Outcomes of transconjunctival sutureless 27-gauge micro-incision vitrectomy surgery in diabetic vitreous haemorrhage

Objective: To evaluate the visual outcomes of 27-gauge transconjunctival sutureless vitrectomy surgery and its complications in patients with diabetic vitreous hemorrhage

Methods: A quasi-experimental study was conducted where eighty seven eyes of 87 uncontrolled type II diabetes mellitus patients presenting with diabetic vitreous hemorrhage were selected to undergo 27-gauge transconjunctival sutureless micro-incision vitrectomy surgery. Main outcome measured was best corrected visual acuity [BCVA]. Post-operative complications were also screened for at each visit. The follow ups were at post-operative day one, one month, three months and six months respectively

Results: Out of 87 patients, 52 [59.8%] were males and 35 [40.2%] were females. The mean age of the patients was 52.32 +/- 6.78 years [95% CI: 53.13 - 55.57]. For most of the patients, the BCVA improved progressively with each subsequent follow up visit. Pre-operative BCVA was 1.01 +/- 0.206 logMar, compared to BCVA at final follow up of 0.44 +/- 0.231 [p-value < 0.001]. Six [6.9%] patients developed recurrent vitreous hemorrhage during the study period, four [4.6%] developed cataract, one [1.1%] had increased intraocular pressure and sub conjunctival hemorrhage was present in two [2.3%]

Conclusion: 27-gauge micro-incision vitrectomy surgery is an effective sutureless surgery with favorable outcomes, in terms of vision, in patients with diabetic vitreous hemorrhage. The associated complications are few which can be easily managed

Comparison of 1000-centistoke versus 5000-centistoke silicone oil in complex retinal detachment surgery

Objective: To compare the efficacy and complications of using 1000-centistoke versus 5000-centistoke silicone oil for complex retinal detachment repair

Study Design: Case series

Place and Duration of Study: LRBT Tertiary Eye Hospital, Karachi, from January 2007 to June 2013

Methodology: Eighty-five eyes [85 patients] presenting with superior rhegmatogenous retinal detachments associated with PVR grades B and C [involving not more than 3 clock hours] were randomized to either 1000 centistokes [n=44] or 5000 centistokes [n=41] silicone oil group. All patients underwent 23-gauge pars plana vitrectomy surgery with silicone oil intraocular tamponade. Patient data was analysed at 18 months post-operatively. IBM SPSS 21 was used for data analysis

Results: There were 52 male and 33 female patients aged between 22 and 70 years [45.2 +/- 16.2]. After the first surgery, successful reattachment of the retina was achieved in 67 eyes [78.8%]; of which 35 eyes were in 1000-centistoke and 32 eyes in 5000-centistoke groups. Mean pre-operative Best Corrected Visual Acuity [BCVA] was 1.63 +/- 0.54 which was improved to a mean post-operative BCVA of 1.46 +/- 0.78 [1.42 +/- 0.74 in 1000-centistoke group; 1.49 +/- 0.78 in 5000 centistoke group]. The 1000-centistoke group had a significantly higher frequency of oil emulsification which necessitated early removal of silicone oil. There were 66 eyes [77%] with at least one complication [34 eyes in 1000-centistoke group; 32 eyes in 5000-centistoke group] including cataract, corneal abnormalities, raised IOP, hypotony, vitreous haemorrhage and retinal redetachment

Conclusion: Although visual and anatomical outcomes were comparable between the two groups, the 1000-centistoke silicone oil group developed early oil emulsification necessitating its early removal

Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery

Objective: To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery [MIVS] for diabetic vitreous haemorrhage

Methods:One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab [Avastin] which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity [BCVA] assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis

Result: A total of 122 patients were included; 78 [63.9%] males and 44 [36.1%] females. Mean age at the time of surgery was 51.4 +/- 13.66 years. The mean preoperative BCVA was 1.64 +/- 0.427 logMAR which improved to 0.57 +/- 0.253 logMAR at 12 months post-operatively [p-value < 0.001]. Recurrent vitreous haemorrhage was seen in four patients [3.28%]. one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients

Visual outcome of 25-gauge microincision vitrectomy surgery in diabetic vitreous haemorrhage

To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery [MIVS] in diabetic vitreous haemorrhage. This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus [[DM] were included. There were 43 [71.7%] males and 17 [28.3%] females. Age range was 40 - 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity [BCVA] assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively. Best corrected visual acuity [BCVA] gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 +/- 0.226 logMAR, which was improved after final follow up to 0.457 +/- 0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract [1.7%], one [1.7%] had ocular hypotony defined as intraocular pressure < 5 mmHg and one [1.7%] developed endophthalmitis. 25-gauge micro incision vitrectomy surgery [MIVS] is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications

Visual acuity after trans-scleral sutured posterior chamber intraocular lens

To determine the changes in visual acuity in patients undergoing Trans-Scleral Sutured Posterior Chamber Intra-Ocular Lens [TSSPCIOL] implantation at a tertiary care hospital in Karachi, Pakistan. Case series. LRBT Tertiary Eye Hospital, Karachi, from January 2006 to December 2010. Records of all patients undergoing implantation of TSSPCIOL were reviewed. Patients with diagnosed glaucoma, diabetic retinopathy, macular degeneration, history of recurrent uveitis, corneal haze or central corneal scars were excluded. For the final analysis, 70 eyes out of a total of 75 were selected. Main outcomes of interest were pre and postoperative visual acuities and surgical complications. SPSS 21 was used for data analysis. Pre-operatively, the average Best Spectacle-Corrected Visual Acuity [BSCVA] was 6/36 on the Snellen chart. This improved to 6/12 postoperatively. The mean improvement seen was 2.4 lines on the Snellen chart [p < 0.05]. Complications include transient intraocular pressure elevation in 25 eyes [36%], IOL tilt in 4 eyes [7.1%], Cystoid Macular Edema [CME] in 4 eyes [5.7%], vitreous haemorrhage in 2 eyes [2.9%], hyphema in 2 eyes [2.9%], uveitis in 1 eye [1.4%], and retinal detachment 1 eye [1.4%]. No IOL subluxation, suture erosion, iris capture, choroidal effusion or endophthalmitis was encountered and no re-operations were needed. TSSPCIOLs are a good management option for patients with aphakia in whom PC IOLs cannot be placed