Visual outcomes of macular hole surgery

Objective: To determine the mean visual improvement after internal limiting membrane [ILM] peeling assisted with brilliant blue staining of ILM in macular hole, and stratify the mean visual improvement in different stages of macular hole. Study Design: Quasi-experimental study. Place and Duration of Study: Eye outpatient department [OPD], Lahore General Hospital, Lahore from October 2013 to December 2014

Methodology: Patients with macular hole underwent measurement of best corrected visual acuity [BCVA] and fundus examination with indirect slit lamp biomicroscopy before surgery. The diagnosis of all patients was confirmed on optical coherence tomography. All patients had 23G trans-conjunctival three ports pars plana vitrectomy, ILM peeling, and endotamponade of SF6. The mean visual improvement of different stages of macular hole was noted. Paired t-test was applied

Results: There were 30 patients, 15 males and 15 females [50%]. The mean age was 62 +/-10.95 years. They presented with low mean preoperative visual acuity [VA] of 0.96 +/-0.11 logMar. The mean postoperative VA was 0.63 +/-0.24 logMar. The mean visual increase was 0.33 +/-0.22 logMar [p <0.001]. In patients with stage 2 macular hole, mean visual increase was 0.35 +/-0.20 logMar [p < 0.001]. In patients with stage 3 macular hole, mean visual increase was 0.44 +/-0.21 logMar [p <0.001], and in patients with stage 4 macular hole it was 0.13 +/- 0.1 logMar [p = 0.004]

Conclusion: ILM peeling assisted with brilliant blue is a promising surgery for those patients who have decreased vision due to macular hole, in 2 - 4 stages of macular hole

Management of ocular complications in Terson's syndrome

To evaluate and manage the patients presenting with vitreous hemorrhage and intracranial hemorrhage simultaneously. Prospective observational study. A total of 6 patients presenting with vitreous hemorrhage were included in this case series. Study was conducted at Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity, slit lamp examination and dilated fundus examination was done. Ultrasound B scans and CT brain was done in all patients. According to the clinical findings a management plan was formulated. Findings were recorded on a proforma for analysis. A total of 12 eyes of 6 patients [all males, age range 25-60 years were included in the study. Vision improved in two cases by conservative management and in one case by 23G pars plana vitrectomy. Vision remained the same on in one case, deteriorated in one and one patient was lost to follow up. Ocular complications in Terson's syndrome can have good outcome if treated conservatively and/or surgically

Visual outcomes of Harada disease

To evaluate visual outcome of patients diagnosed with Harada Disease. A prospective observational study A total of 4 patients presenting with exudative retinal detachment were included in this case series. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular exam including visual acuity, slit lamp examination and dilated fundus examination was done. Fundus photos and Optical Coherence Tomography pre and post treatment was done in almost all patients. Patient A, 37/F, presented with VA CF OD and CF in OS and B/L exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA was improved to 6/6 in Right eye and 6/9 in Left eye. Patient B, 35/F, presented with VA CF in both eyes and exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA of both eyes was 6/6P.Patient C, 38/F, presented with BCVA 6/60 in both eyes and exudative retinal detachment. After 8 weeks of treatment B/L retina was flat and BCVA was 6/6 in both eyes. Patient D 20/F presented with VA CF in both eyes and B/L exudative retinal detachment. At 2nd follow-up visit [Post treatment 14 days] B.C.V.A. was 6/6P OD and 6/9 in OS. Patient is still under treatment and follow-ups. The visual prognosis is good for patients with Harada disease and the disease may manifest itself with minimum neurological features

Diagnostic role of polymerase chain reaction in active uveitis

To evaluate the role of polymerase chain reaction [PCR] for detection of Mycobacterium tuberculosis in the vitreous humor samples obtained from eyes with active uveitis. A total of 15 patients were included in the study with the signs of anterior, intermediate or posterior uveitis. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity using Snellen's chart, slit lamp examination and detailed dilated fundus examination was done. All patients were advised complete blood count with ESR, Mantoux test and chest x-ray. Vitreous fluid samples were taken and sent for polymerase chain reaction for Mycobacterium tuberculosis [MTB] DNA. Vitreous samples from 15 [15-45 +/- 5yrs] patients, 9 male and 6 female, with signs of anterior, intermediate or posterior uveitis on slit lamp examination were taken and sent for Mycobacterium tuberculosis DNA on PCR. In 4 out of 15 samples [26.6%] Mycobacterium tuberculosis DNA on PCR was detected. Out of the 15 patients, 6 were females [15-45 years] with 1 [16.6%] positive PCR and 9 [15-40years] males with 3 [33.3%] positive PCR for Mycobacterium tuberculosis DNA. 2 of the male patients were positive for Toxoplasma and one of them was also positive for Cytomegalo virus on TORCH test. PCR can be effectively used for the diagnosis of intraocular tuberculosis in the presence of clinically identified cases of uveitis

Inverted papilloma of ureter: a rare cause of hydronephrosis

A case of hydronephrosis with a rare underlying cause in a 35 years old male is described. He reported with pain in the left lumbar region with a past history of left ureterolithotomy. The ultrasound and IVU studies were suggestive of left hydronephroureter. CT Scan showed left hydronephroureter with narrowing at the lower end of left ureter. Ureterorenoscopy [URS] confirmed polypoidal lesions in the left lower ureter, completely obliterating the lumen and involving the whole circumferential wall of the lower ureter. The biopsy of the lesion revealed an inflammatory polyp. Accordingly open surgical intervention was planned. Excision of the lower third of left ureter with ureteric reimplantation was done with a Boari flap. The histopathology report of the lower third of ureter confirmed inverted papilloma of ureter. The patient made a smooth postoperative recovery

Bladder outlet obstruction in a 5 years boy

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra

Pattern of malignant renal tumours using 2004 who classification of renal tumours on radical nephrectomy

Objective: To determine the type of malignant renal tumours subjected to radical nephrectomy at a tertiary care urology unit using the 2004 WHO classification for renal tumours. Methods: It was an observational study conducted at Department of Urology, AFIU Rawalpindi, from October 2008 to September 2010. The study included 92 patients with malignant renal tumours of both genders aged above 15 years. The histopathological types and grades were recorded along with the gross tumour presentation. The data was entered in structured proforma and analysed for descriptive statistics using SPSS-14. Results: Over the span of 24 months study, 92 cases of malignant renal tumours were subjected to radical nephrectomy. The age was 16–82 [57.23 +/- 14.61] Years and male to female ratio was 2.1:1. The lesions were mostly unifocal [96.7%] and 58.6% affecting the right side. The commonest malignant renal tumour encountered was the conventional clear cell renal carcinoma [78.2%]. The other tumours in descending order were the transitional cell carcinoma [7.6%], papillary [chromphilic] renal cell carcinoma [6.5%], renal cell carcinoma unclassified [3.2%], chromophobe renal cell carcinoma [2.1%], Wilm's tumour and oncocytoma [1.7%]. T1 lesions were found in 42 cases [45.6%], T2 lesions in 25 cases [27.1%], T3a lesions in 17 cases [18.4%] each, while 8 cases [8.6%] had T3b lesions. Four cases had high and 3 had low grade lesions in transitional cell carcinoma. Wilm's tumour had favourable prognosis, 1 case had oncocytoma limited to kidney. Among the rest, 26 [28.2%] were G1, 35 [38%] were G2, 16 [17.3%] were G3, and 6 [6.5] were G4. Conclusion: The commonest type of the malignant renal neoplasm remains the clear cell [conventional] renal cell carcinoma. The lesions from T1 to T3 are amenable to radical nephrectomy and may not include the ipsilateral adrenalectomy as well. The grade may range from G1 to G4

rare complication of forgotten ureteral stent

A 35 years old lady presented with history of something coming out of the genitalia for the last 5 days. She also had history of pain in the left lumbar region which was initially investigated but the patient did not follow-up. About 15 years ago she also underwent left ureteric reimplantation. On examination, a stick like tube was protruding out of the urethral meatus which was fixed to the underlying vesical calculus. The calculus was evident radiologically and on ultrasound. The projecting portion of the stick like tube was cut and the vesical calculus with the inner portion of the tube was removed by open procedure. On evaluation of the specimen, it was found that the vesical calculus was fixed to the plastic tube which had concretions around it. This plastic tube had been placed after the ureteric reimplantation done 15 years age and the patients was not aware of it

Inguinal hernia repair: a comparison of lichtenstein and darn techniques

To compare the number of postoperative complications and early recurrence between Lichtenstein tension free hernioplasty and Darn repair, for inguinal hernia. The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi from 1st Jan 2001 to 30th Nov 2002 and included 100 patients. The study design was quasi experimental. A total of 100 patients were selected. 50 patients were treated with Lichtenstein tension free hernioplasty [Group A] and 50 with Darn repair [Group B]. Cases were followed up for one year. The male to female ratio was 46.5:1. Total no of postoperative complications were 7[14.58%] in Group A and 21 [44.68%] in Group B. Haematoma was the most common complication followed by urinary retention and wound infection in both the study groups. Complications like haematoma [8.33% versus 14.89%], urinary retention [2.08% versus 12.76%], wound infection [2.08% versus 8.51%], scar pain [2.08% versus 6.38%] and testicular atrophy [0% versus 2.13%] were significantly low in Lichtenstein tension free hernioplasty as compared to Darn repair [P<0.05]. The early recurrence rate in this study was significantly low in Group A [0] as compared to Group B [O versus 4] but this is statistically insignificant [P>0.05]. Depending upon the surgeon's skills, Lichtenstein tension free hernioplasty has a definite superiority over Darn repair