Manchester Royal Eye Hospital

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% Confidence Interval (CI): 0.71-0.83; I2 = 59.8%). Subgroup analysis demonstrated a pooled primary reattachment rate for SB of 0.90 (95% CI: 0.70-1.00; I2 = 12.7%) and for PPV of 0.71 (95% CI: 0.60-0.80; I2 = 49.1%). The pooled reoperation rate was 0.24 (95% CI: 0.08-0.45). Qualitative analysis showed that while BCVA outcomes were heterogeneously reported, they generally improved postoperatively. Surgical success was highly dependent on disease stage. Surgical management of FEVR-associated RD achieves high primary reattachment rates. While both SB and PPV yield favourable outcomes, the choice of procedure should be tailored to disease severity and patient characteristics. The evidence suggests SB may be preferred for uncomplicated rhegmatogenous detachments, while PPV is often necessary for more advanced and complex cases.

Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS). A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements. Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care. This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

Receiving a diagnosis of a vision-threatening eye condition is a psychologically salient event for many patients. Across ophthalmology, fear, uncertainty, and emotional distress are commonly observed at the time of diagnosis, often before substantial functional vision loss occurs. Although depression and anxiety are well documented in chronic eye disease, diagnosis-linked distress remains inconsistently recognised and is rarely addressed systematically within routine ophthalmic care. This article introduces post-visual diagnosis distress (PVDD) as a descriptive, nondiagnostic framework to characterise the predictable, loss-related emotional responses that may arise following the diagnosis of a vision-threatening or irreversible eye condition. PVDD is not proposed as a psychiatric disorder, but as a clinically meaningful construct that helps legitimise patient experience, supports empathetic communication, and facilitates timely recognition and appropriate signposting when distress is significant. Drawing on evidence from age-related macular degeneration, glaucoma, and other chronic eye diseases, and informed by multidisciplinary perspectives spanning ophthalmology, psychiatry, counselling, patient advocacy, and public health, the article argues that recognising PVDD may improve patient engagement, quality of life, and psychological outcomes.

There may be considerable untapped potential in using large-scale electronic primary care optometry referral data to understand referral patterns. This study aims to evaluate the feasibility of using different analytical methods for this type of dataset. A total of 12,339 electronic referrals made by primary care optometrists in November 2023 were examined. The dataset contained 36 demographic and clinical variables. Preprocessing involved categorising and normalising referral conditions and merging similar attributes to enhance consistency. The feasibility of descriptive evaluations of referral conditions to both ophthalmology in secondary care and within primary care was explored, and a regression analysis was conducted to investigate potential associations between patient sex and referral patterns. A spatial analysis was also conducted to map the geographic distribution of referrals and their association with social deprivation. Of all referrals, 77.3% were directed to ophthalmology in secondary care, 14.1% within primary eyecare optometry and non-optometric services, with the remaining 8.5% being unspecified. Cataracts (17.2%), glaucoma (13.5%) and YAG laser capsulotomy (12.1%) emerged as the most frequent referral reasons. Regression analysis identified significant sex differences, where referral proportions for female patients were higher than males for conditions such as glaucoma and neuro-ophthalmology (p = 0.001). Spatial analysis revealed no significant difference between the referral ratio and the deprivation level. This study demonstrated viability for evaluating electronic optometry referrals. Despite data limitations, these findings indicate that data quality and scope can support established analytical methods. Moreover, the scale of data variables suggests expanding sample sizes and extending time windows could reveal clinically informative patterns in referrals. Future investigations may further validate findings, helping to understand local, regional or national referral patterns within optometry and potentially address inequalities in eyecare.

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. 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. 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%). 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.

Adult intermittent exotropia (IXT) is less well studied than paediatric IXT, yet counselling is challenging due to postoperative exodrift, diplopia risk, and differing functional expectations. This systematic review synthesised surgical outcomes for adult (≥18 years) IXT. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020-guided systematic review of PubMed/MEDLINE was performed using two searches ("surgical" AND "outcomes" AND "exotropia"; "surgery" AND "intermittent exotropia"), limited to English-language human studies published within the last 10 years. Eligible studies reported postoperative motor alignment and/or reoperation, diplopia, drift, or binocular outcomes in adults with IXT. Motor success was narratively standardised to ≤10 prism dioptres (PD) of orthotropia at distance (allowing ≤5 PD esodeviation where applicable). Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Due to heterogeneity in outcomes and follow-up, meta-analysis was not undertaken. Six studies (one randomised prospective interventional study and five retrospective cohorts) comprising 552 participants were included. Mean age ranged from 27 to 42 years, and preoperative distance deviation was typically 30-40 PD (one study >50 PD). Reported motor success ranged from 47.6% to 90% across primary endpoints of three months to two years or longer, with most studies demonstrating progressive exotropic drift over time. Diplopia was generally transient and varied by early postoperative alignment and intervention. No major adverse events occurred, and a low reoperation rate was reported.Overall risk of bias was serious in most studies, primarily due to confounding and selection bias. Adult IXT surgery achieves moderate-to-high motor success, but outcomes vary with technique, early alignment, and follow-up duration. Prospective adult-only studies with standardised endpoints and patient-centred outcomes are needed.

To evaluate surgical outcomes and predictors of success in a mixed cohort of patients undergoing esotropia surgery at a large UK tertiary centre. This retrospective chart review included all patients who underwent extraocular muscle surgery for esotropia between July 2020 and June 2025. Demographic data, esotropia subtype, visual acuity, preoperative deviation, surgical procedure, total surgical dose, and postoperative deviation at last follow-up were collected. The primary outcome was surgical success at six weeks, defined as postoperative deviation ≤10 prism dioptres (PD). Secondary outcomes included surgical dose response and factors associated with surgical success. Univariate and multivariate analyses were performed. Seventy patients met the inclusion criteria. Mean age at surgery was 8.0 ± 3.9 years, and mean preoperative deviation was 37.7 ± 13.4 PD. Bilateral medial rectus recession was the most common procedure (81.4%). Surgical success at six weeks was achieved in 50% of patients, with an overcorrection rate of 1.4%. In multivariate analysis, older age at surgery predicted a higher likelihood of success (OR 1.37, p = 0.014). The mean surgical dose response was 2.39 ± 1.95 PD/mm and was significantly higher among successful cases (p < 0.001). Larger preoperative deviation was independently associated with a higher dose response. In this mixed-aetiology real-world cohort, early surgical success was adequate. Older age and higher surgical dose response were associated with better alignment outcomes, whereas sex, visual acuity, esotropia subtype, and procedure type were not predictive of success.

ABSTRACT Purpose Case report describing electroretinography findings in a child with a pathogenic mutation in ATP1A3 Methods Details of this case were retrospectively reviewed. History was significant for progressive high myopia and alternating hemiplegia of childhood with a confirmed genetic diagnosis. Results Electroretinography findings demonstrated evidence of both rod and cone dystrophy in a child with a pathogenic mutation in ATP1A3 causing alternating hemiplegia of childhood Conclusions This report details a previously under-reported associated between mutations in ATP1A3 and retinal dystrophy. We believe that wider dissemination of these findings will help counsel patients and family members about vision loss that may be attributed to retinal rather than optic nerve findings.

Disclosure: S.S. Dhage: None. A. Bose: None. A. Cook: None.Introduction and background Hypothalamo-pituitary (HP) dysfunction can occur as a direct consequence of local tumours, surgery for these tumours and as a delayed effect after cranial or whole-body radiotherapy for various cancers including craniopharyngiomas, intracerebral and nasopharyngeal tumours, and haematological malignancies like lymphomas. HP dysfunction can affect various hormones in the HP axis resulting in various hormone deficiencies. As per the European Group on Graves’ orbitopathy (EUGOGO) guidelines, orbital radiotherapy (ORT) is considered an effective second-line treatment for moderate-to-severe and active TED, especially in patients with significant diplopia. Mild retinopathy as a long term sequalae is the most recognised complication in about 3 to 14 % of patients especially in those with hypertension and diabetes. HP dysfunction has not been previously reported in these patients who received ORT for TED. Case report We present case of a patient who received ORT with a total dose of 20 Gy in 12 fractions completed in September 2010 for the treatment of steroid resistant and diplopia predominant TED. Two years following completion of ORT, the patient began experiencing irregular periods, hot flushes, and mood swings but her gonadotrophins and oestradiol remained low normal. Eventually she had cessation of menses but with normal gonadotrophins. She remained on long term low dose steroids due to severe asthma and developed primary hypothyroidism after remission of her Graves` thyrotoxicosis. Symptoms of persistent fatigue, tiredness and lethargy with the background of ORT for TED and early menopause with normal gonadotropins, prompted further evaluation of possible growth hormone (GH)deficiency due to HP dysfunction. Her adult GH deficiency assessment (AGHDA) score was 23/25 and peak GH level was 1.13 ug/L on insulin tolerance test (ITT); which confirmed diagnosis of adult GH deficiency. Discussion and Conclusion Despite radiotherapy induced HP dysfunction being extensively reviewed in literature, these cases have not been associated with ORT for TED. ORT is often described as an effective and safe treatment option for TED with no major adverse events even after long term follow up. This case highlights a potential association between orbital radiotherapy for Graves' TED and development of hypopituitarism as a long-term complication. There are no studies or research linking hypopituitarism to ORT. This case proposes a potential need of long-term endocrine monitoring in patients undergoing ORT to detect and manage potential complications such as hypopituitarism.Presentation: Monday, July 14, 2025