Aim: To investigate the cause of visual loss following removal of intraocular silicone oil in patients who underwent vitrectomies for retinal detachment or giant retinal tear. Methods: The clinical records of three cases with visual loss following removal of silicone oil were reviewed. Investigations carried out included fundus fluorescein angiogram, optical coherence tomography, and electrophysiological studies. Results: Visual acuities dropped from 6/9 to 6/36 in two cases and 6/24 to 3/24 in the third. None of the three cases had macula detachment at any stage. Fundus fluorescein angiogram and optical coherence tomography were normal in all cases. Pattern electroretinogram showed reduced amplitudes of the P50 and N95 components. Multifocal electroretinogram indicated a selective damage to the central part of the macula. Conclusions:The results suggest that the abnormality arises predominantly in the central part of the macula, especially the outer and middle layers. However, the exact mechanism still remains obscure.S ilicone oil has a well established role in vitreoretinal surgery. With the improvement of microsurgical techniques, silicone oil has been successfully used in the management of complicated retinal detachments associated with proliferative vitreoretinopathy, giant retinal tears, proliferative diabetic retinopathy, severe trauma, and cytomegalovirus related retinal detachments.

We report the case of a 58-year-old man who despite having an intralenticular metallic foreign body maintained good vision for at least 40 years. We describe the natural course of intraocular foreign body and the healing capacity of the anterior lens capsule as well as management issues to consider when dealing with intraocular foreign bodies.

zoledronic acid. Our case mirrored these previously reported cases with onset being between 24 and 48 h after infusion initiation, bilateral involvement, and a good response to topical steroid treatment with bisphosphonate discontinuation.With regard to our patient, the conjunctivitis affected primarily the inferior fornix raising the possibility of an allergic response to the topical antibiotic; however, she does not have a history of atopy and has no previous exposure to chloramphenicol, making such a severe reaction unlikely to be due to the primary exposure to the ointment. There is the possibility that the inflammation may be a consequence of the primary pathology; however, there are no reports in the literature of anterior uveitis being associated with either MGUS or multiple myeloma and with the evidence detailed above regarding other bisphosphonates, we must assume that the uveitis is secondary to the treatment. It would be unethical to rechallenge the patient to see if a recurrence occurred.Bisphosphonates are being used successfully in an increasingly broad range of disorders and with their increasing use, the ophthalmology and haematology communities should be aware of the potential ocular side effects. Case report ReferencesA 45-year-old lady has been attending the outpatient department for the past 20 years. She has a history of recurrent episodes of episcleritis, scleritis, and anterior uveitis which was controlled by topical steroids, mydriatics, and oral nonsteroidal anti-inflammatory drugs. A full systemic evaluation was carried out during the early stage revealed erosive changes of the sacroiliac joint compatible with ankylosing spondylitis in addition to being positive for HLA-B27. She presented 3 years ago to the accident and emergency department with a painful, red swollen left outer ear and was admitted to the ENT ward. She was treated with intravenous antibiotics for possible infective perichondritis but did not respond. In addition, her right eye was red and painful, and she also complained of experiencing intermittent joint pains with swelling of the left ankle. Of importance in her medical history was a 12-year history of sudden hearing loss in her right ear of unknown cause, and she has also recently been diagnosed with hypertension.

Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy. Intraocular tamponade agents have been in use by vitreoretinal surgeons for nearly a century. The effectiveness of an internal agent relies on its ability to make contact with the internal surface of the vitreous cavity. In the short term, this is controlled by the agent's specific gravity and interfacial tensions. In the long term, the viscosity of the material is critical to maintaining its integrity and thus reducing dispersion. The commonly used tamponade agents such as perfluoropropane (C3F8), sulfur hexafluoride (SF6), and silicone oil are "lighter than water" hence, float upward in the aqueous. A consequence of this is that in the upright position the superior retina is very well supported, leaving the inferior retina less well so. More recently, there has been interest in the development of "heavier than water" long-term tamponade agents that sink in the eye. Heavy silicone oil is a transparent, homogenous solution of two substances used as a single tamponade agent with improved properties and a specific gravity greater than water. Densiron (one of the two available heavy silicone oil's) is a mixture of perfluorohexyloctane (F6H8, with a specific gravity of 1.35 g/ml and viscosity of 2.5 mPas), and conventional silicone oil (specific gravity of 0.97 g/ml and viscosity of 5700 mPas depending on the molecular weight). The specific gravity of Densiron is 1.06 g/ml and the viscosity is 1400 mPas, making it a novel heavier-than-water, long-term internal tamponade agent, which means that in the upright position it sinks and provides support for the inferior retina.

Sequential surgery appears to offer no significant advantages over the triple procedure in terms of refractive predictability or variability. There was a slight trend toward more patients achieving 6/12 or better vision in the sequential group.