ABSTRACT.Purpose: To conduct a randomized prospective clinical trial to compare primary vitrectomy without scleral buckling versus conventional scleral buckling surgery in pseudophakic primary retinal detachment (PPRD) in terms of anatomic attachment rate, functional outcome and complications. Methods: Fifty consecutive eyes of 50 patients with PPRD were randomized into two groups, with 25 patients in each of group 1 (scleral buckling group) and group 2 (pars plana vitrectomy without buckling group) in a hospital setting and followed up at 1 week, 2 weeks, 6 weeks and 6 months. Results: A primary reattachment rate of 76% (19 retinas) was obtained in group 1, while a reattachment rate of 84% (21 retinas) was achieved in group 2. The final anatomic reattachment rate was 100% in both groups. The causes of failure in group 1 were proliferative vitreoretinopathy in five eyes and open break/ missed break in one eye. The causes of failure in group 2 were missed break/ open break in three eyes and proliferative vitreoretinopathy in one eye. Best corrected visual acuity (BCVA) at 2 weeks was better in group 1, while the final BCVA at end of 6 months was two lines better in group 2. The mean change in refractive error was -1.38 D in group 1 and -0.85 D in group 2. Conclusions: Pars plana vitrectomy without buckling provides an effective treatment for PPRD and results in better longterm visual and anatomic outcomes than conventional scleral buckling.

Most ocular injuries in children are preventable and occur from unsupervised games like bow and arrow and firecracker, which can lead to significant visual loss.

TO THE EDITOR: In their article, Chiang et al 1 have updated the International Classification of Retinopathy of Prematurity (ICROP) to improve objectivity of finding, as well as to encompass clinical variations observed in regression or reactivation of retinopathy of prematurity (ROP), particularly after treatment with anti-vascular endothelial growth factor. The authors have subclassified zone II as anterior and posterior to identify the more serious disease in posterior zone II. However, the standard of care for the disease in both the zones is likely to be laser photocoagulation. To best of our knowledge, there is currently no study that has attempted to compare the outcomes of treatment between the anterior and posterior locations of zone II. In contrast, ROP in zone I, particularly posterior zone I, has been shown to have poor structural outcomes with laser monotherapy as opposed to a combination therapy with anti vascular endothelial growth factor and laser photocoagulation. 2,3 Kychenthal et al 4 have defined posterior zone I as a circular area centered on the optic nerve head, with a radius being the distance between the center of the optic disc and the fovea. However, this subdivision of zone II has not been used universally for documentation, sometimes referred to as the half zone. We suggest, similar to zone II, that zone I also be subdivided into anterior and posterior with reference to the fovea. This subdivision will not only ensure the objectivity of documentation of disease involving zone I, it will also have direct implications for deciding the appropriate treatment and prognosis based on currently available evidence.In the current classification, aggressive posterior ROP (APROP) has been replaced by aggressive ROP. For this change, the authors have cited a series of "fulminate ROP" by Shah et al. 2 The description of fulminate disease given by the authors in this article is very typical of APROP as described in ICROP 2. In their description, it is a disease that usually occurs within a definite zone, extending nasally 2 to 3 diameters from the disc margin and edge of the macula temporally. This area roughly corresponds with posterior zone I as described by Kychenthal et al. 4 The average gestational age and birth weight of infants in this series was more than typically described for fulminate ROP by others authors. Shah et al concluded that the zone I ROP occurred in babies with higher gestational ages and birth weights in India than in Western countries. We feel the word "posterior" in APROP can be retained because it is an integral part of disease description.

The aim of this study was to determine the evolving trends of retinopathy of prematurity (ROP) at a tertiary neonatal intensive care unit. In an ongoing screening programme for ROP, we estimated the incidence of ROP among at-risk neonates in a tertiary care unit. We compared our data over the last 12 months (1999-2000; period II) to the previously published data (1993-94; period I) to study changes in the spectrum of the disease. The overall incidence of ROP in period II was not significantly different from the incidence in period I (32 vs. 20 per cent, p > 0.05). However, a decreasing trend in the proportion of severe ROP (stage III) from 46 to 21 per cent in the later period was noted. The need for cryotherapy also dropped significantly compared with the earlier period (8 vs. 46 per cent respectively, p < 0.05). On multivariate analysis, apnea (p < 0.001; RR = 12.5; 95 per cent CI, 3.03-50.9; clinical sepsis (p < 0.001; RR = 5.7; 95 per cent CI, 1.6-20.7); and male sex (p < 0.001; RR = 6.3; 95 per cent CI 1.6-25.5) emerged as significant risk factors. Although the incidence of ROP is static, the more severe form of the disease (stage III) is showing a decline. Our data suggests that efficient management of apnea and sepsis may be crucial in further minimizing the risk of ROP.

Although primary vitrectomy can achieve anatomical and functional success rates comparable with those achieved by scleral buckling in uncomplicated forms of phakic RRD, the major drawback of the procedure is the high incidence of postoperative cataract formation. Moreover, visual rehabilitation takes place earlier with scleral buckling than with vitrectomy. Scleral buckling should thus be used as the primary surgical modality in the treatment of uncomplicated RRD where the media are sufficiently clear.

A toxic effect of Baerveldt GDI, which could lead to the alteration in pigmentation, has not been considered because the patient received a bilateral GDI placement. The presence of a serous-haemorrhagic choroidal detachment should be considered after unexplainable iris colour change and looked for with an echographic evaluation especially to detect the peripheral and flat forms.

Although primary vitrectomy can achieve anatomical and functional success rates comparable with those achieved by scleral buckling in uncomplicated forms of phakic RRD, the major drawback of the procedure is the high incidence of postoperative cataract formation. Moreover, visual rehabilitation takes place earlier with scleral buckling than with vitrectomy. Scleral buckling should thus be used as the primary surgical modality in the treatment of uncomplicated RRD where the media are sufficiently clear.

Fireworks-related ocular injuries commonly affect young male subjects of northern India. Visual outcome is better in eyes having better initial BCVA or closed globe injury and if relative afferent pupillary defect, bottle rocket injury, intraocular foreign body, and endophthalmitis are absent.