ABSTRACT
Objective: to evaluate the anatomical and functional outcomes of retinectomy in the management of primary rhegmatogenous retinal detachments with inferior retinal breaks and advanced proliferative vitreoretinopathy [PVR C]
Study Design: quasi-experimental study
Place and Duration of Study: LRBT, Free Base Eye Hospital, Karachi, from July 2015 to June 2017
Methodology: forty eyes of 40 patients with primary inferior retinal breaks macula off detachments and advanced proliferative vitreoretinopathy [grade C] in which retinectomy was performed were included. Primary outcome measured was anatomic success, defined as complete retinal reattachment between neurosensory retina and retinal pigment epithelium at six months follow-up. Secondary outcomes included changes in best corrected visual acuity and postoperative complications. The follow-up period was up to six months after the last surgery. Association was determined between the retinectomy extension and the best corrected visual acuity postoperatively
Results: retina was reattached after single operation in 29 eyes [72.5%], after the second operation in eight eyes [20%], and after the third operation in two eyes [5%]. Final retinal reattachment was achieved in 39 out of 40 eyes [97.5%]. The preoperative visual acuity was counting fingers CF in eight eyes [20%], hand motion HM in 28 eyes [70%], and light perception PL in four eyes [10%]. The postoperative visual acuity improved in 27 eyes [67.5%], remained stable in 11 eyes [27.5%], and worsened in 2 eyes [5%]. There was no statistically significant association between the retinectomy extension and maximum postoperative best corrected visual acuity [p=0.098]. The significant postoperative complications were retinal redetachment and hypotony
Conclusion: retinectomies are effective in managing primary rhegmatogenous retinal detachment with severe PVR [PVR C], and Increase the final retinal reattachment rate
ABSTRACT
Objective: To evaluate the visual outcomes of 27-gauge transconjunctival sutureless vitrectomy surgery and its complications in patients with diabetic vitreous hemorrhage
Methods: A quasi-experimental study was conducted where eighty seven eyes of 87 uncontrolled type II diabetes mellitus patients presenting with diabetic vitreous hemorrhage were selected to undergo 27-gauge transconjunctival sutureless micro-incision vitrectomy surgery. Main outcome measured was best corrected visual acuity [BCVA]. Post-operative complications were also screened for at each visit. The follow ups were at post-operative day one, one month, three months and six months respectively
Results: Out of 87 patients, 52 [59.8%] were males and 35 [40.2%] were females. The mean age of the patients was 52.32 +/- 6.78 years [95% CI: 53.13 - 55.57]. For most of the patients, the BCVA improved progressively with each subsequent follow up visit. Pre-operative BCVA was 1.01 +/- 0.206 logMar, compared to BCVA at final follow up of 0.44 +/- 0.231 [p-value < 0.001]. Six [6.9%] patients developed recurrent vitreous hemorrhage during the study period, four [4.6%] developed cataract, one [1.1%] had increased intraocular pressure and sub conjunctival hemorrhage was present in two [2.3%]
Conclusion: 27-gauge micro-incision vitrectomy surgery is an effective sutureless surgery with favorable outcomes, in terms of vision, in patients with diabetic vitreous hemorrhage. The associated complications are few which can be easily managed
ABSTRACT
Objective: To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery [MIVS] for diabetic vitreous haemorrhage
Methods:One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab [Avastin] which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity [BCVA] assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis
Result: A total of 122 patients were included; 78 [63.9%] males and 44 [36.1%] females. Mean age at the time of surgery was 51.4 +/- 13.66 years. The mean preoperative BCVA was 1.64 +/- 0.427 logMAR which improved to 0.57 +/- 0.253 logMAR at 12 months post-operatively [p-value < 0.001]. Recurrent vitreous haemorrhage was seen in four patients [3.28%]. one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients
ABSTRACT
Objective: To assess the visual and anatomical outcomes following idiopathic macular epiretinal membrane [IERM] surgery
Study Design: Case series
Place and Duration of Study: Layton Rehmatulla Benevolent Trust [L.R.B.T], Free Base Eye Hospital, Karachi, from January 2015 to June 2016
Methodology: Thirty eyes of thirty patients affected with idiopathic macular epiretinal membrane stage 2 were enrolled in this study. They subsequently underwent 23-gauge pars plana vitrectomy [PPV] with epiretinal membrane removal without internal limiting membrane peeling. The visual outcome was measured as improvement in best corrected visual acuity [BCVA] of at least two or more lines on ETDRS chart as compared to preoperative BCVA. The anatomical outcome was measured as decrease in foveal thickness on Spectral Domain-Optical Coherence Tomography [SD-OCT]. Patients were followed for a period of 06 months
Results: At the end of follow-ups, 23 [76%] eyes out of 30 gained 2 or more lines of vision. In 05 [16%] eyes, BCVA remained same and only 02 [6.6%] eyes showed worsening of vision. Mean preoperative foveal thickness was 392 +/- 20 micro m, whereas mean postoperative thickness was 305 +/- 16 micro m with an average decrease of 87 micro m, in foveal thickness. Recurrence of ERM was found to be the most frequent complication
Conclusion: IERM surgery is a safe procedure and beneficial in achieving significant visual acuity improvement and anatomical recovery in the majority of cases
ABSTRACT
To evaluate the efficacy, visual outcome and complication following Nd:Yag laser hyaloidtomy for subhyaloid hemorrhage. This interventional case series was managed at LRBT, Free Base Eye Hospital Karachi from January 2010 to December 2010. It included 30 eyes of 30 patients with subhyaloid hemorrhage due to different causes which underwent Nd: Yag laser sublyaloidotomy. Out of thirty patients, eighteen [60%] were male and twelve [40%] were females. Mean age was 32.57 years. Males pre-dominated the study. Pre laser visual acuity was between counting finger at one meter in 22 patients [73.33%] and between counting finger one meter to hand movement in 8 patients [26.66%]. Vision improved to 6/6 in 10 patients [33%], 6/9 - 6/12 in 17 patients [56.66%] and between 6/24 - 6/60 in 3 patients [9.99%] at the end of follow up. Complications were persistent vitreous hemorrhage in one [3.33%] patient, failed drainage in one [3.33%] patient and metamorphopsia in one [3.33%] patient. Nd: Yag laser hyloidotomy is an excellent technique for management of Subhyaloid hemorrhage with early visual recovery provided there is no macular pathology