Optical coherence tomography macular findings after successful scleral buckling in eyes with compromised visual status

Objective: To determine the optical coherence tomography [OCT] macular findings after successful scleral buckling in eyes with compromised visual status. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan, from February 2015 to November 2016

Methodology: Patients with postoperative best corrected visual acuity [BCVA] less than 6/6, successful scleral buckling, and flat macula clinically, aged 18-70 years, were included. OCT scan [OCT-Spectralis, Heidelberg Engineering, GmbH 69121] of central 30 degrees around fovea was performed three months postoperatively. Foveal detachment, epimacular membrane [EMM] and cystoid macular edema [CME], were studied on OCT after successful buckling surgery in eyes with compromised visual status

Results: A total of 164 eyes of 164 patients [92 males 72 females] were assessed with OCT. Foveal detachment [FD] was present in 54 cases [32.9%], cystoid macular edema [CME] in 30 [18.3%], and epimacular membrane [EMM] in 11 cases [6.7%]; while no abnormality was detected in 69 [42.1%] cases on OCT

Conclusion: OCT is very helpful in identifying the cause of limited visual recovery after successful retinal detachment [RD] surgery

Visual outcome after pars plana vitrectomy in diabetic vitreous hemorrhage

Objectives: To determine visual outcome and frequency of complications after pars plana vitrectomy in diabetic vitreous hemorrhage

Methodology: This was interventional case series conducted at department of ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 2013 to June 2014. Known diabetic patients above 16 years of age, having vitreous hemorrhage were included. Standard three ports pars plana vitrectomy [PPV] with membrane peeling, endolaser and without endotamponade by single study surgeon was done in all patients. Best corrected visual acuity was noted pre operatively and on 1st day, 2nd week and 8th week post operatively. P- value <0.05 was considered statistically significant. Post-operative complications and visual improvement were noted at final visit

Results: Total of 50 patients having diabetic vitreous hemorrhage were included in the study. Mean age was 41.4 years. Male patients were 66%. Clear lens was present in 46% patients and cortical lens vacuoles in 36% patients. Fresh vitreous hemorrhage was present in 80%. Baseline and final post-operative best corrected visual acuity logarithm minimal angle of resolution was 1.01 +/- 0.17 and 0.74+/- 0.25 respectively. The difference in pre and post-operative best corrected visual acuity logarithm minimal angle of resolution was 0.045 which was statistically significant. There were no post-operative complications in 82% patients. Visual improvement was observed in 82%

Conclusion: Most patients with diabetic vitreous hemorrhage regain or retain useful vision after PPV. Many patients may suffer late complications like recurrent vitreous hemorrhage and retinal detachment after successful initial surgery requiring secondary intervention

Open globe injuries with intraocular foreign body: surgical outcome

Objective: To determine surgical outcome and residual co-morbidities after surgical intervention in eyes having Open Globe Injury [OGI] with retained Intra Ocular Foreign Body [IOFB]

Methodology: A prospective interventional case series was carried out at the department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex [HMC], Peshawar from 1st September 2012 to 30th November 2013. Patients who were followed post-op-eratively for at least 90 days were included. Eyes having open globe injury [OGI] and intraocular foreign body [IOFB] who had surgical intervention were included in our study. Visual outcome was determined comparing final best corrected visual acuity [BCVA] with initial BCVA. Co-morbidities were noted at final follow up. For data analysis, Snellen's VA was converted to log MAR VA. Data was analyzed by SPSS version 16

Results: Total of 35 patients were included in our study. Male were 94.3% compared to 5.3% females. Mean age was 32.42 years. Bomb blast injury was cause of eye trauma in 60% cases while 40% were doing hammer and chisel work at the time of trauma. IOFB was impacted in anterior segment in 20% cases while it was impacted in posterior segment in 80% cases. IOFB removal was achieved in 33[94.28%] cases; silicone oil was used as temponade in 48.57% cases. Primary repair was required in 40% cases while rest 21[60%] eyes had self sealed wound. Primary surgical intervention in the form of Pars Plana Vitrectomy, IOFB removal with the use of intraocular magnet or forceps was carried out in 71% cases. Mean BCVA log MAR improved from initial BCVA of 2.20 to 1.20. Common comorbidities at final visit were corneal scars, macular scars and cataract

Conclusion: Bomb blast injuries are most common cause of OGI with IOFB in our region. Significant visual improvement occurs in most of the cases after skilled vitreo-retinal surgical interventions. Common ocular co-morbidities are corneal scar, macular scar and cataract

Frequency of diabetic retinopathy in a tertiary care hospital using digital retinal imaging technology

The objective of this study was to determine the frequency of diabetic retinopathy in a tertiary care hospital using digital retinal imaging technology. This descriptive study was carried out in the department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad medical complex Peshawar. Patients referred from outpatient department, general practitioners and from private clinics were included and after taking their basic demographic data were referred to the department of Diabetes for Fundus Photograph using Canon CR1 non-mydriatic digital retinal camera. Photographs were analyzed first by Endocrinologist and later by an Ophthalmologist to assess the severity of retinopathy. Two thousand one hundred and twenty three patients with type 2 diabetes were evaluated clinically followed by fundus photography by retinal digital imaging. The frequency retinopathy and maculopathy was 32.03% and 6.31% respectively [both retinopathy and maculopathy 38.34%]. Three seventy four patients [17.6% patients] received laser treatment for prevention of blindness. Screening for Diabetic retinopathy using digital camera is a useful technique and detects DR effectively in diabetic patients in a tertiary care setting. This technique is useful in mass screening and can detect, reduce and prevent blindness due to diabetes in our population

Anti vascular endothelial growth factor [bevacizumab] in central retinal vein occlusion: an interventional case series

Vascular endothelial growth factor plays major role in ocular angiogenesis and retinal edema production and is a step forward in the management of ocular neovascularization and retinal edematous pathologies. To determine the efficacy and safety of intra-vitreal Avastin [Bevacizumab] in cases having central retinal vein occlusion. A prospective interventional study. This study was done at Said Anwar Medical Centre, Dabgari Gardens, Peshawar from June, 2007 to September, 2009. All patients with central retinal occlusion occurring in the past 3 months and seen between the study period were included in the study. Diagnosis of central retinal vein occlusion was made clinically by slit lamp biomicroscopy with 78D examination Patients who had received any treatment for and eyes which already had developed Anterior Segment Neovascularization, Neovascularization elsewhere or Neovascularization on disc at presentation were excluded. Dose of 0.05 ml [1.25mg] of Avastin [Bevacizumab] was used as intra vitreal injection every month for 3 months in cases that presented within a month of occlusion and less injections were given in dose presenting later. Follow-up was done at 30th, 60[th], 90[th] and 120[th] day after the onset of disease. Visual outcome was defined as Snellen's or LogMar Best Corrected Visual Acuity at final follow up, of 120[th] day, compared to the visual acuity at presentation. Data were analyzed by SPSS version 17. Total of 17 eyes of 17 patients were included in this study. Eleven [64.7%] patients were males while 6 [35.3%] were females. Total of 40 intra-vitreal injections of Avastin were given to patients with a mean of 2.35 injections per eye. Good visual outcome was achieved in 10 [58.8%]] eyes, while 7[41.2%] had stable visual outcome. Mean initial Best Corrected Visual Acuity [LogMar] in all 17 eyes was 1.79 [SD +/- 0.87] which significantly improved to a mean of 1.18 [SD+0.77] at final follow up. Mean improvement in Best Corrected Visual Acuity [LogMar] after paired sample test in all patients at final follow up on day 120 was 0.61[SD+0.84]. Retinal hemorrhages and macular edema decreased clinically on examination on consecutive follow up visits. No eye developed neovascularization elsewhere, neovascularization on the disc, neovascularization, retinal tears, retinal.detachment, lens trauma, endophthalmitis or anterior chamber activity. Bevacizumab [Avastin] is an effective and safe treatment option for central retinal vein occlusion affected eyes and resulted in improvement in visual acuity. It reduced macular edema and prevented ocular neovascularization at least for short term

Complications of conventional sclera buckling occurring during and after treatment of rhegmatogenous retinal detachment

To identify and determine the frequency of the intra-operative and early postoperative compkicaitons of Cinventional Scieral Buckling [CSB] ans the primary surgical intervention in patients with Phegmatogenous Retinal Detachment [RRD]. A quasi-interventional study. Khyber Institute of Ophthalmic Medicl Sciences [KIOMS], Postgraduate Medical Institute [PGMI], Hayatabad Medical Complex [HMC], Peshawar, from April 2005 to June 2006. Fifty consecutive patients who underwent CSB and fulfilled the inclusion criteria, were included in the study. Operative details and any intra-operative complications were noted. The patients underwent another detailed clinical examination and pain assessment on the first postoperative day. All the patients were followed-up minimum for 3 months. Postoperative complications were identified and recorded. The data was analyzed on SPSS 120 for measures of central tendency and dispersion. There were 36 males and 14 female subjects. Mean age was 37.18 +/- 20.145 years. Encirclement [56%] was the most frequently used CSB technique, sixteen [32%] patients had at least one intra-operative complication. Intra-operative complications were iatrogenic sclera break [2%], accidental Sub Retinal Fluid [SRF] drainage [8%], choroidal haemorrhage [2%], subretinal haemorrhage [14%], retinal incarceration [2%], vitreous haemorrhage [6%], raised [4%] or very low [2%], intra-operative IOP and hyphema [2%]. Postoperative complications included systemic complications [24%], choroidal detachment [8%], vitreous haemorrahge [16%], raised IOP [22%], angle closure [2%] and explants exposure [6%]. Mean refractive change in spherical equivalent was -1.478 +/- 0.698 D. final re-attachment rate was [82%] and final BCVA of > 6/60 was achieved in 62% of the subjects in the treated eyes. CSB is a safe and effective option for treating uncomplicated RRD, but it is associated with certain complications. Sub-retinal bleed was the most common intra-operative complication. Raised IOP was most the common early postoperative complication followed by choroidal detachment

Pattern of pediatric ocular trauma in Hayatabad Medical Complex Peshawar

To determine the pattern and causes of pediatric ocular trauma in Hayatabad Medical Complex, Peshawar. A cross sectional descriptive study Department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 1999 to June 2004. The medical records of 481 children aged upto 16 years who suffered ocular trauma were reviewed retrospectively. Age and gender distribution, nature and source of trauma, presentation and ocular features were analyzed. Pediatric ocular trauma constituted 43.5% of total traumatic ophthalmic admission. Four children were victims of bilateral trauma. Male to female ratio was 3.3:1.Twenty five percent children were below 5 years of age, 47.8% were between 5 to 10 years of age and 27.2% were between 10 to 16 years. About 51% injuries were of open globe type and 37.6% closed globe, superficial non perforating injuries, burns and adnexal pathologies were present in 11.3%. Domestic injuries were more common [47.2%]. At the time of admission 14.6% eyes were infected, 2.3% required evisceration or enucleation. Majority [67.3%] of the children presented late [one week later] to the hospital. Male children were affected more than female by trauma. Half of ocular trauma resulted in open globe injuries and almost 50% of cases were related to domestic injuries. Majority of cases presented late and were secondarily infected

Ocular emergencies

To describe clinical data about ocular emergencies [OE] and their management. Design: Descriptive study. Place and Duration of Study: This study was conducted from 1st January, 2000 to 31st December, 2002 at the Department of Ophthalmology, Khyber institute of Ophthalmic Medical Sciences, Lady Reading Hospital, Peshawar. Material and A comprehensive analysis of the computer record available for admitted ocular emergencies was undertaken in terms of gender, age, etiology, procedure performed and hospital stay. Ocular emergencies [1961] were 18.49% of total admissions. Male to female ratio was 2:1. Non-traumatic ocular emergencies were 1058 [53.95%] with male to female ratio of 1.47:1. In the non-traumatic ocular emergencies, majority [67.2%] were 40 years or above. Traumatic ocular emergencies were 925 [47.16%] with male to female ratio of 2.77:1. Majority [83.78%] of traumatic ocular emergencies were below 40 years and 562 [60.75%] below 20 years of age. Only 150 [16.21%] cases were 40 years and above. Corneal ulcers [44.51%] and glaucoma [24.38%] were the most common non-traumatic ocular emergencies, whereas, open globe injuries [73.4%] were leading the traumatic ocular emergencies. Total surgical procedures performed were 1382 [13.7% of total major ophthalmic surgery]. Average stay in hospital was 5.5 days. Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions

Conventional retinal reattachment surgery

To evaluate the surgical outcome in rhegmatogenous retinal detachment [RRD] cases operated by conventional retinal reattachment techniques. Design: Descriptive study. Place and Duration of Study: This study was conducted at Eye Unit, Hayatabad Medical Complex [HMC], KIOMS, Peshawar, from July, 2002 to December, 2002. Materials and A retrospective analysis of ophthalmic record of rhegmatogenous retinal detachment operated by conventional retinal reattachment surgery was done. Anatomic outcome was evaluated in relation to duration of presentation and pre-operative proliferative vitreoretinopathy [PVR]. Postoperative visual acuity [VA] was compared to pre-operative VA. Complications and causes of failure of anatomic success were also analyzed. A total of 40 cases were studied. Male to female ratio was approx 2:1. Retinal breaks were localized in 70% cases, 37.5% cases had single break while 32.5% cases had more than one retinal breaks. Forty two% had total retinal detachment while 57.5% had less than total retinal detachment. Five% had attached macula at presentation. Immediate postoperative retinal reattachment was attained in 80% cases but ultimate anatomic success after at least 6 months of follow up was 72.5%. Patients who presented earlier [upto 1 year] had 75% anatomic success while those who presented later than 1 year had 50% success rate. Postoperative visual improvement was noted in 80% cases with flat macula, 65% had VA 6/60 or better after surgery. Most common cause of failure of anatomical reattachment was PVR [63.63% of failed conventional surgery]. Most common postoperative complication was raised intraocular pressure [> 21 mmHg] in 25 cases. There is more chance of retinal reattachment and visual restoration in cases that present earlier. PVR is the main cause of failure of conventional retinal reattachment surgery. Postoperative visual improvement is directly related to surgical reattachment of the macula

Presentation of diabetic retinopathy

The aim of this study is to evaluate the presentation of diabetic retinopathy in diabetic patients presenting to Ophthalmology out patient.The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over a period of 1 year from January 1999 to December 1999. A total of hundred cases were evaluated. A thorough and complete history was followed by careful Ophthalmological examination. Systemic evaluation for diabetic complications was also carried out. Male to female ratio in our study was 1.4: 1. Ninety one [91%] were cases of non-insulin dependent diabetes mellitus [NIDDM] and only 9% cases were of insulin dependent diabetes mellitus [IDDM]. Non proliferative diabetic retinopathy [NPDR] was found in 28.6% of NIDDM cases and 22.2% of IDDM cases. Proliferative diabetic retinopathy [PDR] was found in 9.8% of NIDDM cases and 11% of IDDM cases. Diabetic maculopathy was found in 15.4% of NIDDM whereas it was present in 33.3% of IDDM cases. Diabetic retinopathy is common sequalae of diabetes. Its presence and complications are strongly related to duration and control of diabetes. Diabetic maculopathy is commonest cause of visual impairment in diabetic patients

Corneal complications of vernal catarrh

To identify the magnitude and types of corneal complications of vernal catarrh and the extent of visual impairment caused by them. Design: A cross-sectional study. Place and Duration of Study: Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex [HMC], Peshawar, from March, 1999 to May, 2000. Subjects and All cases of vernal catarrh who agreed to an informed consent were included in the study. Patients who were difficult to be examined by a slit lamp were excluded from the study. The diagnosis was made mainly on the basis of history and clinical examination. Slit lamp examination was done in every case together with fluorescein staining of cornea. The variables were recorded and statistically analyzed. Superficial punctate keratitis [45%] was the most common corneal complication. Visual impairment was more pronounced in cases with shield ulcers [14%] and corneal plaques [8%]. A strong association with keratoconus [15%] was also noted. Corneal opacification [9%], hydrops [6%] and pseudogerentoxon [3%] were also found. Corneal complications in VKC are common, potentially serious and may cause marked visual impairment