Diabetic macular edema; role of intravitreal bevacizumab in treating clinically significant diabetic macular edema

To evaluate the effect of Intravitreal Bevacuzimab on Best Corrected Visual Acuity in patients with clinically significant diabetic macular edema. A prospective uncontrolled interventional case series in which 42 eyes of 31 consecutive diabetic patients with clinically significant macular edema and no significant comorbid ocular association presenting in the outpatients department of Holy Family Hospital and EYE SURGERY clinic, Rawalpindi Pakistan and opting for the treatment from 1st September 2013 to 31st January 2014 were given an intravitreal injection of Bevacizumab. BCVA was documented prior to and four weeks after the injection. Main outcome measure was changes in BCVA. Out of the 31 patients included in the study 14[45.16%] were male and 17 [54.83%] female. Average age was 56.1 +/- 7.6. All 31 patients [42 eyes] came for follow up and their BCVA recorded. 41 [97.61%] eyes showed an improvement of one or more line on Snellen's chart at 4 weeks. 14 [33.33%] eyes showed an improvement of one line, 19 [45.23%] eyes an improvement of two lines, 6 [14.28%] eyes three lines and just 2 [4.76%] eyes had an improvement of four lines on Snellen's chart at 4 weeks. Only 1[2.38%] eye remained same with no worsening. On log MAR conversion scale for Snellen's letters the BCVA improved from 0.76 +/- 0.27 to 0.47 +/- 0.27 [p< 0.001]. No significant complications were observed in any of the eyes. The use of intravitreal Bevacizumab [1.25mg/0.05ml] is a safe and effective moe of treatment for clinically significant diabetic macular edema

Clinical manifestations of Goldenhar syndrome

Goldenhar syndrome is a congenital disorder with diverse clinical presentation. This case series describes various clinical manifestations of Goldenhar Syndrome. 11 patients at least two of the described features of Goldenhar syndrome were randomly included in the study to form a case series. Clinical data of all these subjects was documented, described in percentages and analyzed. Out of the 11 patients studied, 6 were females and 5 males. Mean age was 7.3 years [ranging from 1 year to 23 years]. 7 [63.6%] patients had a limbal dermoid, 6 [54.5%] patient had mandibular hypoplasia, whereas only 3 [27.3%] presented with hemifacial microsomia. Spinal defects and polydactyly were present in [36.4%] patients each. There was one patient [9%] who had both microphthalmia and lid coloboma in addition to limbal dermoid. Similarly, renal defect [atrophic kidney], cleft upper lip and palate and CNS defect [7th nerve palsy] were present in one patient [9%] each. None of our patients had either cardiac or GIT defect. In our study we were able to document the variable manifestations of Goldenhar syndrome with their frequencies. This knowledge base will help us in planning treatment and assistance strategies or these patients

Retrospective analysis of cases of acute endophthalmitis after surgery

To find out the prevalence and visual outcome of acute endophthalmitis after cataract surgery. Retrospective. 1[st] January 2001 to 31st December 2009. Wah Medical College, P.O.F. Hospital Wah Cantt, Rawalpindi. Fifty cases of acute endophthalmitis who had undergone treatment. Each case of acute endophthalmitis was evaluated in terms of presentation, detailed examination, treatment and outcome. Microbiological culture of the vitreous aspirates was also done to identify the causative organism. The analysis was also meant to identify the prognostic factors of visual outcome of these cases. Fifty patients presented with acute endophthalmitis out of the fifteen thousand cataract surgeries performed during the 9 year period. The incidence of endophthalmitis was 0.33% [95% CI]. A vitreous biopsy with intravitreal injection of antibiotics was done in all the cases presenting with acute endophthalmitis. Decreased visual acuity [90%] and pain [75%] were the main presenting features in these cases. There were 36 [72%] culture positive cases, with staphylococci [50%] being the most common organism found. Vitreous biopsy yielded positive results in 36 [72%] patients while negative results with no microbial growth was found in 14[28%] patients. There were 20 [40%] growths of coagulase negative staphylococci, 5 [10%] growths of streptococci, 8 [16%] growths of coagulase positive staphylococci, and 3 [6%] of gram negative organisms. The final visual outcome was recorded after one month. 8 [16%] patients achieved 6/12 or better, 26 [52%] patients achieved moderately good visual acuity 6/60 to 6/12, while 16 [32%] patients achieved poor visual acuity of less than 6/60. Of the latter group who had poor visual acuity, 2 [4%] patients had only perception of light while 1 [2%] patient had no perception of light and 1 [2%] patient had blind and painful eye who had to undergo evisceration. 6 [16%] patients achieved 6/12 or better visual acuity. The incidence of endophthalmitis is consistent with other studies. Laboratory diagnosis of the vitreous aspirates helps in the treatment. Achieving a good visual outcome is possible with treatment of the cases of acute endophthalmitis