Haematological profile of Chronic Kidney Disease Stage 5 patients undergoing maintenance Hemodialysis at a tertiary care centre.

Background: Kidneys play a central role in the regulation of body fluids, electrolytes and acid- base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. Timely intervention and effective management will minimize complications and can potentially be lifesaving. Aim: To study the haematological profile in patients of chronic kidney disease (CKD) Stage 5 undergoing haemodialysis and to correlate the relation if any, between the study parameters. Material and Methods: Study was conducted on 60 patients undergoing hemodialysis thrice a week. Complete hemogram, RFT, LFT, serum sodium, potassium, calcium and phosphorus values were obtained and their associations were statistically analysed. Results: Out of 60 patients studied, 20% (n=12) had hemoglobin values <8 g/dl, 36% (n=36) had 8-10 g/dl and 12% (n=12) had ?10 g/dl. 18% (n=11) had mild hyponatremia (130-135 mEq/L), 38% (n=23) had moderate (125-129 mEq/L) and 44% (n=26) had severe (<125 mEq/L) hyponatremia.80% of the study group (n=48) had serum calcium <9 mg/dl and 20% (n=12) had >9 mg/dl. 68% (n=41) of the patients had serum phosphorus >5.5 mg/dl and 32% (n=19) of them had <5.5 mg/dl. There was a significant positive correlation of serum sodium with serum calcium (r=0.752, p=0.0001), serum albumin (p=0.0001), hemoglobin (p=0.0001) and significant negative correlation with serum phosphorus (r=-0.730, p=0.0001), serum uric acid (p=0.003). Conclusion: Anemia, hyponatremia, hyperkalemia, hypocalcemia and hyperphosphatemia are most commonly seen in hemodialysis patients. Appropriate timely intervention can significantly prevent the long-term morbidity in such patients.

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

Long-Term Results of Lens-Sparing Vitrectomy for Stages 4B and 5 Retinopathy of Prematurity

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.

Long-Term Results of Lens-Sparing Vitrectomy for Stages 4B and 5 Retinopathy of Prematurity

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.

Surgical management for stage 5 retinopathy of prematurity

To determine the prognosis of advanced retinopathy of prematurity (ROP) after surgery, we reviewed retrospectively the results of vitrectomy performed between November 1987 and December 1993 in 38 eyes with stage 5 ROP. The patients' mean age at surgery was 11 months, mean follow-up period was 24.1 months. Anatomical success, defined as reattachment of posterior pole retina, was achieved in 11 eyes (29.0%) and functional success, defined as presence of fixation and following was achieved in 7 eyes (18.4%). Anatomical success was well correlated with preoperative configuration of retina, i.e. open-funnel type showed better results than closed-funnel type (44.4% compared to 15.0%). There were no differences between anatomical success and failure group according to gestational age, birth weight, age at the time of diagnosis of ROP, chronological and postconceptional age, and body weight at the time of surgery. For good prognosis, it is necessary to operate early in stage 5 ROP when retinal funnel is still open.

Surgical management for stage 5 retinopathy of prematurity

To determine the prognosis of advanced retinopathy of prematurity (ROP) after surgery, we reviewed retrospectively the results of vitrectomy performed between November 1987 and December 1993 in 38 eyes with stage 5 ROP. The patients' mean age at surgery was 11 months, mean follow-up period was 24.1 months. Anatomical success, defined as reattachment of posterior pole retina, was achieved in 11 eyes (29.0%) and functional success, defined as presence of fixation and following was achieved in 7 eyes (18.4%). Anatomical success was well correlated with preoperative configuration of retina, i.e. open-funnel type showed better results than closed-funnel type (44.4% compared to 15.0%). There were no differences between anatomical success and failure group according to gestational age, birth weight, age at the time of diagnosis of ROP, chronological and postconceptional age, and body weight at the time of surgery. For good prognosis, it is necessary to operate early in stage 5 ROP when retinal funnel is still open.