Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema

To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. Interventional study. Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema [CSME], non-proliferative diabetic retinopathy [NPDR] and proliferative diabetic retinopathy [PDR] were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. The male to female ratio was 1:1.44. Out of 218 patients; 129 [59.2%] were males and 89 [40.8%] were females. CSME was found in 82 patients [37.6%] at first postoperative week which declined to 29 cases [13.3%] at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity [BCVA] gradually improved in each subsequent follow-up visit. Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed

Management of macular pucker

To document the outcome of macular pucker surgery in terms of improvement of visual acuity. Design: Interventional quasi experimental study. Setting: Ophthalmology Department, Civil Hospital, Karachi. Patients and Twenty-two patients with macular pucker underwent surgical repair. Pars plana posterior vitrectomy with epiretinal membrane peeling and internal limiting membrane peeling [maculorrhexis] was carried out. Postoperative follow-up was done for one year. Main outcome measure were visual acuity, causes and ocular complications. Data was analyzed using SPSS Version-10. Non-parametric sign test with chi-square statistic was used to compare the pre-operative and postoperative outcome. The macular pucker was successfully removed in 18 patients that revealed high statistical significance regarding improvement in visual acuity. Earlier, significant improvement [18 / 22 cases] was observed at three-month postoperative examination [p < 0.0001]. Insignificant [9/22] postoperative complications were noted at six-month postoperative follow-up. Metamorphopsia was relieved in 18 patients. Ten patients developed cataract, 4 patients developed increased intra-ocular pressure [transient] and two patients developed retinal detachment. Pars plana posterior vitrectomy with epiretinal membrane peeling and internal limiting membrane peeling [maculorrhexis] can successfully remove macular pucker, improve vision and relieve metamorphopsia