Correlation of intraocular pressure with ocular axial length after intravitreal injection of bevacizumab in diabetic macular edema

Objective: To determine the effect of Intravitreal injection of Bevacizumab on IOP in eyes of different axial lengths. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at AFIO Rawalpindi, from Sep 2013 to Jan 2014

Material and Methods: In this study 55 patients scheduled for intravitreal injection of bevacizumab for the treatment of diabetic macular edema were enrolled. An informed written consent was taken from all the patients. All patients underwent clinical ophthalmic examination including uncorrected distance visual acuity, corrected distance visual acuity, slit lamp bio-microscopy and fundus examination with 90 diopter lens. Axial length was measured before IVB using IOL master. Intra Ocular Pressure [IOP] was measured before and after 1 minute of administration of Intravitreal Bevacizumab [IVB] using Tono-Pen

Result: The mean age of patients was 54.51 +/- 7.53 years with minimum age of 43 years and maximum age of 70 years. There were 26 [47.3%] male and 29 [52.7%] female patients. The mean axial length of the examined eyes was 21.12 +/- 1.80 with range of 6 mm. Mean IOP before IVB was 13.09 +/- 1.62 mmHg. After 1 minute of IVB, mean IOP was 32.8 +/- 6.19 mmHg. A good correlation was observed between the axial length and intraocular pressure rise after 1 min i.e. Pearson correlation [r.] = -0.914 [p-value <0.001] with R2 = 0.835

Conclusion: There is significant rise in IOP after intravitreal injection of bevacizumab in patients with short axial length as compared to long axial length

Correlation between central corneal thickness and visual fielddefects, cup to disc ratio and retinal nerve fiber layer thickness in primary open angle glaucoma patients

Objective: To evaluate the correlation between Central Corneal Thickness [CCT] and Visual Field [VF] defect parameters like Mean Deviation [MD] and Pattern Standard Deviation [PSD], Cup-to-Disc Ratio [CDR] and Retinal Nerve Fibre Layer Thickness [RNFL-T] in Primary Open-Angle Glaucoma [POAG] patients

Methods: This cross sectional study was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from September 2015 to September 2016. Sixty eyes of 30 patients with diagnosed POAG were analysed. Correlation of CCT with other variables was studied

Results: Mean age of study population was 43.13 +/- 7.54 years. Out of 30 patients, 19 [63.33%] were males and 11 [36.67%] were females. Mean CCT, MD, PSD, CDR and RNFL-T of study population was 528.57 +/- 25.47microm, -9.11 +/- 3.07, 6.93 +/- 2.73, 0.63 +/- 0.13 and 77.79 +/- 10.44microm respectively. There was significant correlation of CCT with MD, PSD and CDR [r=-0.52, p<0.001; r=-0.59, p<0.001; r=-0.41, p=0.001 respectively]. The correlation of CCT with RNFL-T was not statistically significant [r=-0.14, p=0.284]

Conclusion: Central corneal thickness had significant correlation with visual field parameters like mean deviation and pattern standard deviation, as well as with cup-to-disc ratio. However, central corneal thickness had no significant relationship with retinal nerve fibre layer thickness

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

Objective: To determine the efficacy of topical Nepafenac [0.1%], administered post-operatively in prevention of Macular Edema [ME], after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy [NPDR]

Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness [CMT] of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography

Results: Mean age of study population was 60.97 +/- 4.91 years. Out of 60 patients, 34 [56.7%] were males and 24 [43.3%] were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5 +/- 10.86microm, 228.83 +/- 14.56 microm, 2.33 +/- 10.45 microm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93 +/- 11.69microm, 236.17 +/- 16.16 microm, 12.23 +/- 12.40microm and 5.51% respectively. ME was observed in one patient [3.3%] in Group-1, and seven patients [23.3%] in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant [p<0.05]

Conclusion: 0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy [NPDR]

Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results

Objective: The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking [TE-CXL] with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking[CXL] in adult Pakistani population with progressive keratoconus

Methods: This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel [[riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose] and vibeX Xtra [riboflavin 0.25%] [Avedro, USA]] were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities [UDVA, CDVA], spherical equivalent [SE], astigmatism, pachymetry at thinnest point [Pachy thin], apex keratometry [Kmax], simulated and steep keratometry [Sim K, steep K] were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm[2] for 10 min [total dose 30 mW/cm[2]]

Results: The mean age of the patient was 24.54 +/- 5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points [p=0.000, 0.004, 0.000, 0.004 respectively]. Kmax and pachy thin were significantly reduced over baseline at 1 year [p=0.000, 0.004 respectively]. Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported

Conclusion: Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus