Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years

Purpose: To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies. Methods: This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis. Results: A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%). Conclusion: Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).

Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment

Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD. Methods: We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning. Results: A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less. Conclusion: PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.

Correlation Between Preoperative OCT Pattern and Visual Improvement in Macular Epiretinal Membrane

PURPOSE: To analyze the correlation between preoperative characteristics of optical coherence tomography (OCT) image and visual improvement in macular epiretinal membrane (ERM) and to determine whether preoperative difference upon OCT pattern is a prognostic indicator of high postoperative visual acuity. METHODS: We retrospectively reviewed the records of 99 patients (100 eyes) with ERM, who were treated by vitrectomy and followed for more than four months. We classified the OCT images of preoperative ERM into three different types: flat macula, convex macula, and concave macula. Then we compared the preoperative visual improvement among the three types. RESULTS: The causes of ERM were idiopathic in 59 eyes, diabetic retinopathy in 16 eyes, uveitis in 9 eyes, and retinal vein occlusion in 6 eyes. The types of OCT were flat macula in 30 eyes, convex macula in 62 eyes, and concave macula in 8 eyes. The grades of visual improvement of LogMAR (logarism of minimum angle of resolution) were 0.49, 0.48, and 0.46, respectively. All three groups showed a significant level of visual improvement. In the secondary ERM group, preoperative and postoperative Log MAR of convex macula revealed lower preoperative and postoperative visual acuity than that of the flat and concave macula (P<0.05). There was a higher degree of visual improvement in patients with pseudophakia, but preoperative central macular thickness (CMT) and the presence of internal limiting membrane (ILM) peeling were not corrected with visual improvement. CONCLUSIONS: This study demonstrated that vitrectomy for epiretinal membrane resulted in favorable visual improvement. There is no correction between preoperative morphologic difference upon OCT and the degree of visual improvement in ERM.

Clinical Findings and Prognosis of Persistent Hyperplastic Primary Vitreous

PURPOSE: To evaluate the clinical findings, visual improvement and preservation of eye according to treatment modality among children with persistent hyperplastic primary vitreous (PHPV) METHODS: A retrospective study, from 1982 to 2001, at Seoul National University Children's Hospital RESULTS: The subjects for investigation were 126 PHPV eyes in 114 children. The mean age at first exam was 3.6 +/- 3.5months, and the mean age at operation was 13.3 +/- 12.1months. Combined type (67%) was most common, followed by posterior (24%), and anterior (9%) types. The chief complaints in order of frequency were are leukocoria (35%), no fixation (23%), strabismus (21%), and microophthalmia (12%). Percentages of eye preservation and visual improvement over 20/1000 were 77%, and 57%, respectively. Nevertheless, the percentage of visual improvement over 20/200 in the anterior type was 25%. CONCLUSIONS: Combined type was most common in PHPV. Clinical findings and treatment modality varieds according to the type. Visual prognosis was poor. However, the post-treatment status was good in view of the treatment purpose. Therefore we can optain a good outcome through active treatment after the exact classification of PHPV eyes and by establishing the treatment purpose.

Macroaneurysms of Retinal Arteries

Two patients with spontaneous intraretinal or subretinal hemorrhages were found, on evaluation by fluorescein angiography, to have macroaneurysms involving the major retinal arteries. Both patients were male in their seventies. One patient had a history of systemic hypertension. In the other patient, hypertension was discovered at the time of consultation. With absorption of the hemorrhage and the macular star, two patients experienced appreciable improvement in vision. Laser thrapy was not applied to both patients. The aneurysms diminished in size after 6 to 8 months as a result of fibrous changes within the arterial walls.

Vitreous Surgery for Macular Hole

Idiopathic macular holes are believed to arise from traction of the posterior vitreous membrane. Traditionally, macular holes have been considered as untreatable condition, but recently vitreous surgeries are being attempted to manage them. Pars plana vitrectomy in conjunction with separation of the posteror vitreous membrane and intraocular achieve visual improvement and anatomic reattachment in eyes with full thickness macular hole. A total of 9 eyes which included 2 eyes with stage 2 macular hole and 7 eyes with stage 4 macular hole underwent vitrectomy. The macular holes were successfully occluded in all 9 eyes and visual improvement of two lines or more was achieved in 6(67%) in which symptom duration was 3 months or less and/or hole size was 1/3DD or smaller. These results suggested that the full thickness macular holes would be surgically treatable lesions and better visual results can be expected in cases with shorter duration and smaller size.

Laser Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion

We observed 44 eyes of 43 patients who were diagnosed as macular edema in branch retinal vein occlusion(BRVO) by fluorescein angiogram, which had been followed up over 6 months after argon-green laser photocoagulation. In our cases, sixth decade of age was most commonly affected and there were no significant difference in sexual prevalence and laterality. Eighty six percent was 0.5 or less in initial visual acuity and 59.1% was 0.5 or more in final visual acuity. Increased visual acuity of 2 lines or more was 61.4% and decrease was only 9.1%. After laser treatment, visual improvements of each comparing group were as follow: 60.7% in superotemporal and 62.5% in inferotemporal, 56.5% in hypertensive patients and 66.7% in normotensive patients, 61.5% in below 6 months from onset of symptom until entry into laser photocoagulation and 61.1% in over 7 months, and there were no significant statistical difference.

Clinical Approach for Visual Achievement in Amblyopia Treatment

We retrospectively studied 60 amblyopic patients who had been treated for 12 months or more. They were divided into three age groups; below 5.5 years, 5.5 years to 8 years and 8 years or more, and visual improvements were compared with three age groups. The visual improvements were 5 line increase in both of below 5.5 year group and 5.5 year to 8 year age group and 3 line increase in 8 year and older group. In all three age groups, two-thirds of the improvements were achieved during the first three months of treatment There was no difference in visual improvement according to amblyopic type(strabismic, anisometropic, strabismic and anisometropic amblyopia). Treatment failures seemed to be the later onset of treatment, eccentric fixation and large anisometropic difference.

A Clinical Study on Therapeutic Effect of the Argon Laser Photocoagulation on Central Serous Chorioretinopathy

In selected cases of central serous chorioretinopathy the pigment epithelial defect can be sealed with laser photocoagulation. The authors analyzed the effectiveness of laser photocoagulation on visual improvement and duration of the disease in laser treated group, as compared to untreated group, which represented na tural course of the disease. A verage healing time was 5.2 weeks in treated group and 13.9 weeks in untreated group, which revealed statistically significant difference between two groups(p<0.01). No difference was noted in visual outcome between two groups. The initial visual acuity was influenced by the type of dye leaking, the distance of leaking point from center of fovea and the size of sensory retinal detachment in fluorescein angiography. But the final visual acuity was only ihfluenced by the size of sensory retinal detachment. The number and location of leaking point did not influence the initial and final visual acuity in both treated and untreated group.