of retinal breaks (P = 1.000). Postoperative complications occurred in three eyes, of which one had transient cystoid macular edema and two had transient vitreous hemorrhage. Approximately 88.8% of patients completed a quality-of-life survey, which revealed that 96% were "satisfied" with the results of the operation, and 94% rated the experience as a "complete success."Conclusion: Sutureless 25-gauge pars plana vitrectomy for symptomatic vitreous floaters improved visual acuity, resulted in a high patient satisfaction quality-of-life survey, and had a low rate of postoperative complications. Sutureless pars plana vitrectomy should be considered as a viable means of managing patients with symptomatic vitreous floaters.

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he standard clinical evaluation of ptosis includes manual measurements of eyelid positions to quantify the degree of ptosis and its effect on a patient's vision. This value is most often expressed as the margin reflex distance 1 (MRD1), defined by the vertical distance between the upper eyelid margin and the corneal light reflex, which is the specular reflection at the corneal apex from a light source that is aligned with the visual axis (eg, a penlight). Similarly, the margin reflex distance 2 (MRD2) is the vertical distance between the corneal light reflex and the lower eyelid margin. Another way that ptosis is commonly quantified is to plot the area of visual field deprivation that results from eyelid malposition by performing Goldmann perimetry, once with the eyelid in its natural position and again with the eyelid taped up to simulate the results of surgical correction. Problems that limit the usefulness of these methods include operator dependence, subjectivity, patient movement, and cognitive inability to participate in testing (eg, in children or cognitively impaired adults). The capability to objectively extract mea-IMPORTANCE Measurements of the margin reflex distances 1 and 2 are crucial for the surgical planning of ptosis repair and blepharoplasty. Facial photographs annotated with automated measurements of eyelid position could provide objective, accurate, and reproducible documentation of these features. OBJECTIVES To describe a software algorithm for determining the margin reflex distances 1 and 2 from facial photographs and to evaluate its agreement with manual measurements of the margin reflex distances 1 and 2. DESIGN, SETTING, AND PARTICIPANTS Observational study at a single-surgeon oculoplastic private practice among 55 eyes of 28 adult volunteers. The study dates were July 30, 2014, to September 12, 2014. The dates of our analysis were October 12, 2014, to June 18, 2015. MAIN OUTCOMES AND MEASURES Agreement between manual and automated measurements of the margin reflex distances 1 and 2. RESULTS Among 55 eyes of 28 participants, automated margin reflex distance 1 measurements were strongly correlated with manual measurements (r = 0.97; 95% CI, r = 0.95 to r = 0.98; P < .001). The bias of automated margin reflex distance 1 measurements was 0.03 mm (95% CI, −0.06 to 0.12 mm), with 95% confidence limits of −0.66 and 0.71 mm. Automated margin reflex distance 2 measurements were strongly correlated with manual measurements (r = 0.96; 95% CI, r = 0.93 to r = 0.98; P < .001). The bias of automated margin reflex distance 2 measurements was 0.13 mm (95% CI, 0.03-0.22 mm), with 95% confidence limits of −0.54 and 0.80 mm. CONCLUSIONS AND RELEVANCE Automated ptosis measurements produced by our software algorithm compare favorably with manually performed clinical measurements. An automated, photography-based system could provide an archival and highly reproducible means for obtaining the margin reflex distances 1 and 2 and other facial morphometric data.

The risk of hemorrhagic complications in systemically anticoagulated patients receiving intravitreal injections is extremely low. Because of the demonstrated thromboembolic risk of stopping anticoagulant therapy, we recommend that patients continue their current regiment without cessation.