impact of bevacizumab in combination with pan-retinal photocoagulation in high risk proliferative diabetic retinopathy cases, comparative study

To evaluate the effects of Pan retinal photocoagulation [PRP] alone as a treatment of high risk Proliferative diabetic retinopathy [PDR] compared to the intravitreal Avastin injection in combination with PRP for the same cases. 60 patients were enrolled in this prospective randomized study as all patients were diagnosed as high risk PDR. The right eyes of all patients were treated by PRP full scatter and the left eyes were treated by 1.25 mg. Avastin injection in 0.1 ml two days prior also to full scatter PRP treatment in two sessions two weeks apart. Pre-treatment as well as post-treatment full ophthalmological assessment was done for all eyes in the two groups in the form of best corrected visual acuity[BCVA], Fluorescein Angiography, and also central foveal thickness by optical coherence tomography[OCT], all eyes were followed-up for one year. There was a significant difference between the PRP and the PRP assisted group in the area of fluorescein leakage from active neovascularization elsewhere [NVE]. As regards BCVA, there was a significant difference between the two groups at the end of follow-up period, favoring the PRP assisted group by at least two lines [P=0.05]. Also, the total area of actively leaking NVE's was significantly lower in PRP assisted group compared to the PRP group only [P<0.001]. The rate of complication in the form of vitreous hemorrhage and epiretinal membrane formation was also higher in the PRP group only but it was not statistically significant. The combined used of intravitreal Avastin with PRP for the high risk cases of PDR seems to give a more stabilized effect on the degree of PDR as well as on vision compared to the PRP treatment alone

Optical coherence tomography [OCT] as a prognostic tool before removal of idiopathic epimacular membrane [EMM]

Idiopathic Epimacular Membrane [macular pucker] is a mild manifestation of proliferative vitreo-retinopathic spectrum of disease. It is termed idiopathic if it happened in eyes without any previous ocular diseases. Surgery of Idiopathic EMM has been a common vitreo-retinal disease for many years, and several prognostic factors have been implicated in each removal. With the advance of Optical Coherence Tomography [OCT], it provides us with a detailed cross sectional study of the vitreo-retinal juncture and it is used as a well efficient prognostic tool, that we are aiming for evaluating its efficacy in this study. A prospective study including 30 eyes of Idiopathic EMM were included in this study. All the membranes were removed by standard 3-port vitrectomy with peeling of the EMM by diamond dusted needle. Best corrected visual acuity and standard OCT for the macula were done pre and post operatively 3 months after surgery. Among the 30 eyes that were included in this study, 18 were males [60%] and 12 were females [40%] with an age average of 48-72 with a mean of 61.4. There was a clinically significant improvement in best corrected visual acuity pre and post-operatively [as P=.957] and also there was a clinically significant improvement with the central foveal thickness by OCT on pre and post-operatively [as P=.878]. 6 eyes [20%] got a vision of 20/20 post-operatively and 25 eyes [83.33%] showed improvement than the pre-operative level. Also, all eyes [100%] showed improvement in their CFT, but none of them regained the normal foveal configuration. So, there is no positive correlation found between the best corrected visual acuity and the central foveal thickness, either pre-operative or post-operative. OCT is of great value and importance in detecting the abnormal vitreo-retinal relation, and also, in detecting the secondary effect on the underlying retina, like spaces, pseudohole, or even true hole formation with EMM formation which are more important than the thickness by itself before surgical removal of epimacular membrane

Idiopathic macular holes, with internal limiting membrane [ILM]- assisted peeling, anatomical and visual outcomes

The use of trypan blue seems to have less toxic effect to retinal pigment epithelium [RPE] than any other stain as stated by Haritoglou. Retrospective study has constructed by reviewing a series of 40 patients with stage II, III, and IV, after doing standard pars plana vitrectomy and ILM-assisted peeling by use of membrane blue dye [by DORC Company]. Idiopathic macular hole who underwent macular hole surgery between September 2004 to September 2006. All patients done by me with standard pars plana vitrectomy and ILM-assisted peeling by use of membrane blue dye [by DORC Company]. I followed up most of the patients for up to 1 year post operatively stressing on the functional and anatomical result of the surgery. As regards the visual improvement, 27 eyes [67.5%] showed significant improvement in relation to their pre-operative level [P<0.05], while 8 eyes [20%], showed stabilization of their pre-operative level. And 5 eyes [12.5%] showed deterioration of vision. In the improved group of eyes that composed of 27 eyes, 6 eyes were from grade II hole [22.2%], 12 eyes were from grade III hole [44.4%] and 9 eyes were from grade IV hole [33.3%] that means all grade II hole included in this study showed substantial improvement in their visual acuity of more than 3 lines. Also the duration of symptoms in improved group was < 6 months in all eyes as demonstrated. For the stabilized cases of 8 eyes [20%], none were from grade II hole. 2 eyes were from grade III hole, and 6 eyes were from grade IV hole. For the 5 deteriorated eyes, 4 eyes were from grade III hole and 1 eye was from grade IV hole, and the duration of symptoms in 4 of them were >1year while only 1 eye was < 6 months, 4 of them need 2 surgeries while only 1 needs one surgery. All the phakic eyes [21 eyes] included in this study, 15 eyes [71.4%] end up with cataract extraction after 6 months of the hole surgery and only 2 eyes in the whole study have retinal detachment in the follow-up period that necessitate another surgery with long tamponade with silicon oil. In this study we have 2 eyes [5%] of retinal detachment from the 40 initial patients due to sclerotomy related late retinal break that needs another surgery with long lasting tamponade with silicon oil

Visual functions after optic nerve neuritis treated according to the optic neuritis treatment trial [ONTT]

The annual incidence of optic neuritis as estimated and population based studies is approximately 5 per 100000 per year. The aim of this work is to asses the effect of optic neuritis treatment according to [ONTT] by measures of visual acuity, color vision, and visual field. 24 patients diagnosed as acute optic neuritis were treatment according to [ONTT] by Intravenous methylprednisolone 250mg every 6 hours for 3 days, followed by an oral prednisone 1mg/kg/day for 11 days. The rate of visual recovery and long term visual outcome were both assisted by measures of visual acuity, color vision, and visual field at base line then at 6 and 12 months post treatment. Visual acuity recovery began rapidly within the first week in the treatment course but continued improvement for up to one month post treatment. Also, most patients [20 patients] recovered to 20/20 or near 20/20 acuity. As regards color vision 4 from 16 affected did not show any changes. The other 12 showed improvement after the treatment and stabilized till the end of follow up. As regards the visual field defect, it was only positive in 16 eyes [66.67%] in the form of cecocentral scotoma in 10 eyes [41.67%] and generalized depression in the peripheral field in 6 eyes [25%] the other 8 eyes [33.33%] showed no significant field changes. As regards the pain with extraocular muscle movement, it was positive specially with looking up in 20 [83.33%] patients, the other 4 [16.67%] was not presented with pain. All the 20 patients recovered from pain after 2 weeks of treatment. There was no recurrence of the inflammation within the one year follow up time after the first tapering of the steroid after the initial therapy. Treatment with intravenous methyl-prednisolone for 3 days followed by oral prednisone according to [ONTT] for 11 days then gradual tapering is of benefit for early recovery of vision and in reducing the time of recurrences in the early follow up time and restoring most of the visual functions like color discrimination and contrast sensitivity

Modified full thickness transverse tarsotomy with marginal rotation for entropion

Is to compare the effectiveness of old technique of Wies operation to the new modification on the degree of lid correction for entropion. Two groups each of 20 eyes of primary entropion from the out clinic of Tanta University Hospital, The first group had treated with the old technique described by Wies of full thickness Tarsotomy with marginal rotation. The second group had treated with the new modification of the transverse bile both groups were followed up for 6 month for the degree of correction. Both treated groups showed reasonable Marginal flap rotation with correction of the primary entropion, but the correction in the second group was substantial, also there was no recurrence in the second group compared to two cases of recurrence in the first group that favor the modified technique. The modified full thickness tarsotomy with marginal rotational flap has superior result to the old technique described by Wies in correction of upper lid entropion

Different concentrations of indocyanine green ICG for capsular staining in mature cataract

To evaluate the efficacy of 2 different concentrations of ICG in enhancing the visualization of anterior capsule during Capsulorhenxis [CCC] in white cataract. This study included twenty eyes with mature cataract prepared for extracapsular cataract extraction. The eyes were classified into two groups A and B, each included 10 patients. The anterior lens capsule was stained with either Indocyanine green 0.5% solution [group A] or with Indocyanine green 1% solution [group B]. After capsulorhexis was performed, routine extracapsular cataract extraction was performed. Postoperative evaluation included full ophthalmological evaluation. Follow up period was 6 months. Indocyanine green capsular staining enabled us to perform capsulorhexis successfully in all eyes in both groups. However, 1% Indocyanine green stained lens capsule [group B] showed better contrast against the white cortex than that obtained in eyes stained with Indocyanine green 0.5% solution [group A]. No adverse reactions were observed in both groups up to 6 months Indocyanine green staining of the anterior lens capsule appears to be safe technique to facilitate the performance of capsulorhexis in white cataract. 1% concentration provides better visualization and contrast without compromising the safety of the ocular structures