The Sunderland Eye Infirmary is a health facility in Sunderland, Tyne and Wear. It is managed by the South Tyneside and Sunderland NHS Foundation Trust..
Over the last 25 years, there has been a shift away from ab externo scleral buckling to vitrectomy and internal tamponade for the repair of rhegmatogenous retinal detachments (RRD). Despite this, there are still specific indications for scleral buckle. There is little recent research on which patient and surgical factors influence the success or failure of buckle surgery for RRDs. A review of 1015 eyes in the BEAVRS/Euretina database treated by a scleral buckle between January 2011 and September 2022. Demographics, characteristics of the RRD, and details of the buckling procedure were assessed to determine which factors were associated with surgical success. Success was defined as an attached retina with a minimum follow up of 6 weeks. Potential risk factors were analysed by multivariable logistic regression. 54.4
Aims To establish consensus-based guidance on optimising anti-vascular endothelial growth factor (VEGF) and corticosteroid use in centre-involving diabetic macular oedema (CI-DMO).Methods A two-round modified Delphi study was conducted among medical retina (MR) specialists in the National Health Service in England. In total, 82 statements were developed by a steering group and rated by a wider Delphi panel using a four-point Likert scale. Consensus was predefined as ≥75%.Results In rounds one and two, 30 and 39 MR specialists responded to the survey, respectively. In total, consensus was achieved for 64/82 statements (78%). Key outcomes were consensus on the value of personalised treatment strategies, consensus of MR specialists to validate a definition of non-response to intravitreal treatment for DMO as a reduction in central retinal thickness (CRT) by ≤10% and a suboptimal response as a reduction in CRT by 10–20% (these thresholds were adapted from those proposed by Downey et al). Early evaluation of anti-VEGF treatment response should be made at 3–6 months and after trying two different types of anti-VEGF agents. The panel reached moderate consensus that corticosteroid therapy may be considered after 9–12 months in patients with persistent suboptimal response or high treatment burden. The panel also supported consideration of transition to sustained-release corticosteroid therapy in selected patients demonstrating a positive response to short-acting corticosteroids.Conclusions This Delphi study provides a consensus-based framework to support personalised treatment decisions in CI-DMO, highlighting the importance of timely optimisation of anti-VEGF and corticosteroid therapies in cases of suboptimal response and non-response. However, as these recommendations are derived from expert consensus rather than prospective clinical validation and all panellists were from England, generalisability to other healthcare settings may be limited. Additionally, patient representatives were not included, and the recommendations require validation in clinical practice.
BACKGROUND:Errors in intravitreal fluorinated gas selection or dilution can result in unintended expansile concentrations, causing irreversible visual loss. We aimed to quantify the problem using national incident reporting, published literature and a UK surgeon survey, developing expert consensus recommendations on safe storage, handling and intraocular use. METHODS:NHS England patient safety incident repositories (National Reporting and Learning System and Learn from Patient Safety Events) were searched for events related to intravitreal gas use (2010-2025), followed by thematic analysis. A targeted literature review identified sight-threatening complications associated with incorrect gas concentration. In parallel, a national survey of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) assessed preparation practices, complications, management strategies, storage and environmental considerations. An expert panel synthesised findings into consensus recommendations. RESULTS:National reporting identified 47 relevant incidents; 29 cases involved incorrect gas concentration due to preparation errors. 14 cases resulted in at least moderate harm, including eight with blindness or severe visual impairment; pure gas concentration (100%) administration was documented in six cases. The literature review identified 20 severe cases across 11 publications. Among 108 BEAVRS respondents, 38.9% recalled at least one significant complication related to incorrect gas concentration; 16.7% reported witnessing sight-threatening outcomes, most commonly central retinal artery occlusion. Recommendations focused on clear labelling/colour coding, standardised dilution protocols, staff training, mandatory two-person checks, appropriate use and segregation of pre-mixed iso-expansile gases and adjunctive safety measures (gas cards/wristbands). CONCLUSION:Incorrect intraocular gas concentration is likely under-reported but can cause devastating, preventable harm. Standardised systems for storage, preparation, verification and postoperative review may reduce risk while supporting environmentally responsible practice.
BACKGROUND:Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system, where timely and accurate diagnosis is essential for effective management. Optical coherence tomography (OCT) enables non-invasive evaluation of retinal changes that may serve as biomarkers for MS. Unlike other ophthalmologic diseases, raw cross-sectional OCT images in MS show subtle alterations often indistinguishable from healthy controls (HCs). Consequently, retinal layer thickness and boundary-derived surface features offer greater discriminatory power. METHODS:We investigated three categories of artificial intelligence (AI) models: (1) feature extraction with auto-encoder (AE) and shallow networks, (2) custom-designed deep networks, and (3) fine-tuned pre-trained networks. Retinal layer thickness and surface maps derived from OCT were analyzed to determine the most informative features, with channel-wise combination and mosaicing applied for feature integration. Model interpretability was assessed using occlusion sensitivity and Gradient-weighted Class Activation Mapping (Grad-CAM) visualizations. The dataset included 38 HC and 78 MS eyes obtained from independent public and local sources. Patient-wise partitioning was implemented to prevent data leakage. RESULTS:The proposed deep network using channel-wise combined thickness maps of retinal nerve fiber layer (RNFL), ganglion cell and inner plexiform layer (GCIPL), and inner nuclear layer (INL) layers achieved balanced accuracy of 97.3% (SD = 4.16; 95% CI: 92.3-100%), specificity of 97.3% (SD = 5.59; 95% CI: 92.6-100%), sensitivity of 97.4% (SD = 3.54; 95% CI: 92.6-100%), g-mean of 97.3% (SD = 4.18; 95% CI: 92.24-100%), F1-score of 98.0% (SD = 3.86; 95% CI: 92.6-100%), and an AUC of 0.96 (SD = 0.08; 95% CI: 0.95-1.00). Notably, the high performance observed in internal cross-validation was achieved when public and local datasets were combined. However, performance decreased substantially in cross-dataset evaluations, where models were trained on one dataset and tested on the other, indicating limited external generalizability, particularly when trained on public data and applied to local clinical data. CONCLUSIONS:AI-based analysis of OCT-derived retinal layer features enables accurate and interpretable classification of MS, supporting its potential as a valuable clinical biomarker.
