Factors having implications on re-retinal detachments after silicone oil removal.

Aim: To investigate factors having implications on re-retinal detachments (reRD) after silicone oil removal (SOR). Materials and Methods: A retroprospective study of 412 eyes (with attached retina after vitrectomy with silicone oil for rhegmatogenous RD) which underwent SOR was conducted and were followed up for six months after SOR. They were studied for various factors like encirclage, 360° retinopexy, oil emulsification at the time of SOR, duration of oil tamponade and previous retinal surgeries prior to SOR with their implications on reRD after SOR. Results: Encirclage, 360 laser barrage, both, emulsification of oil (P=0.021, P=0.001, P=0.001, P=0.001, respectively) were associated with lower risks of reRD after SOR whereas duration of tamponade (P=0.980) was not. Conclusion: Factors like encirclage, 360 retinopexy, their combination, oil emulsification reduced the incidence of re RD after SOR whereas duration of tamponade does not have statistical significant correlation with re RD after SOR.

Surgical choroidal neovascular membrane removal in the era of anti-vascular endothelial growth factor agents.

Intravitreal anti-vascular endothelial growth factor (VEGF) agents have obtained acceptance as the mainstay in the management strategy of subfoveal choroidal neovascular membranes (CNVM) due to varying etiologies. Few drawbacks include need for repeated intravitreal injections, with its adjunct risks, and the lack of a predefined treatment end point, which can cause doubts and uncertainty in the mind of the patient. Furthermore, it remains a significant financial burden for the patient. Herein we report our data of three patients who were reluctant for further re-injections of anti-VEGF agents and were therefore offered surgical removal of the CNVM by submacular surgery as an alternative treatment plan.

A comparative debate on the various anti-vascular endothelial growth factor drugs: pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin).

Wet age-related macular degeneration and diabetic retinopathy are pathological consequences of vascular endothelial growth factor (VEGF) release as a reaction to deficiency of oxygen and nutrients in the macular cells. Conventional treatment modalities have been constrained by limited success. Convincing evidence exists that targeting VEGF signaling is a significant approach for the therapy of these ocular angiogenesis-dependent disorders. We have come a long way since the approval of the first angiogenesis inhibitors in medicine. The clinical use of these drugs has provided enormous tempo to clinical and pharmacological research. It has also significantly altered patient outcome and expectations. In the following brief, we will discuss the development and emergence of these drugs as well as the anticipated future course based on evidence.

Role of early radial optic neurotomy in central retinal vein occlusion.

PURPOSE: To determine safety, clinical and visual results, and potential complications of early radial optic neurotomy (RON) surgery in eyes with central retinal vein occlusion (CRVO), with relative afferent pupillary defect and visual acuity MATERIALS AND METHODS: This prospective, interventional case-series included 24 patients of CRVO who underwent RON within 2 months of disease onset. The preoperative examination included slitlamp biomicroscopy, fundus photography and fluorescein angiography. Foveal thickness was measured using optical coherence tomography (OCT) in the last 6 eyes only. In each case, RON was performed after informed consent. Two radial incisions were placed in the nasal quadrant of the optic disc, using a micro-vitreoretinal blade. The postoperative change in vision, clinical picture, fundus photographs, angiograms and foveal thickness by OCT were the main outcome variables studied. The Wilcoxan signed test was used to assess the results. RESULTS: Average symptom duration was 37.8 +/- 15.2 days (range 15-60 days, median: 34.5 days) and follow-up 7.7 +/- 2.1 months (range 1-12 months, median: 8 months). Visual outcome: 2 (8.33%) eyes each had fall and preservation of pre-RON visual acuity respectively. Twenty eyes (83.33%) showed increase in vision (of average 3 lines). Pre and postoperative vision ranged from 0.017-0.1 (average:0.061) and 0.017-0.667 (average: 0.17) respectively (P < 0.05). Clinical and angiographic outcome: decline in macular oedema, decreased or resolved intraretinal haemorrhages, resolution of venous dilatation and disc oedema could be appreciated in all cases. Foveal thickness: average pre and postoperative foveal thickness was 834.17 microm and 556.17 microm respectively (P < 0.05) in the 6 eyes where it was measured before and after RON. One eye developed retinal-detachment. CONCLUSION: Radial optic neurotomy is better than the natural course in eyes with CRVO, with vision < 6/60.

Juvenile rhegmatogenous retinal detachment.

PURPOSE: To review the clinical features, evaluate visual, and anatomical outcomes and potential complications following surgery for rhegmatogenous retinal detachment (RRD) in juveniles. METHODS: Retrospective, consecutive case series of children and young adults (birth through 18 years) who underwent surgerys for RRD between February 1999 and January 2002. RESULTS: The authors reviewed a consecutive series of 111 eyes of 105 juveniles [86 (77.47%) eyes belonged to male and 25 (22.52%) to female subjects] operated for RRD. The mean age of patients was 13.62 years. Bilateral retinal detachment was present in 12 (10.8%); 51 (46%) patients had some form of bilateral ocular pathology at initial presentation. The two most common aetiologies were non-penetrating trauma (45.04%) and myopia (41.44%). Decreased vision was the most frequent symptom. The mean duration of symptoms was 165.36 days. The commonest retinal break was a retinal hole (34.23%). Late diagnosis was common, evidenced by high frequency of macular detachment (97.29%) and proliferative vitreoretinopathy (PVR) (45.94%) at initial presentation. The most commonly performed primary surgery was scleral buckle (61.26%). The average postoperative follow-up after the first procedure was 10 months (range 8-19 months). Final retinal reattachment was accomplished in 78.37% (87/111) with a mean of 1.29 surgeries per eye. Improvement, no change and decline in vision was seen in 50 (48%), 32 (31%) and 22 (21%) eyes respectively. CONCLUSION: Non-penetrating injury and myopia were the most common cause for RRD in juveniles. Fellow eyes commonly had vision-threatening abnormalities. Final anatomical and visual recovery rates were encouraging despite late initial presentation and high rates of macular detachment, and PVR at initial presentation.

Transpupillary thermotherapy for treatment of choroidal neovascularization secondary to age-related macular degeneration in Indian eyes.

AIM: To evaluate the efficacy of transpupillary thermotherapy (TTT) for treatment of subfoveal choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD), and to define accurate power settings for this procedure in Indian eyes. METHODS: A prospective, nonrandomised study of 160 eyes of 144 patients with subfoveal CNV. The laser settings included 2 mm spot and 300 mw power or 3 mm spot and 400-600 mw power. Two separate 3 mm spots were used in larger lesions. The treatment was given for 60 seconds at each point. RESULTS: Ninety-nine eyes had classic membranes and 61 eyes had occult membranes. Following treatment, 79 of 99 (79.8%) classic and 52 of 61 (85%) occult membranes regressed. Visual improvement (> or = 2 lines) was seen in 29 (29.3%) eyes and 12 (19.6%) eyes; visual stabilisation (1 line) in 39 (39.4%) eyes, and 35 (57.4%) eyes; and reduction of vision (< or = 2 lines) in 31 (31.3%) eyes and 14 (22.9%) eyes with classic and occult membranes respectively. Mean follow-up was 12 months. One patient suffered inadvertant foveal burn. CONCLUSION: TTT is effective in the management of subfoveal membranes in Indian eyes. They respond to lower energy levels compared to the Caucasian eyes.