Efficacy of intravitreal bevacizumab combined with pan retinal photocoagulation versus panretinal photocoagulation alone in treatment of proliferative diabetic retinopathy

Objective: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy

Methods: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], slit lamp examination of anterior and posterior segments. Optical coherence tomography [OCT] and fundus fluorescein angiography [FFA] were carried out and patients were divided in two groups [GP and GI]. Three monthly sessions of Pan retinal photocoagulation [PRP] using Pattern Scan Laser [PASCAL] alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab [IVB] was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups

Results: Seventy six eyes of 50 patients [38 in each group] were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47 +/- 6.08 years while that in group GI was 55.69 +/- 6.58. The magnitude of induced change in BCVA was 0.09 +/- 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 +/- 92.30 um and 117.50 +/- 93.82 um in group GP and GI

Conclusion: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME

Effect of axial length on peripapillary retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography

Objective: To determine the relationship between mean axial length and mean peripapillary retinal nerve fibre layer [RNFL] thickness using spectral domain optical coherence tomography [SD OCT] in healthy subjects

Study Design: Cross sectional study

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Data of 300 eyes of 300 healthy volunteers were collected at AFIO from December 2014 to August 2015 and analysed. Axial length and RNFL thickness of each volunteer was calculated using laser interferometer [IOL master] and SD OCT respectively. Eyes were divided in three groups based on axial length. Statistical analysis of the data were done using SPSS version 17.0

Results: Mean age of study population was 23.16 +/- 3.73 years. Mean axial length was 24.40 +/- 1.50 millimetres [mm]. Mean of average peripapillary RNFL thickness was 128.87 +/- 9.94 micrometres [micro m]. Mean peripapillary RNFL thickness of superior, inferior, nasal and temporal quadrant was 158.27 +/- 11.04 micro m, 152.92 +/- 14.54 micro m, 103.85 +/- 5.01 micro m and 100.45 +/- 11.59 micro m respectively. Mean RNFL thickness, as well as RNFL thicknesses of each quadrant was also significantly different between hypermetropic, emmetropic and myopic eyes [p-value<0.001]. There was also a strong negative correlation between axial length and peripapillary retinal nerve fibre layer thickness [r= -0.964, p-value<0.001]

Conclusion: Variation in axial length significantly affects the measurement of RNFL thickness and must be counted for, while diagnosing glaucoma on basis of thinning of RNFL

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure

Objective: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration [ONSF] in patients with raised intracranial pressure [ICP]

Methods: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015.Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure

Results: Thirteen [72.22%] patients underwent ONSF bilaterally, while five [27.78%] underwent unilateral ONSF. Best corrected visual acuity [BCVA] improved in 24 [77.4%], remained stable in four [12.9%] and deteriorated in three [9.7%] patients. Papilledema improved in 27 [87.1%] while remained stable in four [12.9%] according to Frisenscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant [p<0.001]. There was significant negative correlation [r= -0.434, p=.017] between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia

Conclusion: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema

Amniotic membrane transplantation in primary pterygium compared with bare sclera technique

To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation [AMT]. An experimental study. Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. A pilot study of 70 patients was conducted. Patients were divided in two groups. In group I, pterygium excision was done by bare sclera technique while in group II, AMT was done after excision. Patients were followed for 6 months. Proportion of recurrence of pterygium was noted in each group and compared with chi-square test with significance at p < 0.05. Number of patients who presented with recurrence of pterygium in group-I were 12 [37.5%] and in group-II were 4 [12.9%]. Chi-square tests showed that there was a statistically significant difference in frequency of recurrence between the two groups [p = 0.025]. AMT after excision of pterygium appeared to be safe and effective way of treating primary pterygium as compared to bare sclera technique due to lesser recurrence at 6 months

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness