Retinal thickness and visual acuity in diabetic macular edema: an optical coherence tomography-based study

Objective: To determine the relationship between foveal [retinal] thickness and visual acuity in diabetic macular edema through optical coherence tomography [OCT] mapping software

Study Design: Cross-sectional descriptive study

Place and Duration of Study: The'Retina Clinic of Al-Shifa Trust Eye Hospital, Rawalpindi, from August 2011 to August 2012. Methodology: Eighty eyes of 68 patients with clinical diagnosis of diabetic macular edema, based on complete ophthalmic examination, were enrolled. The best-corrected visual acuity was recorded on logMar scale

OCT imaging was performed through dilated pupil by experienced operator. Foveal thickness was determined. OCT parameters of macular thickness were analysed with baseline variables including age, duration since diagnosed with diabetes, and visual acuity

Results: The mean visual acuity was 0.81 [0.2 - 1.8] logMar units. The average foveal thickness was 395.09 +/- 142.26 [183 - 825 pm]. There was moderate correlation between foveal thickness and visual acuity [r[s]= 0.574, p < 0.001], absent in those who had visual acuity worse than 1 logMar. There was a weak positive association between foveal thickness and the duration of diabetes [r[s]=0.249, p < 0.05]. There was, however, no correlation between foveal thickness and age [r[s]=0.012, p=0.919]

Conclusion: There is a moderate correlation between visual acuity and degree of foveal thickening in diabetic macular edema, hence two cannot be used interchangeably in clinical practice

Anisometropia and ptosis in patients with monocular elevation deficiency

Objective: To determine the effect of ptosis on the refractive error in eyes having monocular elevation deficiency. Study Design: Case series. Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2011 to January 2014

Methodology: Visual acuity, refraction, orthoptic assessment and ptosis evaluation of all patients having monocular elevation deficiency [MED] were recorded. Shapiro-Wilk test was used for tests of normality. Median and interquartile range [IQR] was calculated for the data. Non-parametric variables were compared, using the Wilcoxon signed ranks test. P-values of <0.05 were considered significant

Results: A total of 41 MED patients were assessed during the study period. Best corrected visual acuity [BCVA] and refractive error was compared between the eyes having MED and the unaffected eyes of the same patient. The refractive status of patients having ptosis with MED were also compared with those having MED without ptosis. Astigmatic correction and vision had significant difference between both the eyes of the patients. Vision was significantly different between the two eyes of patients in both the groups having either presence or absence of ptosis [p=0.04 and p < 0.001, respectively]

Conclusion: Significant difference in vision and anisoastigmatism was noted between the two eyes of patients with MED in this study. The presence or absence of ptosis affected the vision but did not have a significant effect on the spherical equivalent [SE] and astigmatic correction between both the eyes

Clinical course of retinoblastoma

To determine the clinical manifestations and results of current treatment for patients with retinoblastoma [Rb] in a tertiary care eye hospital in the north west of Pakistan. Case series. Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from January 2006 and December 2009. The data of 139 patients diagnosed as having retinoblastoma was collected. Gender, age at diagnosis, laterally, presenting sign, classification of tumour, treatment modality and outcome were noted. The mean age of presentation in this patients ranged from 6 to 50 months [mean: 24.05 +/- 10.74 months] The most common presenting sign was leucocoria in 78 eyes [44.1%]. One hundred and one [72.7%] patients had unilateral retinoblastoma. Using the International Classification of Retinoblastoma [ICRB], 135 [76.3%]eyes were placed in group-E. one hundred and twenty four [77.5%] eyes were enucleated or exenterated while globe preservation was achieved by chemoreduction and/or focal therapy in the rest of the treated eyes [n = 36, 22.5%]. Twenty three [16.5%] cases were lost to follow-up before one year. Ninety two [66.2%] patients survived, being free of tumour, at least one year after the completion of treatment. Most children with Rb showed an advanced stage of tumour at the time of diagnosis. Measures to improve the rate of globe preservation and patient survival by early diagnosis and intervention are the need of the hour

Retinal thickness evaluation in healthy eyes from north-west Punjab through optical coherence tomography

To determine the mean retinal thickness in healthy eyes from north-west Punjab through commercially available optical coherence tomography [OCT] mapping software, version 3.0, from the Stratus OCT [OCT3]. Descriptive study. Al-Shifa Trust Eye Hospital, Rawalpindi, from August 2008 to February 2009. One hundred and two eyes of 75 healthy north-west Punjabis, fulfilling inclusion criteria were enrolled from OPD of Al-Shifa Trust Eye Hospital. After informed consent, demographic detail was taken. Best-corrected Snellen visual acuity was recorded. OCT was performed by using Stratus Carl Zeiss OCT through dilated pupil by an experienced operator. The retinal thickness was divided into 9 sections and displayed as three concentric circles including a central circle at fovea [1 mm], an inner ring [3 mm] and an outer ring [6 mm], each ring being divided into four quadrants. OCT parameters of macular thickness were analysed with baseline variables including age, gender and best corrected visual acuity. The mean central foveal thickness [at foveola] was 166.30 +/- 24.95 micro m while the mean foveal thickness [in central 1000 microns] was 194.89 +/- 21.33 micro m. There was no correlation between macular thickness and either age [r=0.109, p=0.275] or gender [Eta=0.128] or best corrected visual acuity [Eta=0.234]. Reference values were determined for mean retinal thickness in healthy eyes from north-west Punjab through OCT. These measurements were upto 54-micro m higher and upto 29 micro m lower than some previously reported healthy retinal thickness values. Therefore, normative database should be determined for the population under study based on regional and ethnic differences

Bilateral iridocorneal endothelial [ICE] syndrome with microspherophakia

Iridocorneal endothelial syndrome is described to be a rare, usually unilateral ocular condition in young females. There are three known overlapping clinical variants of this condition namely, essential iris atrophy, Cogan-Reese and Chandler syndrome. We report a case of bilateral iridocorneal endothelial [ICE]syndrome with microspherophakia. A 25 years old female presented with microspherophakic lens dislocated into anterior chamber in right eye, and displaced inferiorly in left eye. She was also diagnosed with ICE syndrome and underwent lensectomies in both eyes. This unique combination has never been reported before