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

Outcome of laser photocoagulation in chronic and recurrent central serous chorioretinopathy

To evaluate the outcome of laser photocoagulation in recurrent and chronic non resolving Central Serous Chorioretinopathy [CSCR]. In this interventional case series 9 eyes of 9 patients with recurrent or chronic CSCR underwent focal laser photocoagulation. Best corrected visual acuity [BCVA], Fluorescein Angiography [FA], Optical Coherence Tomography [OCT] were performed prior to treatment as baseline workup while BCVA and OCT were reassessed at 1 week, 1 month and three months after treatment. One month after treatment, CSCR in 5 [55.55%] eyes was completely resolved, 3 [33.33%] eyes showed partial resolution of sub-retinal fluid [SRF] while in 1 [11.11%] eye SRF did not resolve at all. However after 3 months residual SRF in 2 [22.22%] eyes resolved completely while the status of other 2 [22.22%] eyes remained same. The treatment of chronic or recurrent CSCR with laser photocoagulation may result in prompt resolution of sub-retinal fluid which can be associated with rapidly improved vision. Although this case series is limited in follow up and number of patients, the encouraging results and lack of visually significant complications suggests need for further evaluation

Mono therapy versus double therapy versus triple therapy in the treatment of diabetic macular edema

To compare the efficacy of macular laser photocoagulation [MPC] alone or MPC with intravitreal Bevacizumab or MPC with both intravitreal bevacizumab and intravitreal triamcinolone as primary treatment of Diabetic macular edema [DME]. A randomized clinical trial. Fifty eyes of 30 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three treatments groups. In Group-1, 20 eyes underwent focal or modified grid laser, In group-2, 15 eyes received 1.25 mg / 0.05ml of intravitreal bevacizumab [IVB] followed by MPC while in group-3, 15 eyes received 1.25 mg / 0.05ml of IVB and 2 mg / 0.05ml of intravitreal triamcinolone [IVT] followed by MPC. At 12 weeks after treatment, average improvement of visual acuity in group-1 was 1.0 line, in group-2 was 1.5 lines and in group-3 was 2.0 lines. Average central macular thickness reduction was significantly more [p=0.001] in group-3 [354 +/- 110 [micro]m] than in group- 1 [1 67 +/- 57 [micro]m] and group- 2 [278 +/- 76 [micro]m]. Up to 12 weeks triple therapy group showed better visual outcome than the other two groups where as the average reduction in central macular thickness was also more in triple therapy group. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after this treatment

Comparison of latanoprost with timolol in lowering intraocular pressure in patients with primary open angle glaucoma

To evaluate efficacy of latanoprost as compared to timolol in lowering intraocular pressure [IOP] in patients with primary open angle glaucoma [POAG]. Comparative study. A total number of 40 patients included in this study at the department of ophthalmology Nishtar Hospital Multan, out of which 20 patients received latanoprost eye drops once daily and 20 patients received timolol eye drops twice daily. There were two groups each comprising of 20 eyes. Effect of intraocular pressure was studied by using Timolol in group I and Latanoprost in group II. Timolol was prescribed twice daily as one drop in the morning and one drop in the evening, while Latanoprost was prescribed once daily as one drop in the evening. At the end of study with six months follow-up, the mean reduction in IOP from base line was 5.63 mm Hg [22.56%] in patients receiving Timolol and 7.88 mm Hg [30.13%] in patients receiving Latanoprost Latanoprost 0.005% is an effective ocular hypotensive agent than Timolol 0.5% in lowering IOP in primary open angle glaucoma