A Rare Case of Acrodermatitis Enteropathica in a One Year Old Child.

Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder caused by zinc deficiency.[1] It can be classified as primary zinc deficiency, genetically based zinc deficiency (classical, AE, acquired zinc deficiency of lactogenic origin), and acquired secondary zinc deficiency.[2] Genetic zinc deficiency is associated with the defects in two zinc transporters, of which one is involved in intestinal zinc uptake ZRT- and IRT-like Protein-4 (ZIP), causing classical and AE. The other is responsible for zinc secretion in breast milk zinc transporter-2 (ZnT) resulting in zinc deficiency of lactogenic origin.[3] Here, we have discussed and reviewed the clinical aspects and probable role of zinc transporters in the manifestation of AE.Acrodermatitis enteropathica (AE), manifests as acral and periorificial dermatitis, alopecia, intractable diarrhoea, and failure to thrive. It is classified as primary zinc deficiency, genetically based deficiency, and acquired secondary deficiency. We hereby report a case of genetically based AE in a one year old child. After reviewing the literature, we have also emphasized the possible role of genetics in the manifestation of AE

The Effect of Functional Endoscopic Sinus Surgery on Pulmonary Functions of Patients with Pulmonary Diseases and Sinusitis

Background: Coexistence of upper and lower respiratory diseases is common. This coexistence of sinus disease and pulmonary diseases was first described by Galen in the second century. Since chronic sinusitis and pulmonary diseases are closely related, surgical treatment of chronic sinusitis could improve pulmonary functions and reduces the need for medication. This study was made to assess the efficacy of FESS on pulmonary functions of patients with chronic sinusitis and pulmonary diseases. Methods: The study was conducted in the Department of ENT of a tertiary care centre. Pulmonary function tests: Included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and mid expiratory phase of the forced expiratory flow (FEF 25%-75%) were observed of each patients before and after FESS using a spirometer. Results: Scoring results for COPD before and after FESS were shown in Table 5, the score for mild, moderate and severe COPD were 44.4%, 33.3%, 22.2%; and improved postoperatively to 11.1%, 16.6%,11.1% respectively. Scoring results for asthma before and after FESS are the score for mild, moderate and severe asthma were 27.08%,50%, 22.9%; and improved postoperatively to 8.3%, 25%, 29.1% respectively. The mean of spirometric parameters before and after FESS shows an improvement as follows: The FVC was improved from72 ± 3.78 to 82 ± 4.12, FEV1 from 70 ± 4.08 to 89 ± 4.56 and FEF 25-75% from 76 ± 2.92 to 88 ± 2.65 with statistical significance for all parameters p <0.001. Conclusion: Findings of the current study suggest that FESS is effective in improving pulmonary functions in patients suffering from pulmonary diseases as well as sinusitis with or without nasal polyp. Therefore, we strongly suggest that surgery for the sinusitis earlier in the course of the disease gives a far better outcome and could be beneficial for the pulmonary diseases.

Urgent ureteroscopies in acute ureteric colic requiring intervention

Background: Urolithiasis, in general, constitutes a significant volume of the daily clinical activities in our institution

Objective: To evaluate the outcome of ureteroscopies performed in patients admitted acutely with symptomatic ureteric calculi compared with elective ureteroscopies

Design: A retrospective review

Setting: Department of Urology, King Hamad University Hospital, Bahrain

Method: All ureteroscopy [URS] procedures performed for symptomatic ureteric calculi between 1 January 2013 to 31 December 2013 were reviewed. These procedures were divided into two groups: urgent URS and elective URS group. Both groups were comparable in personal and stone characteristics

Result: One hundred ninety-five procedures were performed on 167 patients. One hundred twenty-seven [65.1%] procedures were urgent and 68 [34.9%] were elective. The cohort included 131 males and 36 females with a mean age of 41.5 years, a range of 19 to 74. One hundred fortynine [76.4%] procedures were performed on male patients, while 46 [23.5%] were performed on female patients. The mean stone size for patients undergoing urgent URS was 7.7 mm and 8.3 mm for elective procedures; approximately one-third of patients had more than one stone. Eighty-one stones in the urgent group were distally located; fifty-seven were in the elective group. The most common indication for urgent URS was pain refractory to injectable analgesia. LASER was used in 182 [93.3%] procedures, 179 [91.7%] procedures were urgent. Seventeen [8.7%] complications were documented for urgent URS and 8 [4.1%] for elective cases, no statistical significance, P value = 0.74

Conclusion: Urgent URS procedure is a safe and cost effective option compared with Elective URS. It should be the preferred option when resources and expertise are available

Seasonal variation in stroke in a teaching hospital of Khyber Pakhtunkhwa

Objective: to determine seasonal variation in the occurrence of stroke and its subtypes [ischemic stroke and hemorrhagic stroke] during summer and winter and to observe the frequency of common risk factors for stroke

Methodology: the present descriptive study was conducted in the Department of Medicine, MTI Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan, over a period of one year from 1st January 2014 to 31st December 2014. A total of 321 patients of any age and either gender were included. The diagnosis was established based on history, clinical examination and supplemented by CT scan of brain

Results: in winter 58.56% of patients and in summer 41.48% of patients were presented. Ischemic stroke was present in 66.04% patients while hemorrhagic stroke in 33.95% patients. Males had more strokes as compared to females [60.75% Vs. 39.25%]. In males highest number of strokes was found in 60-69 age groups whereas in females it was in 50-59 age groups. In winter the strokes increased in all age groups comparative to summer. Hypertension [34.26%] was the highest risk factor for stroke

Conclusion: stroke showed seasonal variation. Winter season was associated with increased frequency of stroke and its subtype of hemorrhagic stroke. There was variation of gender, season and stroke types in different age groups. Hypertension was found to be the highest risk factor

Leiomyoma of the ureter: a conservative approach

We present a case of bladder leiomyoma and concurrent left lower ureteric leiomyoma in a sixty-two year old Bahraini male without any other comorbid conditions. He had infrequent hematuria for the last two years; it was associated with burning and discomfort during urination, frequency and urgency. Urine culture did not reveal any growth. Contrast CT abdomen revealed a mass in the bladder and lower ureteral narrowing with hydronephrosis. Histopathology of both lesions revealed leiomyoma. Limited resection with subsequent stenting saved patient from having major surgery. The patient was followed up after removal of left ureteric stent. He had MAG3 [Mercapto Acetyl Triglycine] scan, which was satisfactory with no restriction to drainage

Non-culture-based diagnostic methods for the diagnosis of invasive candidiasis: are they helpful to clinicians?

Invasive candidiasis in immune-compromised patients is associated with high attributable mortality. Early detection of candidemia and accurate identification of Candida species are essential pre-requisites for improved prognosis. Since clinical presentation is non-specific and blood culture-based methods lack sensitivity, detection of immunological and molecular markers has provided an alternative for early diagnosis of invasive candidiasis. Serial estimations of these biomarkers have also proved useful to initiate pre-emptive therapy in suspected patients before clinical signs appear and to monitor response to therapy. Antigen-based methods include detection of beta-D-glucan [panfungal marker] and Candida mannan [genus-specific marker]. Detection of both, Candida mannan and anti-mannan antibodies has higher sensitivity. While false positive / negative results remain a problem, these markers provide a useful adjunct to the diagnosis if performed in select patient population. Recent advances have also been made in nucleic acid-based detection methods. A commercial real-time PCR assay [Light Cycler Septi Fast] for detection of clinically important Candida spp. in blood specimens within six hours is now available. Molecular methods have also resulted in speciesspecific identification of yeast isolates within an hour. While these advances aid in early and specific diagnosis of candidemia and invasive candidiasis, further evaluation of these approaches in different clinical settings is also needed

Frequency and clinical presentations of hepatitis B and C virus co-infection in tertiary care hospital

To study the frequency and clinical presentations of hepatitis B and C virus co-infection in a tertiary care hospital. This descriptive study was conducted at Lady Reading Hospital Peshawar, Pakistan from January 2011 to January 2012. A total of 52 patients with positive HBsAg and anti HCV antibodies were included in the study. Clinical, demographic, laboratory data and results of the liver and abdominal ultrasound were recorded. Furthermore, both qualitative and quantitative PCR were performed. Data was analyzed using SPSS v 16. P

Antibiotic sensitivity pattern of Salmonella serotypes in patients with enteric fever in a teaching hospital

To determine the sensitivity of salmonella serotypes to antibiotics in patients with enteric fever. This descriptive study was carried out in medical units of Lady Reading Hospital Peshawar from January 2008 to December 2011. Patients were included by consecutive sampling technique. Blood samples were collected from patients with clinically suspected enteric fever and were sent to hospital laboratory for culture and sensitivity[C/S]. Salmonella colonies were identified using standard biochemical tests including fermentation of glucose, negative urease reaction, lysine decarboxylase, negative indole test, H2S production, and fermentation of dulcitol. Serological confirmation tests included polyvalent antisera for flagellar and somatic antigens. Antibiotic susceptibility was checked by Kirby- Bauer disc diffusion method for 22 antibiotics. Blood cultures of 106[61%] patients out of 173 patients were positive for salmonella species. Salmonella Typhi was found in 54.7% while salmonella paratyphi A in 32.1% and B in 13.2%. The sensitivity of salmonella species for ceftriaxone and ceftazidime was found to be 100%, followed by imipenem[98.1%] and meropenem [96.2%]. The sensitivity of drugs like amoxicillin, chloramphenicol and co-trimaxazolewere 2.8%, 12.3% and 22.6% respectively. Regarding quinolones, most sensitive was moxifloxacin49.1%, followed by ciprofloxacin 48.1%. Salmonella typhi was fully sensitive to meropenum, ceftriaxoneand cetazidime while paratyphi A or B was fully sensitive to ceftriaxone, ceftazidime and imipenem. The sensitivity of salmonella species was very low to the first line agents such as amoxicillin, chloramphenicol and co-trimaxazole. Salmonella species were fully sensitive to third generation cephalosporins such as ceftriaxone and ceftazidime

PubMed-based quantitative analysis of biomedical publications in the SAARC countries: 1985-2009

To conduct a geographical analysis of biomedical publications from the South Asian Association for Regional Cooperation [SAARC] countries over the past 25 years [1985-2009] using the PubMed database. A qualitative study. Web-based search during September 2010. A data extraction program, developed by one of the authors [SFS], was used to extract the raw publication counts from the downloaded PubMed data. A search of PubMed was performed for all journals indexed by selecting the advanced search option and entering the country name in the 'affiliation' field. The publications were normalized by total population, adult illiteracy rate, gross domestic product [GDP], secondary school enrollment ratio and Internet usage rate. The number of PubMed-listed papers published by the SAARC countries over the last 25 years axilla 141,783, which is 1.1% of the total papers indexed by PubMed in the same period. India alone produced 90.5% of total publications generated by SAARC countries. The average number of papers published per year from 1985 to 2009 was 5671 and number of publication increased approximately 242-fold. Normalizing by the population [per million] and GDP [per billion], India [133, 27.6%] and Nepal [323, 37.3%] had the highest publications respectively. There was a marked imbalance among the SAARC countries in terms of biomedical research and publication. Because of huge population and the high disease burden, biomedical research and publication output should receive special attention to formulate health policies, re-orient medical education curricula, and alleviate diseases and poverty

Medical record documentation of patients admitted to a medical unit in a teaching hospital

To compare the standards of documentation with audit study 2005 and to determine that changes have been implemented. This descriptive audit study was conducted in the medical C unit of Lady Reading Hospital, Peshawar - Pakistan from 1[st] January 2010 31[st] December 2010. Out of 3684 patients admitted during the year2010. 200 case notes were randomly selected and subjected to re-audit. The clinical notes were broadly analysed for documentation of six parameters. Each parameter's documentation was to be graded as very good, good, average, poor or not documented. Personal bio-data was documented average in 195[97.5%] cases; History and examination were average in 98[49%] cases and good in 85[42.5%] cases; Investigations were documented good in 140[70%] and average in 13[6.5%] cases. Progress notes were good in130[65%]cases and treatment was documented good in194[97%]cases.In105[52.5%]charts, one or more of the six selected items were not documented at all. Progress notes were not written in 48[24%], investigations in35 [17.5%].diagnosis in16 [8%], history and examination in4[2%],bio-data in 2[1%]and treatment in1[0.5%] of the case notes. For comparison between audit 2005 and present audit 2010,the P value was 0.05. No change was made in the previous five years and no steps of improvement have been implemented

Infective endocarditis: a rare cause of acute coronary syndrome

This is a case report of a 26 years old female who presented in emergency with sudden onset of chest heaviness and dyspnoea. She had suffered a stroke in the past and was treated with anti-tuberculous medication. Her ECG revealed STelevation myocardial infarction and thrombolysis was performed but was unsuccessful. Further workup during in-hospital stay revealed evidence of infective endocarditis and Streptococcus species were isolated. She was started on penicillin and gentamycin with good recovery. This case presented a management problem during initial presentation as there was insufficient data on thrombolysis during such situation. It is also a diagnostic problem as the initial picture was dominated by acute coronary syndrome. There is need to develop consensus based on expert opinion about management in such situations

Visual outcome and complications after modified Cionni endocapsular tension ring and intraocular lens implantation in eyes with subluxated lenses

To evaluate the visual outcome and complications after modified capsular tension ring [CTR] and intraocular lens implantation [IOL] in eyes with subluxated lenses. This is a prospective case series managed at Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Thirty three eyes with subluxated lenses having zonular weakness less than 180 degrees were implanted modified CTR and IOL implant after lens matter aspiration. Main outcome measures were postoperative best-corrected visual acuity [BCVA], IOL centration, and complications. The age of 24 patients ranged from 2.5 to 38 years, mean 13.34 +/- 9.8 years. The follow up period was 20.87 +/- 2.40 months. The mean pre operative logMAR BCVA was 0.98 +/- 0.52 SD and the mean post operative logMAR BCVA was 0.38 +/- 0.32 SD [p value 0.000]. Intractable secondary glaucoma was seen in 01[03%] eye. One eye [03%] needed surgical anterior capsulotomy for anterior capsular phimosis. At the last follow-up visit, the modified CTR provided excellent centration and positioning in all cases. Modified CTR and primary IOL implantation in the capsular bag gives good visual outcome with no serious complications. However, it requires a highly experienced surgeon and sufficient patience for a relatively time-consuming procedure

Presentation of amblyopia at a tertiary care hospital in Karachi

To study the type and density of amblyopia in children visiting pediatric ophthalmology and strabismus unit in the department of ophthalmology at Civil Hospital Karachi. This prospective study was conducted in pediatric ophthalmology and strabismus unit of department of ophthalmology Civil Hospital Karachi, from June 2009 to May 2010. All children under 15 years of age diagnosed with different types of amblyopia underwent standard procedure of orthoptic assessment and were divided into four pediatric age groups. Statistical analysis by simple descriptive analysis was carried out. During the study period, 239 patients were diagnosed with different types of amblyopia including 128 [53.55%] cases with refractive amblyopia, 58 [24.26%] cases with strabismic amblyopia and 53 [22.17%] cases with deprivation amblyopia. Severe amblyopia was seen in 59 [24.68%] cases with refractive errors, 25 [10.46%] cases with strabismus while all 53 [22.17%] cases with deprivation amblyopia had severe density of amblyopia. Amblyopia is a common cause of visual impairment in pediatric age group. Refractive amblyopia is the most frequent type while children with stimulus deprivation have higher chances of having severe density amblyopia. Children with amblyopia should be diagnosed at an early age for successful treatment. An effective screening program for early diagnosis and prompt treatment is recommended to prevent our future generation from visual impairment

Retinoblastoma: clinical picture and grouping at the time of first presentation

To study the clinical picture and staging of retinoblastoma at the time of first presentation. This prospective study of consecutive case series was conducted in the department of ophthalmology, Dow University of Health Sciences and Civil Hospital, Karachi, from October 2007 to September 2009. Twenty patients with unilateral or bilateral retinoblastoma were examined during this period. Parents of every patient were interviewed in detail. Patients were examined under general anesthesia to measure corneal diameter, anterior chamber examination with hand held slit lamp. IOP was recorded with Perkin's tonometer; fundoscopy with indentation was performed with indirect ophthalmoscope. International intraocular classification of retinoblastoma [IICR] was used for grouping of retinoblastoma. Ultrasonography and neuroimaging were performed in all cases. Twenty patients were found to have retinoblastoma with a mean age of 3.86 years [SD=2.56] with a minimum of one year and maximum of 12 years. Out of 20 patients there were 12 [60%] male and 08 [40%] female. Thirteen [65%] were from urban and 07 patients [35%] from rural areas. Family history of retinoblastoma was positive in two patients [10%].Bilateral retinoblastoma was present in 10 patients [50%] and unilateral retinoblastoma in other 10 patients [50%].The most common clinical presentation of retinoblastoma was Leukocoria that was seen in 12 patients [60%] followed by anterior segment involvement in three patients [15%], orbital Cellulitis in three patients [15%], strabismus in one patient [5%] and phthisis bulbi in one patient [5%]. Among 10 patients with unilateral retinoblastoma 60% had group E, 20% had group D and another 20% with group C of IICR at the time of presentation. Twenty eyes of 10 patients with bilateral retinoblastoma showed group E in 13 eyes [65%], group D in four eyes [20%], group C in two eyes [10%] and group A in one eye [5%]. Leukocoria is the commonest clinical presentation of retinoblastoma. In developed countries 95% of children with retinoblastoma present with limited stage disease and are cured while in our set-up most patients still present with advanced diseases and cure rates are very low. Educational programs are required to educate general public, parents of retinoblastoma patients. Collaboration with pediatricians to check red reflex on every well baby visit is mandatory for early diagnosis

A comparative study on intertidal faunal biodiversity of selected beaches of Mumbai coast.

Comparative study has been done to examine the biodiversity and ecological status of the intertidal region of Tata Institute of Fundamental Research (TIFR), Bandstand and National Centre for Performing Arts (NCPA) rocky beaches in Mumbai, West coast of India. A total of 50 species of intertidal organisms were recorded from these shores. Shannon and Simpson’s diversity index, Margalef’s richness index and Pielou’s evenness index indicated different level of ecological state of the shore in different months. Dendrograms and 2-D non metric MDS ordination from Bray-Curtis similarity matrix of occurrence of intertidal organisms from these sites showed highest similarity and combination pattern of occurrence between Nerita oryzarum and Planaxis sulcatus in TIFR and Bandstand shore. Nerita oryzarum and Tactarius malaccanus at NCPA shore. Abundance/ biomass comparison (ABC) method of determining level of disturbance also pointed towards the polluted status of these shores. Study concludes that though these beaches are highly disturbed due to anthropogenic activities, they still support a rich intertidal biodiversity which need immediate attention for protection and conservation.

Stargardt's disease: clinical presentation and fundus fluorescein angiographic findings

Objective: To document the clinical presentation and fundus fluorescein angiographic findings in Stargardt's disease

Methodology: This descriptive study was conducted at the Department of Ophthalmology Unit-I Civil Hospital Karachi and Unit III Lyari General Hospital Karachi of Dow University of Health Sciences from June 2004 to May 2008. Patients were selected from the out patient department of Sindh Govt. Lyari General Hospital and Civil Hospital Karachi fulfilling the inclusion criteria. Sociodemographic data and family history were obtained and patients subjected to complete ophthalmic examination of anterior and posterior segment and Fundus Fluorescein Angiography

Results: Thirty patient were found to have Stargardt's disease. Mean age was 18.4 +/- 6.9 years. Twenty two [73.4%] patients were found to be 20 years of age or below. Males [18 [60%]] outnumbered the females [12[40%]]. Visual acuity at presentation revealed a symmetric loss of vision in right and left eyes [P=0.410 at 99% CI]. Macula showed atrophic lesion in 12 cases [40%], beaten bronze in 13 [43.3%] cases and varnished appearance in 5 [16.7%] cases. Retinal flecks were found in 18 [60%] patients only. Fundus fluorescein angiography revealed dark choroids and elliptical hyperfluorescent lesion at the macula in all the patients. Tiny hyperfluorescent areas not corresponding to the area of flecks were found only in 18 [60%] patients

Conclusion: We conclude that Stargardt's disease has varied presentation and there is a familial and genetic predilection

Frequency of different types of paediatric ocular trauma attending a tertiary care paediatric ophthalmology department

To assess the etiological factors and circumstances associated with the occurrence of eye injuries in children attending a tertiary care pediatric ophthalmology department. This study was conducted at the Department of Pediatric Ophthalmology, Civil Hospital, Karachi from August 2007 to July 2009. Personal information, clinical findings and management plan was recorded on a prescribed performa. Variables studied included: age, sex, date of injury, place of injury, involved eye, circumstance and mechanism of injury, initial visual acuity and immediate management. A total of 462 patients under the age of 16 years presented with ocular trauma. There were 297[64.3%] males and 165[35.7%] females. Mean age was 7.03 +/- 3.61 years. Most cases 198 [42.9%] belonged to the schoolgoing age group [6 to 11years]. The injuries occurred most frequently at home [215 patients, 46.5%].Blunt trauma occurred in 228[49.4%] cases followed by penetrating in 162[35.1%] cases. Injuries restricted to the eyelid occurred in 61 [13.2%] accidents, closed globe injury occurred in 338 [73.1%] and open globe injury in 63 [13.7%] accidents. Visual acuity was better than 6/12 in 245 [53.0%] children. Two hundred and fifteen children [46.5%] were prescribed only general measures like pressure patching, warm or cold compresses antibiotics or lubricant eye drops. Surgical management was required in 121[26.2%] patients. This study has shown frequencies of different type of ocular trauma which can be minimized by taking preventive measures as adopted in developed countries

Clinical presentation of vernal keratoconjunctivitis [VKC]: a hospital based study

Objective: to determine the various clinical manifestations of Vernal Keratoconjunctivitis [VKC] in Civil Hospital Karachi

Design: descriptive

Method: this is a hospital based study that was conducted at the Eye Department of Civil Hospital Karachi among the patients attending hospital out patients. Patients presenting with signs and symptoms of VKC were clinically evaluated

Results: a total of 400 patients was examined. Two-hundred seventy-eight patients [69.5%] came in the first decade of life. Three-hundred and sixty-eight patients [92%] were males. One hundred and twenty-eight patients [32%] had family history of atopy. Study showed that palpebral VKC was the most common clinical form present in 216 patients [54%], followed by mixed VKC in 104 patients [26%] and limbal VKC in 80 patients [20%]. The symptoms and signs of the disease were present all around the year in 86% of patients with an increase in the summer

Conclusion: VKC is an allergic disorder affecting the children, more common in males than females. The onset of disease is usually after the age of 5 years. It resolves around puberty, rarely after the age of 30 years. Out of the three types, Palpebral VKC was the most common form

Corneal complications of vernal Kerato-conjunctivitis

Objective: to determine the magnitude and types of corneal complications of Vernal Kerato Conjunctivitis [VKC] and their effects on vision

Study design: descriptive case-series

Place and duration: this study was conducted from September 2007 to January 2009 at three institutions in Karachi; Department of Ophthalmology, Dow University of Health Sciences and Civil Hospital, Baqai Medical University Hospital and Sindh Government Qatar Hospital Orangi Town

Methodology: all cases of vernal kerato-conjunctivitis presenting from the different areas of Karachi was included in the study. The diagnosis was made mainly on the basis of history and clinical examination

Results: total 200 patients were examined. Superficial punctate keratitis was the most common corneal complication [46%]. Visual impairment was more pronounced in case of Schield ulcer [16%] and corneal plaques [8%]. Association with keratoconus [13%] was also noted. Corneal opacification [13%] and psuedogerontoxon [4%] were also observed

Conclusion: severe corneal complications of vernal kerato-conjunctivitis [VKC] were observed. Superficial punctate keratitis was the most common. Other complications are potentially serious causing visual impairment

Risk factors and presentation of giant retinal tear

Objective: to determine the risk factors, characteristics and presentation of Giant Retinal Tear

Design: descriptive case-series study

Setting: Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi; from January 2001 to July 2007

Methods: all patients diagnosed as having Giant Retinal Tear [GRT] in the Surgical Retina Clinic, were included in the study. The details of patients' demographics, ocular history, risk factors, refractive status, ocular examination, systemic examination, treatment offered and final outcome were recorded in a specially designed proforma

Results: a total number of 42 eyes of 38 patients with GRT was included in the study. The causative factors in our study were vitreo-retinal degeneration, blunt ocular trauma and complicated cataract surgery. Myopia was the most common ocular risk factor. Most of the patients presented to our hospital after 4 weeks of onset of symptoms with total retinal detachment, advanced proliferative vitro retinopathy and poor visual acuity. Pars Plana Vitrectomy with Silicone oil tamponade, with or without Scleral Buckling was performed in 35 eyes

Conclusion: the major risk factors for GRT are peripheral retinal degenerations, high myopia, ocular trauma, GRT in the fellow eye, family history of retinal detachment, complicated cataract surgery and connective tissue disorders. Various socio economic issues and inadequate patient counseling are responsible for late presentation of patients that leads to extensive PVR