Angiographic patterns of various retinal medical diseases in Pakistan

Objective: To study the angiographic pattern of various retinal medical diseases in Pakistan

Study Design: A hospital based observational study conducted on 13,941 patients presenting at Al Shifa Trust Eye Hospital, Rawalpindi from 1991 to 2011

Subjects and Methods: A complete history of patients was taken after which patients were evaluated thoroughly by carrying out refraction and slit lamp examination followed by direct and indirect ophthalmoscopy. Olympus camera was used for fundus photography and angiography. Color fundus photographs were taken using 400 ASA or 100 ASA kodachrome films. For fundus fluorescein angiography [FFA] 5ml of 10% sodium fluorescein was injected in superficial vein of hand or forearm and recording of angiography was done using 400 ASA Agfapan films. Colored fundus angiography was also done in some patients

Results: We found that diabetic retinopathy was the most common problem in 4265[30.59%] patients followed by venous occlusion in 3415[24.49 %] patients. Age related macular degeneration was diagnosed in 2724 [19.54 %] patients. Acquired maculopathies were found in 2107 [15.12 %] and central serous retinopathy in 1659 [11.90 %] patients while 352 [2.53 %] patients had cystoid maclar edema. 544 [3.9 %] patients were diagnosed with hereditary disorders. This analysis gives us a general review of the retinal diseases in our population

Conclusion: The angiographic pattern of various retinal medical disorders in our population is quite different from many western countries. Retinal vascular disorders are the most common indication of FFA in our setup

Comparison of efficacy of Ranibizumab versus Bevacizumab in neovascular Age Related Macular Degeneration

Objectives: To compare the efficacy of two anti-vascular endothelial growth factor [VEGF] agents in sub retinal neovascular membrane [SRNVM] due to age related macular degeneration [AMD]

Study Design: Comparative, non-randomized interventional study

Subjects and Methods: The study was conducted at Al-Shifa Trust Eye Hospital in which 861 eyes of 794 patients were included. Patients in each group got 3 intravitreal anti-VEGF injections and were followed up for six months. Intravitreal dose used for Bevacizumab was 1.25 mg and Ranibizumab 0.5mg every 4 weeks. At each follow up, visual acuity and macular thickness on Optical Coherence Tomography [OCT] were analysed

Results: Total 790 patients of Bevacizumab group had the mean baseline VA of 0.9 log MAR and mean macular OCT thickness of 526 micro m. At the end of treatment, their mean BCVA AND OCT macular thickness was 0.69 log MAR and 261 micro m respectively, showing statistically significant improvement. 71 patients of Ranibizumab group had mean baseline VA of 0.7 in log MAR chart and their mean OCT thickness of macula was 416 micro m. They showed significant improvement in their mean VA and OCT thickness to 20/70 [0.55 log MAR] and 219 +/- 49 micro m respectively with improvement of 29.62%, and 89.95% respectively which was statistically significant. However, there was no significant difference between two groups in terms of final VA and side effects

Conclusion: Both Ranibizumab and Bevacizumab are equally effective in neovascular AMD. Considering the cost, bevacizumab may be the drug of choice as no serious adverse events were found

Complications associated with the use of 5000 - centistoke silicon oil after vitreo - retinal surgery

The purpose of the study was to report and compare the complication rates associated with use of silicon oil after vitreo-retinal surgery. This was a prospective hospital based study spanning over a period from January 2004 to June 2005. A total of 69 patients with different vitreo-retinal diseases were operated by a single surgeon using standard three ports pars plana vitrectomy technique and 5000-centistoke silicon oil. Depending upon the intra-operative situation, additional procedures were performed including use of an encircling band, relaxing retinotomy and use of perfluorocarbon liquids. The major post-operative complications observed were, development of cataract in 46 [85.18%] out of 54 patients, early post-operative raised intra-ocular pressure [IOP>25 mmHg] in 28 [40.57%] patients, keratopathy [including corneal edema, corneal abrasions and band keratopathy] in 15 [21.73%] patients, emulsification of silicon oil in 5 [7.26%] patients, glaucoma in 5 [7.26%] patients on final follow-up and ocular hyopotony in 1 [1.44%] patients. Retinal re-attachment in 35 [72.92%] and retinal re-detachment in 13 [27.08%] patients. Visual out-come was, improved visual acuity in 45 [65.23%] patients, preserved [un-changed] in 10 [14.49%] patients and was reduced in 14 [20.28%] patients. The use of silicon oil in vitreo-retinal surgery offers definite advantages however, its complications particularly cataract, glaucoma and kertopathy lead to worries about its use for prolonged retinal temponade

Refractive error study in strabismic children: results from Al-Shifa Trust, Rawalpindi, Pakistan

To assess the prevalence of refractive error and visual impairment in children with strabismus. Study design:-Hospital based prospective study. July 1995 to June 1998. A total of 1120 strabismic children between the ages of 02-l 5 years were examined to identify those having refractive error. visual acuity measurement, cycloplegic retinoscopy, ocular motility evaluation and examination of the external eye, anterior segment, media and fundus were performed in all the strabismic children. Out of 1120 strabismic children, 622 [55.54%] had esotropia, 370 [3104%] had exotropia and 128 [11.42%] had vertical strabismus.148 [13.21%] were emmetropic, 972 [86.79%] strabismic children had refractive errors. Esotropia was the most common strabismus followed by exotropia and vertical strabismus. Severe visual impairment was found in 27.30% of the strabismic children. The most common refractive error was hypermetropia followed by astigmatism and myopia. About half of all the strabismic children had amblyopia

Role of intraoperative 360 retinal endophotocoagulation in the management of giant retinal tears

To determine the effectiveness of intraoperative 360 degree retinal photocoagulation in the management of giant retinal tears [GRTs]. Departments of Vitreoretina, Al Shifa Trust Eye Hospital, Rawalpindi. From 2000 to 2004. Sixteen eyes of 16 consecutive patients with GRTs were operated at Al Shifa trust eye hospital. Eyes included in this study underwent pars plana vitrectomy, perfluorocarbon liquid injection, 360 degree retinal photocoagulation and silicone oil exchange. Retinopexy was applied to the edges of the tear through endolaser photocoagulation and extended over 360 degree to the peripheral attached retina. No scieral bijckle was placed in any of these cases. The extent of the GRT was 180 degree or greater in four eyes and 90 degree to 180 degree in twelve eyes. The lower edge of the GRT was located in the inferior quadrant in fourteen eyes. PVR was grade A in five eyes, grade B in eight eyes and grade C in three eyes. In 12 [75%] of the 16 eyes, the retina was successfully reattached after surgery and 360 degree laser photocoagulation. The silicone oil was removed after a mean period of twelve weeks. Two of the four eyes were successfully reoperated by performing relaxing retinotomies. At the end of the follow up, the retinal was reattached in 14 [87.5%] of the 16 eyes. The mean follow up period was 14 months [range 5-23 months]. The success rate of management of GRTs with pars plana vitrectomy, internal temponade and 360 photocoagulation of the retina without scleral buckle is high

Al-Shifa Endophthalmitis Study: Protocol of treatment and prognosis

Purpose of Study: To assess the success rate of Al-Shifa treatment protocol for post-operative endophthalmitis

Study design: Retrospective analysis of treated cases

Methodology: All the patients presenting with post-operative endophthalmitis were given the standard treatment after obtaining intracameral and intravitreal samples. The treatment given was intravitreal vancomycin 1.0 mg with 0.05cc of kenacort, intracameral vancomycin 0.45mg in .04cc along with 25 mg sub-conjunctival vancomycin. Topical half hourly antibiotics employed postoperatively were tobramycin, dexamethasone combination with ciprofloxacin round the clock for first 36 hrs. Patients also received postoperative topical cycloplegics. The main study outcomes were visual acuity and media clarity. The total follow up was 8-12 weeks

Results: 57 patients with postoperative endophthalmitis were included in the study. All the patients presented with severe visual disability ranging from perception of Hand Movements to perception of light only. There was no retinal view of any kind in 77%, while in the rest only red reflex was visible. By the final study follow-up, 53% patients achieved visual acuity of 6/18 or better, 14% achieved 6/30 or better, 26% patients had final visual acuities up to hand movements and only four [7%] patients were with no light perception at the final study follow-up visit. In 73% of patients, media cleared to show the retinal view

Conclusion: With modern management, endophthalmitis is no more the ravaging disease it was in the past. Many patients who develop endophthalmitis will maintain reading vision in the involved eye. Therefore the rapid initiation of appropriate treatment may result in excellent visual results