Passive removal of silicone oil through 23 gauge transconjunctival sutureless vitrectomy system

Objective: To study the outcomes of passive removal of silicone oil by 23 Gauge Transconjunctival Sutureless Vitrectomy System

Methods: This prospective, consecutive case series study was conducted at Ophthalmology Department Unit I, Dow University of Health Sciences, Civil Hospital Karachi from January 2011 to December 2014. Only psuedophakic eyes with silicone oil temponade were selected. Main outcome measures were intra ocular pressure, time taken for removal of silicone oil, per operative and post operative complications. Pre and post operative IOP was compared by using two-tailed paired t-test and mean values with standard deviation were computed using difference of 95% confidence interval. Chi square test was applied for correlation of different variables. P-value of less than 0.05 was considered statistically significant

Results: Out of 79 patients who underwent passive ROSO, 38 [48.1%] were males. Mean age of patients was 47.5 +/- 7.1 [sd] years. Mean time taken for passive ROSO was 7.31 +/- 2.41 [sd] minutes. Pre and post operative intra ocular pressure shows statistically significant [p=0.000] decrease in IOP. Retinal redetachment found in 13 [16.5%] cases during follow up period

Conclusion: Passive removal of silicone oil with 23 G suture less vitrectomy system is safe and effective in terms of less per operative and post operative complications. In this simple technique, there is less tissue trauma and little time consumed so it provides more comfort to patients and surgeons as well

Combined phacoemulsification, vitrectomy and endolaser photocoagulation in patients with diabetic retinopathy and cataract

To determine the outcomes of early vitrectomy and endolaser photocoagulation effects during phacoemulsification in cataractous eyes with diabetic retinopathy. Descriptive study. Ophthalmology Department Unit-II, DUHS, Civil Hospital, Karachi, and Al-Noor Eye Clinic, Karachi, from February 2009 to December 2010. Consecutive 54 patients with 7 - 15 years duration of type II diabetes with severe non-proliferative diabetic retinopathy [NPDR] and early proliferative diabetic retinopathy [PDR] who had cataract grade I and II underwent vitrectomy, endolaser photocoagulation and phacoemulsification with IOL implantation. Best corrected visual acuity was main outcomes measure assessed till 6 months follow-up. Out of 54 eyes, 32 patients were females and 22 were males. Majority 47 [87%] eyes gained significant [p < 0.001] improvement of best corrected visual acuity of four lines or better while 5 [9.3%] eyes retained stable visual acuity. In only 2 eyes, vision declined to 3/60 or less. Early vitrectomy with phacoemulsification in severe NPDR and early PDR patients, if assisted or augmented with endolaser photocoagulation, maximizes, early visual rehabilitation with less morbidity and may retard progression of retinopathy

Impact of duration of macula off rhegmatogenous retinal detachment on visual outcome

To assess impact of,duration of macular detachment on visual outcome after scleral buckling for retinal detachment with macula off. Prospective, descriptive case series was conducted at Ophthalmology Department Dow University of Health Sciences, Civil Hospital Karachi and Al Noor Eye Clinic Karachi from May 2012 to June 2013. Five groups were made according to period of macular detachment. Best corrected Visual acuity [BCVA] was main outcome measure. P value < 0.001 was considered significant. Mean duration of macula off was 17.0 +/- 4.0 [SD] days. Mean pre-operative VA in patients with immediate, early, intermediate, delayed or late group were 2/60, 2/60, Counting figure [CF] 3 meters [m], CF2 m and Hand Movement [HM] respectively. Only 48.48% patients of those repaired within 7 to15 days had significantly better [P < 0.001] BCVA [6/9-6/18] than the other groups. Only 19.35% patients of intermediate group achieved BCVA 6/18-6/24 [P < 0.001] which was comparatively better than the delayed and late group. Scleral buckle surgery for macular-off Rhegmatogenous Retinal Detachment has good postoperative visual outcomes if repaired within two weeks

Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema

To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. Interventional study. Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema [CSME], non-proliferative diabetic retinopathy [NPDR] and proliferative diabetic retinopathy [PDR] were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. The male to female ratio was 1:1.44. Out of 218 patients; 129 [59.2%] were males and 89 [40.8%] were females. CSME was found in 82 patients [37.6%] at first postoperative week which declined to 29 cases [13.3%] at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity [BCVA] gradually improved in each subsequent follow-up visit. Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed

Posterior assisted levitation [PAL] by using akahoshi/wahab irrigating pars plana levitator

To assess the outcome of irrigating Akahoshi/Wahab pars plana levitator for posterior assisted levitation in dropped nucleus during phacoemulsification. A case series. Ophthalmology Unit-III, Dow University of Health Sciences at Sindh Government Lyari General Hospital and Al-Noor Eye Hospital, Karachi, from January 2008 to December 2009. Cases of dropped nucleus during phacoemulsification were recruited. Predisposing factors and stage of phacoemulsification at which dropped nucleus were recognized. Levitator was inserted through pars plana after vitrectomy around nucleus and levitation was carried out. Follow-up was done till 6 months. Thirty two patients including 18 males [56.3%] and 14 females [43.8%] underwent pars plana levitation. Predisposing factors were pupillary miosis in 9 cases, Brunescent cataract in 7 cases, pseudoexfoliation in another 7 cases, hypermature cataract in 5 cases and extended capsulorrhexis in 4 cases. Posterior capsular rent occurred in 22 [68.8%] cases while zonular dehiscence / rupture were found in 10 cases [31.3%]. Nuclei were dropped during quadrant aspiration in 10 cases [31.3%] and during chopping in 8 cases [25%]. Another 5 cases [15.6%] occurred during each hydrodissection and chopping while 4 cases [12.5%] were found during sculpting of nuclei. Final best corrected visual acuity was 6/12 and better in 22 cases [68.8%] while in 10 cases [31.3%] it was 6/18 to 6/36. No complication related to pars plana levitator was observed. Posterior assisted levitation of dropped nucleus during phacoemulsification by irrigating Akahoshi/Wahab pars plana levitator is a fast and safe surgical technique

Comparison of conventional phacoemulsification technique VS. cool phacoemulsification technique with the importance of phacoemulsification variables

To compare the efficacy and outcome after cool phacoemulsification with conventional phacoemulsification techniques in terms of effective phacoemulsification time [EPT], wound size and operative complications along with other variables used for the technique. Randomized controlled clinical trial [RCCT]. Ophthalmology Unit III, Sindh Government Lyari General Hospital and DUHS and Al Noor Eye Hospital, Karachi, from January to December 2008. One hundred eyes with nuclear/cortico-nuclear cataract on LOCS III [Lens Opacities Classification System III] underwent phacoemulsification. Fifty eyes were randomized to have surgery by standard phacoemulsification technique and the other 50 eyes by cool phacoemulsification technique. Efficacy and outcomes were judged in terms of variables like effective phaco time, vacuum and power used, quantity of Ringer's lactate solution used and corneal burn. The results between the two groups were compared. Among the phaco variables, the vacuum used in all cases ranged from 100 to 200 mmHg in group A with mean vacuum of 145.3 +/- 29.6 and 300 to 350 mmHg with mean value of 325.8 +/- 14.5 in group B at phaco II [p<0.001]. There was a significant difference in amount of Ringer's lactate used during surgery with 100-180 ml in conventional phacotechnique as opposed to 75-150 ml in cool phacoemulsification [p<0.001]. EPT in group A was between 30 to 180 seconds with mean of 111.3 +/- 40.4 seconds while in group B, it ranged between 2 to 12 seconds with mean of 6.1 +/- 2.92 seconds [p<0.001]. Rate of intra operative complications was lower in cool phacoemulsification [2%] as compared with conventional technique [18%, p=0.008]. Cool phacoemulsification is a safe technique to operate cataract of all grades. It seems to be superior as it reduces effective phaco time, less operative and postoperative complications and is, therefore, safer for the cornea especially with regard to corneal wound burn. However, significantly greater amount of vacuum is needed