Surgical and visual outcomes of retinal detachment surgery in eyes with chorio-retinal coloboma

Objective: To evaluate the anatomical and visual outcome of surgical management of retinal detachment associated with chorio-retinal coloboma

Study Design: Prospective interventional case series

Place and Duration of Study: This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from Jan 2012 to Dec 2013

Material and Methods: Twenty one eyes [21 patients] that underwent surgery for retinal detachment associated with chorio-retinal colobomas were selected. Evaluation was done on the basis of type of intervention, final visual acuity and anatomical outcome and complications. Out of 21, 19[90.47%] eyes underwent pars plana vitrectomy with silicone oil [SO] and 2[9.52%] underwent primary scleral buckling surgery. SO was removed in 9 [47.36%] eyes at final follow up. Encircling band was placed in 12 [63.15%] eyes based on peroperative judgment of surgeon. Intra-operative lensectomy was performed in 6 [28.57%] eyes. The main outcome measures were retinal re-attachment and visual recovery. Statistical analysis was performed using "IBM statistical package for social sciences [SPSS] Statistics" [version 17.0, Chicago, Illinois, USA]. Qualitative variables were described using percentage; quantitative data were defined using mean +/- standard deviation. The pre op and post op frequency of best corrected visual acuity [BCVA] was compared using Wilcoxan Signed Ranks Test. Confidence interval was 95% [level of significance p<0.05]

Results: The mean number of operations per eye were 1.57 +/- 0.74; mean follow-up was 13.1 months [range 12-18]. The retina remained attached in 18 eyes [85.71%] at final follow-up. The post op BCVA improved significantly as compared to pre op BCVA [p< 0.01]. Mean pre op BCVA was counting fingers [CF] and mean post op value of BCVA was 3/60

Conclusion: Pars plana vitrectomy along with silicon oil tamponade for retinal detachment related to choroiretinal coloboma improves the long-term anatomical outcome however no significant improvement in visual acuity was observed

Changes in macular thickness and visual acuity after intravitreal bevacizumab injfection in patients with retinal vein occlusion

To evaluate the effect of singel Intravitreal Bevacizumab [Avastin] injection on visual acuity [VA] and central retinal thickness [CRT] in patients with macular edema secondary to branch retinal vein occlusion [BRVO] or central retinal vein occlusion [CRVO]. Prospective, non-randomized, interventional case series. This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from March 2012 to February 2013. Twenty three patients with macular edema attributable to vein occlusion received intravitreal injection of Bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion [CRVO] and 14 patients had branch retinal vein occlusion [BRVO]. Complete ophthalmic examination including best corrected visual acuity [BCVA] and optical coherence tomography [OCT] was done at base line and follow up visits. At base line mean visual acuity was Log MAR 0.73 and showed improvement to mean Log MAR 0.39 at 12 weeks after intravitreal Bevacizumab [IVB] injection. Mean CRT was 527 micro m at baseline that decreased to 274 micro m after 12 weeks of IVB treatment. Intravitreal Bevacizumab appears to result in significant short term improvement of VA and macular edema secondary to vein occlusion

Angiotensin converting enzyme inhibitors impair recombinant human erythropoietin induced erythropoiesis in patients with chronic renal failure

To investigate the effects of angiotensin converting enzyme [ACE] inhibitors/angiotensin receptor blockers [ARBs] and other anti-hypertensive agents on recombinant human erythropoietin [rHuEPO] in chronic renal failure [CRF] patients. The present study was conducted at the Nephrology Department, Khan Research Laboratories Hospital and Quaid-i-Azam University, Islamabad, Pakistan during March 2004 to February 2005. One hundred patients, 55 males and 45 females [age range 13-78 years] were divided into 2 groups. Group-I patients received rHuEPO and ACE inhibitors/ARBs while Group-II patients received rHuEPO with other antihypertensives such as calcium channel blockers or beta-adrenergic receptor blockers. Monthly increment in hematocrit [HCT%] was monitored in both groups for 4 continuous months. One-way ANOVA on Dunn's, univariate and multivariate analyses were carried out to determine any significant improvement in erythropoiesis between the 2 treatment groups. Monthly increase in HCT% was significantly greater in the group that was treated with rHuEPO and antihypertensives other than ACE inhibitors/ARBs compared with that treated with ACE inhibitors/ARBs, an effect observed even at a higher dose of rHuEPO, and the patients were iron replete. The present data from our population confirms that ACE inhibitors/ARBs interfere with rHuEPO therapy for treatment of anemia in CRF. The ACE inhibitors/ARBs inhibit erythropoiesis induced by rHuEPO in CRF patients, therefore, simultaneous use of ACE inhibitors/ARBs and rHuEPO should be carried out with caution

Experience of amniotic membrane transplant in corneal diseases at al-shifa trust eye Hospital, Rawalpindi, Pakistan

To assess the quality of human amniotic membrane [HAM] processing at Al-Shifa HAM bank and to analyze the outcome of amniotic membrane transplant in different corneal pathologies at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Prospective Interventional Case Series .Consecutive 102 eyes of as many patients [72 males and 30 females] from July 2006 to August 2007 presented at Corneal Clinic were included in the study. Average age of patients was 38 years [4.5-90 years]. Frozen human amniotic membrane [HAM] from a seronegative donor stored at -80°C in Dulbecco's Modified Eagle Medium [DMEM] and glycerol was used for transplant in different corneal diseases after thawing at room temperature for half an hour. HAM was applied epithelial side up. It was spread over the whole cornea beyond limbus and anchored through continuous/interrupted 10/0 monofilament nylon sutures on the corneal side and 7/0 vicryl on the conjunctival side. Over lay [patch] and in lay [graft] technique was used in most of the cases while multilayered technique was used in case of deep ulcer and corneal perforation. Bandage contact lens [BCL] was applied and discontinued after epithelialization in all the cases. The follow up visits were on post operative day one, one week, one month, three months and then after every six months. In clinical examination luster and lubrication of the eye and stability of corneal surface was noted. In subjective examination, a performa was designed to assess reduction in pain, watering, irritation and status of overall comfort of the patient. Average follow up period was 132 days. Overall 85.3% patients had subjective improvement while 74.5% showed clinical improvement; Visual acuity improved in 49% patients. AMT was repeated in 8 patients. No intraocular infection was reported in study cases. The study concludes that AMT is a useful treatment option in a variety of ocular surface pathologies. However, its efficacy varies in different diseases. The study also proved reliability of processing technique at Al-Shifa Human Amniotic Membrane Bank

Hyperglycemia and hospital outcomes after faist myocardial infarction

To determine in-hospital outcomes post AMI hyperglycemia. 109 patients of acute myocardial infarction were included in this study. Physical examination, ECG tracings, random plasma glucose, serum cholesterol, triglycerides and cardiac enzymes [CPK, LDH and AST] were measured. Hyperglycemic patients [plasma glucose 126mg/dl] were sub-divided into those with a previous history of diabetes and those without any such history. Post AMI plasma glucose levels were exceptionally higher in female patients aged 61-70 years while they were moderately higher in males of age groups 31-40 and 51-60, and females of age group 41-50 years. In-hospital mortality rate was greater in hyperglycemic patients. Most importantly also, significantly greater complications of the heart were encountered in hyperglycemics. Post AMI patients are at a greater risk of developing diabetes and concurrent AMI attack