Aims To assess the long-term anatomical and visual outcomes of primary scleral buckle (SB) surgery for rhegmatogenous retinal detachment (RRD) and identify predictors of surgical and functional success. Methods All primary SB procedures performed at Manchester Royal Eye Hospital between January 2008 and December 2023 were reviewed retrospectively. Preoperative, intraoperative and postoperative data were extracted from electronic records. Primary end-points were single-surgery anatomical success (SSAS) and final best-corrected visual acuity (BCVA); univariate and multivariate regression analyses examined predictive variables and complications. Results 608 eyes were included. SSAS was achieved in 515 eyes (85%) and final anatomical success in 602 eyes (99%). Mean BCVA improved from 0.62±0.85 to 0.32±0.49 logarithm of the minimum angle of resolution (logMAR) (p<0.01). On multivariate analysis, age >40 years (OR 0.55, 95% CI 0.37 to 0.83; p=0.004), macula-off status (OR 0.65, 95% CI 0.44 to 0.97; p=0.034) and ocular trauma (OR 0.40, 95% CI 0.19 to 0.82; p=0.012) independently reduced SSAS. For visual outcomes, macula-off detachment (β=+0.36; p<0.001) and ocular trauma (β=+0.42; p<0.001) were independent predictors of worse postoperative BCVA. The most common complications were subretinal haemorrhage (4.6%), inadvertent deep sutures (3.9%) and postoperative ocular hypertension (7.4%). Conclusions Primary SB provided high anatomical success, significant visual improvement and a favourable safety profile in this large single-centre study. Age above 40 years, macula-off status and ocular trauma predicted poorer SSAS; trauma and macula-off status were also associated with worse postoperative BCVA on multivariate logistic regression.

The pathogenesis of macular holes in eyes with background of age-related macular degeneration (AMD) and the potential causative relationship between these entities remains unclear. In this narrative review, we aim to explore the intricate relationship between the formation of macular holes, both full-thickness and lamellar, and neovascular / non-subtype of AMD. A literature search was performed using the National Center for Biotechnology Information (NCBI) PubMed database, and studies published up to March 2025 were included. We summarize the current evidence on AMD-associated macular holes, and provide insights into the underlying pathophysiological mechanisms, prevalence, prognosis and surgical outcomes. Research to date suggests that macular holes can uncommonly develop in eyes with coexistent AMD, with a contributing role of tractional and degenerative component in their development and progression. Intravitreal anti vascular endothelial growth factor injections for neovascular AMD have been implicated in macular hole formation. Surgical intervention with vitrectomy and internal limiting membrane peel remains the optimal proven method for restoring vision in macular holes, however comprehensive evaluation and individualized management approaches may optimize anatomical and functional outcomes in this patient population. Recent findings underscore that there is no evidence yet of a benefit to using stem cell therapy in macular holes with coexistent AMD. This review sheds light on the postulated pathogenesis of AMD-associated macular holes, discusses practical aspects of prognostic prediction and examines appropriate management options. Current evidence needed to guide clinical practice is both limited and often contradictory, and further studies are warranted to elucidate these findings.

PURPOSE:To evaluate anatomic and functional outcomes after primary pars plana vitrectomy (PPV) for giant retinal tear-related rhegmatogenous retinal detachment (GRT-RRD) and to compare outcomes between gas and silicone oil (SO) tamponade. DESIGN:Retrospective, single-center cohort study. PARTICIPANTS:One hundred ten consecutive eyes undergoing primary PPV for GRT-RRD at a tertiary vitreoretinal service (2012-2024). METHODS:Demographic, preoperative, and intraoperative variables were extracted from routinely collected clinical records. Baseline characteristics and outcomes were first compared between SO and gas groups using univariable analyses. To address confounding by indication, full propensity score matching was then performed. Single-surgery anatomic success (SSAS) was assessed with Firth logistic regression and final best-corrected visual acuity (BCVA) with weighted linear regression using G-computation. MAIN OUTCOME MEASURES:Single-surgery anatomic success, final anatomic success (FAS), and final BCVA (logarithm of the minimum angle of resolution [logMAR]). RESULTS:Mean age was 50.1 (16.0) years, and 83 of 110 (75.5%) patients were men. Macular detachment was present in 46 of 110 (41.8%) eyes. Gas tamponade was used in 76 of 110 (69.1%) eyes (SF6 5 of 110 [4.5%], C2F6 53 of 110 [48.2%], and C3F8 18 of 110 [16.4%]) and SO in 34 of 110 (30.9%) eyes. Single-surgery anatomic success was achieved in 97 of 110 (88.2%) eyes and FAS in 103 of 107 (96.3%). After propensity score matching, male sex was associated with higher odds of SSAS (odds ratio [OR], 4.54; 95% confidence interval [CI], 1.75-11.75; P = 0.002), whereas proliferative vitreoretinopathy (PVR) grade C was associated with lower odds of SSAS (OR, 0.10; 95% CI, 0.02-0.45; P = 0.003). In the overall matched cohort, SO showed a trend toward worse final BCVA versus gas (mean difference [MD], +0.138 logMAR; 95% CI, -0.015 to 0.291; P = 0.077) with similar SSAS. In macula-on matched eyes, SO was associated with worse final BCVA (MD, +0.179 logMAR; 95% CI, 0.018-0.341; P = 0.030) with comparable SSAS (92.6% vs. 90.0%; P = 1.000). CONCLUSIONS:Primary PPV for GRT-RRD achieved high rates of SSAS and FAS, with C2F6 used as the most common tamponade. After adjustment for confounding, male sex was associated with higher SSAS and PVR grade C with lower SSAS. Single-surgery anatomic success was comparable between groups, whereas visual outcomes showed a trend toward better outcomes with gas in the overall cohort; macula-on analysis should be interpreted cautiously because of the small sample size. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose- To describe a case of central retinal artery occlusion following scleral buckling procedure combined with pneumoretinopexy in a patient with sickle cell (HbSC) retinopathy (SCR). Methods- Scleral buckling procedure, combined with injection of 0.3 ml of 100% perfluoropropane (C3F8) gas in the vitreous, was performed without intra-operative complications under general anaesthesia as treatment of two separate macula-sparing rhegmatogenous retinal detachments secondary to round holes, involving superior and inferior retina respectively, in the right eye of a 26-year-old Afro-Caribbean female with sickle cell disease. Results- On day one post-operatively, central retinal artery occlusion (CRAO) was detected in the operated eye. We hypothesize that the expansion of the gas in the postoperative period combined with the presence of a retinal explant might have caused a moderate elevation of the IOP that caused extensive retinal arteriolar shutdown in the backdrop of SCR. Conclusion- CRAO can be a devastating complication following scleral buckling procedure combined with gas insertion in SCR, caution is required when performing scleral explant combined with expansile gas in a patient with sickle cell vasculopathy.

BACKGROUND:Voretigene neparvovec (VN) improves retinal sensitivity in biallelic RPE65-associated inherited retinal dystrophy (IRD), with greater best-corrected visual acuity (BCVA) gains reported in children. METHODS:We describe a 13-year-old male with biallelic RPE65-IRD who underwent bilateral VN treatment without subretinal foveal detachment at the Manchester Royal Eye Hospital. RESULTS:Six weeks post-treatment, BCVA improved by four lines to 0.20 logMAR in the right eye and by three lines to 0.30 logMAR in the left eye. White full-field stimulus threshold (FST) testing showed maximal gains of -37.8 dB in the right eye and -39.1 dB in the left eye. Approximately four years later, the patient presented with marked BCVA decline (0.68 logMAR in the right eye; 0.90 logMAR in the left eye) and FST deterioration to -18.2 dB and -22.8 dB, respectively. Fundoscopy revealed chorioretinal atrophy (CRA) along the vascular arcade, and optical coherence tomography (OCT) showed foveal outer retinal atrophy with relatively preserved perifoveal layers and choroidal hyperreflective foci within the CRA. The rapid BCVA decline, foveal atrophy pattern, and presence of choroidal hyperreflective foci suggest VN-related effects or an inflammatory response as the most likely contributors to CRA development. CONCLUSIONS:These findings underscore the need for long-term follow-up after VN treatment to detect potential late deterioration despite early visual gains. Additionally, patients who exhibit pronounced early FST improvements may benefit from modified or extended immunosuppression to reduce the risk of CRA development.

PURPOSE:To compare anatomical and visual outcomes of inferior versus non-inferior giant retinal tear related rhegmatogenous retinal detachment (GRT-RRD) after primary pars plana vitrectomy (PPV). METHODS:This retrospective single-centre study included 110 eyes undergoing primary PPV for GRT-RRD between 2012 and 2024. Inferior GRTs were defined as GRTs crossing the 5-7 o'clock meridians. Outcomes included single-surgery anatomical success (SSAS), final anatomical success (FAS), postoperative PVR grade C, and best-corrected visual acuity (BCVA). Propensity score matching with double-robust regression and G-computation was used to adjust for baseline confounders. RESULTS:Of 110 eyes, 63 (57.3%) had inferior GRT-RRDs. Inferior GRT-RRDs occurred in younger patients (47 vs 54 years, p=0.01) and were more extensive (6.0 vs 4.5 clock-hours, p=0.027). SSAS (93.5% vs 83.0%), FAS (95.7% vs 93.5%), postoperative PVR-C rates, and BCVA at 2 months and final follow-up were comparable between inferior and non-inferior groups on univariable analysis. After propensity score matching (PSM), inferior GRT crossing was associated with a lower risk of SSAS failure (risk difference -9.9%, p=0.027) in all eyes and with better final follow-up BCVA in macula-on eyes (mean difference -0.493 logMAR, p=0.001). Within inferior GRT-RRDs, gas and silicone oil tamponade achieved similar SSAS (97.4% vs 87.0%), but gas was associated with better final follow-up BCVA (median 0.21 logMAR (20/32) vs 0.55 logMAR (20/70); p<0.001). CONCLUSION:After PSM, inferior GRT-RRDs were associated with a lower risk of SSAS failure and better final follow-up BCVA in macula-on eyes. Gas tamponade achieved comparable anatomical outcomes and was associated with better final follow-up BCVA than silicone oil.

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.

PURPOSE:To assess whether external drainage of subretinal fluid (SRF) improves anatomical or visual outcomes in scleral buckle surgery for rhegmatogenous retinal detachment (RRD). METHODS:Retrospective review of 609 primary scleral buckles performed at Manchester Royal Eye Hospital (2008-2023). Pre/intraoperative characteristics, drainage use, best-corrected visual acuity (BCVA), and single-surgery anatomical success were analyzed. RESULTS:Four hundred twenty-eight patients without SRF drainage and 181 with drainage were included. Groups were similar for age ( P = 0.33), preoperative BCVA ( P = 0.47), RRD type (dialysis vs. retinal hole, P = 0.17), high myopia ( P = 0.52), and trauma ( P = 0.06). Drainage group had more macula-off RRDs (48% vs. 39%, P = 0.05) and were more often operated on by consultants ( P < 0.01). Single-surgery anatomical success rates were 86.7% with drainage and 83.6% without ( P = 0.67). Final BCVA also showed no difference in all ( P = 0.47), macula-on ( P = 1.00), and macula-off eyes ( P = 0.17). After adjusting for age, high myopia, trauma, type of RRD, macula status, and surgeon grade, external SRF drainage was not independently associated with either single-surgery anatomical success (OR = 1.39, 95% confidence interval 0.81 to 2.36, P = 0.23) or postoperative BCVA (B = -0.023, 95% confidence interval -0.093 to 0.048, P = 0.532). Drainage caused subretinal hemorrhage in 34 eyes (18.8%), almost all (32) small and localized to the drainage site; no endophthalmitis, retinal incarceration, or vitreous loss occurred. CONCLUSION:External SRF drainage during scleral buckling is safe but did not improve single-surgery anatomical success or BCVA. Its use should remain individualized based on RRD characteristics and surgeon preference.

Voretigene neparvovec can improve visual function in children with RPE65-associated inherited retinal dystrophy. However, the effect of rapid asymmetric visual improvement on binocular development and amblyopia remains uncertain.A young child underwent sequential treatment 8 months apart. After right-eye treatment, visual acuity improved, fixation switched and a manifest left esotropia developed. Left-eye visual acuity subsequently deteriorated. We describe this as reverse amblyopia in a novel context: reversal of the interocular amblyopic pattern following treatment-induced visual improvement without fellow-eye penalisation. Despite left-eye treatment, refractive correction and attempted occlusion, the marked visual asymmetry persisted. This case highlights a potential binocular effect of rapid unilateral visual improvement and the need for close monitoring between sequential treatments.

PURPOSE:To compare preoperative characteristics and postoperative anatomical and functional outcomes of scleral buckle surgery using sponges versus tires, as well as explant-related complications and the frequency of explant removal. METHODS:This retrospective study included patients with primary rhegmatogenous retinal detachment (RRD) who underwent primary scleral buckling at the Manchester Royal Eye Hospital between 2008 and 2023. Preoperative data included age, macula status, type of RRD, ocular comorbidities and best-corrected visual acuity (BCVA). Postoperative outcomes included single-surgery anatomical success (SSAS), BCVA and explant-related complications (extrusion, infection, high intraocular pressure and persistent diplopia). RESULTS:Among 562 patients (mean age 36 ± 12 years), 183 received sponges and 379 received tires. Sponges were more commonly used in dialysis-related RRD (54% vs. 10%; p < 0.01) and macula-off eyes (52% vs. 36%; p < 0.01), and associated with worse preoperative BCVA (logMAR 0.84 ± 0.81 vs. 0.57 ± 0.72; p < 0.01). SSAS rates were similar between groups (86.0% vs. 83.4%; p = 0.44) and mean BCVA improvement (ΔBCVA) did not differ significantly (0.39 ± 0.57 vs. 0.29 ± 0.58 logMAR; p = 0.29). In multivariable analysis adjusting for relevant clinical covariates, explant type was not independently associated with postoperative BCVA (B = -0.10; p = 0.28) or SSAS (aOR = 0.79; p = 0.71). Buckle extrusion occurred more frequently in the sponge group (12.6% vs. 3.4%; p < 0.01), leading to higher explant removal rates (14.8% vs. 6.1%; p < 0.01). CONCLUSIONS:Sponges were preferentially used in dialysis-related RRD cases and were associated with worse preoperative BCVA and a higher proportion of macula-off RRDs. SSAS rates and ΔBCVA improvement were similar between groups. Sponges had significantly higher extrusion rates, resulting in more frequent explant removal.

To survey current practice and opinion regarding the timing of idiopathic full thickness macular hole (iFTMH) surgery among consultant vitreoretinal surgeons in the United Kingdom (UK), and to provide an overview of the current literature and future direction. An online survey was sent to all members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). Literature search and analysis were conducted on studies that investigated the timing of vitrectomy surgery for iFTMH. A total of 33 responses was received from all regions of the UK except Northern Ireland. The timing from the onset of symptoms to the first vitreoretinal clinic appointment ranged from 1 to 60 months, with a mean of 6.66 ± 10.8 months (95% CI 2.75-10.6). In terms of surgical prioritisation on the listing form, 42.4% (n = 14) were listed as P2 (less than 1 month), 54.5% (n = 18) were listed as P3 (less than 3 months), and 3.03% (n = 1) were listed as P4 (more than 3 months). The average time from the onset of symptoms to operation date in this cohort was 9.87 months. When asked in an ideal world, would they have liked the surgery to be done sooner, the majority (72.7%, n = 24) said 'yes'. The survey found that there were regional variations in waiting times and surgical prioritisation. Expanding teleophthalmology and establishing elective vitreoretinal surgical hubs are crucial for ensuring timely access to care for all iFTMH patients in the UK.

To systematically review the anatomical and functional outcomes of vitreoretinal surgery for familial exudative vitreoretinopathy (FEVR)-associated retinal detachment (RD). A systematic review and meta-analysis were conducted following a PROSPERO-registered protocol. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Ovid, and Medline databases were searched for cohort studies and case series evaluating scleral buckling (SB), pars plana vitrectomy (PPV), or combined procedures for FEVR. Primary outcomes were retinal reattachment rates and postoperative best-corrected visual acuity (BCVA). Secondary outcomes included complication and reoperation rates. Nineteen studies involving a total of 682 eyes were included. The overall pooled primary retinal reattachment rate was 0.77 (95

Objectives: To describe the anatomical and functional outcomes of paediatric rhegmatogenous retinal detachment (RRD) managed primarily with scleral buckle and to identify factors predicting single-surgery anatomical success (SSAS) and postoperative best-recorded visual acuity (BRVA). Methods: A retrospective review was conducted of 49 patients (≤18 years) who underwent primary scleral buckle for RRD between 2008 and 2023 at the Manchester Royal Eye Hospital. Data on patient and RRD characteristics, ocular comorbidities, surgical technique, complications, and postoperative outcomes were collected. SSAS, final anatomical success, and BRVA were assessed. Results: The mean age at surgery was 12 ± 3 years, with macula-off detachment in 57% (28/49). SSAS after scleral buckle surgery was achieved in 71% (35/49). At the second surgery, 13 out of 14 patients underwent vitrectomy, and one patient had repeat scleral buckling. The final anatomical success rate was achieved in 96% (47/49). On multivariable analysis, older age independently predicted higher odds of SSAS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.05–1.91, p = 0.023), whereas macula status, drainage, and trauma were not independent predictors. In a multivariable linear model for postoperative BRVA (logMAR), older age was associated with better BRVA (B = −0.162, 95% CI −0.244 to −0.080, p < 0.001), and macula-off status with worse BRVA (B = 0.520, 95% CI 0.022 to 1.018, p = 0.041); drainage and trauma were not significant. Conclusions: Primary scleral buckle, with secondary vitrectomy if needed, is effective for paediatric RRD, yielding a 71% SSAS and 96% final anatomical success. Older age was independently associated with higher SSAS and better postoperative BRVA, while macula-off presentation was associated with worse postoperative BRVA.