Macular hole is a defect in the neurosensory retina at the center of the fovea, seen in 8.3% of the postuveitic cases. In such cases, macular holes tend to be large and are associated with structural damage in the outer retinal layers. Here, we report a case of bilateral chronic intermediate uveitis treated with sub-Tenon steroids that developed a full-thickness macular hole in the right eye. We treated it surgically with inverted flap technique of internal limiting membrane peeling. Postoperatively, the patient showed Type-1 closure of the hole with visual improvement.

BackgroundWe report occurrence of peculiar tiny white thread like vitreous opacities after intravitreal triamcinolone injection. These persisted without any change for over a year. We ascribe them to aggregation of triamcinolone crystals due to the purification methods.Case presentationSeven patients (8 eyes) with macular edema developed tiny whitish thread like opacities in the vitreous 2–3 months after undergoing an intravitreal injection of triamcinolone acetonide preparation containing benzyl alcohol as preservative. These opacities persisted unchanged for more than a year. The follow up ranged from 91 to 425 days. Vitreous tap was done in one patient which was negative for infection. All patients initially showed improvement but needed re-treatment for recurrence. One patient developed steroid induced rise in intraocular pressure. Microscopic examination of the drug revealed large string like aggregates of triamcinolone crystals.ConclusionsWe hypothesize the possibility of aggregation of triamcinolone crystals into string like structures probably due to the purification methods used during manufacture which led to these thread like opacities in the vitreous.

Purpose: To compare Ngenuity with traditional microscope in vitreoretinal surgeries from surgeon’s perspective Methods: In this retrospective study, we recruited patients who have underwent vitreoretinal (VR) surgeries from 1st August 2017 to 30th August 2017. Patient’s clinical parameters were extracted from electronic medical records (EMR), and also video recordings of the surgeries using the Ngenuity 3D visualization system were analysed. The surgeons were asked to compare Ngenuity 3D visualization system and traditional microscope during each step of the surgery. We administered a questionnaire to compare the two modalities in each step during the surgery in terms of the preferred system, comfort, ergonomic and visual parameters. Results: Out of 31 eyes, primary rhegmatogenous retinal detachment (RRD) was 35% (11 eyes), complex recurrent RRD was 13% (4 eyes) and diabetic TRD was 16% (3 eyes). The educational value, upper body comfort and image resolution was found to be better with Ngenuity than microscope. The depth of perception, field of view and the lower body comfort was graded as similar and time lag was experienced more with Ngenuity. On comparison of the preference of traditional microscope and Ngenuity during surgical steps, preference for Ngenuity was significantly more for posterior segment steps like the truncation of cone (p= <0.00001), PVD induction (p= 0.0001), Endo laser (p=0.0001), Fluid gas exchange (p= 0.0005) and tamponade injection (p=<0.00001). Conclusions: Ngenuity provided improved neck and upper body comfort, greater field of view and was more preferred for posterior segment procedures than anterior segment during VR surgeries.

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