case with bilateral optic disc drusen causing non arteritic ischemic optic neuropathy

To report a rare case of bilateral optic disc drusen causing Non Arteritic Ischemic Optic Neuropathy [NAION]. A 60 years old male with hypermature cataract in right eye was referred for evaluation of posterior segment. Left eye showed impaired color vision with RAPD, disc swelling and peripapillary haemorrhage. On B Scan, echo free vitreous with flat retina associated with hyperechogenic shadow over the disc was seen in both eyes. Right eye after cataract surgery showed disc swelling with suspicion of optic disc drusen. CT scan of brain and eye ball and other systemic examination were normal. On the basis of B scan and clinical features bilateral optic disc drusen with NAION left eye was diagnosed. Optic disc drusen as a cause of NAION is not so common. Routine B Scan in these cases can easily differentiate from other causes of bilateral disc swelling

Clinical indications of enucleation surgery

Purpose: To determine the clinical indications of enucleation surgery at Al-Shifa Trust Eye Hospital Rawalpindi

Participants and Methodology: An observational case series was carried out for the study being conducted at Al-Shifa Trust Eye Hospital, Rawalpindi in which 60 new cases undergoing enucleation during 6 months were included by non probability convenience sampling

Results: There were 31[51.7%] male and 29 [48.3%] female patients with a mean age of 23.51[SD 19.546] years. Malignant tumours [41.66% eyes] were the most common indication of enucleation followed by phthisis bulbi [23.33% eyes] and trauma [16.7% eyes]. Retinoblastoma [RB] was found to be the most common malignant tumour diagnosed in 20% eyes. Students comprised 28.33% of the cases followed by farmers / laborers [23.33%] and housewives [13.33%]. In terms of socioeconomic status 37 [61.66%] patients belonged to lower class

Conclusion: Advanced ocular malignancies, phthisis bulbi and traumatically shattered eye globes are the major indications for enucleation in our country. Protective measures from trauma, early detection of tumours and creating awareness at various levels can decrease the incidence of enucleation

Role of intravitreal bevacizumab [avastin] in the treatment of clinically significant macular edema

To determine efficacy of single intravitreal injection of bevacizumab [Avastin] for treatment of clinically significant macular edema [CSME]. A quasi experimental month study was carried out at the retina clinic of Al Shifa Trust Eye Hospital, Rawalpindi from 1[st] January 2010 to 31[st] December 2010. A total 107 patients with CSME were included in this study. All patients were evaluated for visual acuity, anterior and posterior segment while central macular thickness was documented through optical coherence tomography. A single injection of bevacizumab was administered in all the patients. Outcome measures [improvement in BCVA and decrease in central retinal thickness] were evaluated at 2 weeks, 1 month and 2 months. All except one patient completed 2 months of follow-up. At baseline mean BCVA +/- SD was 0.967591 +/- 0.3705 log MAR of Snellen letters, which significantly improved to 0.808525 +/- 0.3260 at 2 weeks, 0.65581 +/- 0.36078 at 1 month, and 0.6319 +/- 0.3900 at 2 months [for each, p-value < 0.05]. The mean central retinal thickness +/- SD was 502.60 +/- 81.622microm at baseline and significantly decreased to 307.69 +/- 82.306 microm at 2 weeks, 235.75 +/- 63.162 microm at 1 month, and 237.58 +/- 64.230 microm at 2 months [for each, p-value < 0.05]. Primary single intravitreal bevacizumab injection in a concentration of 1.25mg / 0.05ml in patients with CSME resulted in significant improvement in BCVA and central macular thickness as early as 2 weeks after injection, and this beneficial effect persisted for up to 2 months