Effect on Corneal Dioptric power in patients undergoing 23G Suture less plana vitrectomy

Objective: To determine the effect of 23-gauge pars plana vitrectomy on corneal dioptric power through a comparison of difference in pre- and post- surgery keratometry

Study Design: Prospective non-comparative interventional type

Place and Duration of Study: The study was conducted at the Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi from Dec 2016 to Jul 2017

Material and Methods: We studied 33 patients [33 eyes] who underwent 23-gauge vitrectomy with mean age of 46.4 +/- 12.8 years. Among them 13 were females and 20 were males. These patients were divided in four groups on the basis of pre-surgical diagnosis. 18 [55%] patients had rhegmatogenous retinal detachment, 9 [27%] had macular holes 3 [9%] with Vitreous hemorrhage and last 3 [9%] had dislocation of intraocular lens. Total vitrectomy was performed in all patients by standard 23G pars plana vitrectomy [PPV] procedure as used with three scleratomies and tunnel shaped incision. Keratometry readings before the surgery and at the end of 1st, 6th and 12th post procedural weeks were recorded in horizontal [K1] and vertical meridian [K2] by utilizing topcon auto kerato-refractometer

Results: The pre-operative dioptric power of cornea in horizontal and vertical meridian [K1 and K2 respectively] was statistically compared with post- operative dioptric power of cornea at the end of 1st, 6th and 12th postoperative weeks. At the end of first post- operative week there was significant difference between pre and post-operative corneal dioptric power with horizontal p-value<0.05 and vertical <0.04; leading to astigmatism. However, at the end of 6th and 12th post procedural weeks there was no significant difference between pre and post-operative corneal dioptric power which is evident with insignificant p-values. The p-value at the end of 6[th] post-operative week was 0.521 and 0.57 for K1 and K2 respectively. At the end of 12th post-procedural week these values are 0.854 and 0.941 for K1 and K2 respectively. Clinically these patients did not have any sign or symptoms of astigmatism

Conclusion: 23G was found safe procedure in vitreoretinal surgery with no insignificant change in corneal dioptric power except in cases in which silicone oil was used. However, due to small study group and short follow up further studies with longer follow-ups are required to establish the long-term changes in corneal dioptric power after 23G suture less vitrectomy

Management of ocular complications in Terson's syndrome

To evaluate and manage the patients presenting with vitreous hemorrhage and intracranial hemorrhage simultaneously. Prospective observational study. A total of 6 patients presenting with vitreous hemorrhage were included in this case series. Study was conducted at Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity, slit lamp examination and dilated fundus examination was done. Ultrasound B scans and CT brain was done in all patients. According to the clinical findings a management plan was formulated. Findings were recorded on a proforma for analysis. A total of 12 eyes of 6 patients [all males, age range 25-60 years were included in the study. Vision improved in two cases by conservative management and in one case by 23G pars plana vitrectomy. Vision remained the same on in one case, deteriorated in one and one patient was lost to follow up. Ocular complications in Terson's syndrome can have good outcome if treated conservatively and/or surgically

Visual outcomes of Harada disease

To evaluate visual outcome of patients diagnosed with Harada Disease. A prospective observational study A total of 4 patients presenting with exudative retinal detachment were included in this case series. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular exam including visual acuity, slit lamp examination and dilated fundus examination was done. Fundus photos and Optical Coherence Tomography pre and post treatment was done in almost all patients. Patient A, 37/F, presented with VA CF OD and CF in OS and B/L exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA was improved to 6/6 in Right eye and 6/9 in Left eye. Patient B, 35/F, presented with VA CF in both eyes and exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA of both eyes was 6/6P.Patient C, 38/F, presented with BCVA 6/60 in both eyes and exudative retinal detachment. After 8 weeks of treatment B/L retina was flat and BCVA was 6/6 in both eyes. Patient D 20/F presented with VA CF in both eyes and B/L exudative retinal detachment. At 2nd follow-up visit [Post treatment 14 days] B.C.V.A. was 6/6P OD and 6/9 in OS. Patient is still under treatment and follow-ups. The visual prognosis is good for patients with Harada disease and the disease may manifest itself with minimum neurological features

Diagnostic role of polymerase chain reaction in active uveitis

To evaluate the role of polymerase chain reaction [PCR] for detection of Mycobacterium tuberculosis in the vitreous humor samples obtained from eyes with active uveitis. A total of 15 patients were included in the study with the signs of anterior, intermediate or posterior uveitis. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity using Snellen's chart, slit lamp examination and detailed dilated fundus examination was done. All patients were advised complete blood count with ESR, Mantoux test and chest x-ray. Vitreous fluid samples were taken and sent for polymerase chain reaction for Mycobacterium tuberculosis [MTB] DNA. Vitreous samples from 15 [15-45 +/- 5yrs] patients, 9 male and 6 female, with signs of anterior, intermediate or posterior uveitis on slit lamp examination were taken and sent for Mycobacterium tuberculosis DNA on PCR. In 4 out of 15 samples [26.6%] Mycobacterium tuberculosis DNA on PCR was detected. Out of the 15 patients, 6 were females [15-45 years] with 1 [16.6%] positive PCR and 9 [15-40years] males with 3 [33.3%] positive PCR for Mycobacterium tuberculosis DNA. 2 of the male patients were positive for Toxoplasma and one of them was also positive for Cytomegalo virus on TORCH test. PCR can be effectively used for the diagnosis of intraocular tuberculosis in the presence of clinically identified cases of uveitis