A comparative study of post-operative endophthalmitis between immediate versus delayed management of eventful cataract extraction.

OBJECTIVE: To compare the incidence of postoperative endophthalmitis after eventful cataract surgery i.e. posterior capsular rupture, in patients managed with anterior vitrectomy and intra ocular lens implantation intraoperatively to patients managed with anterior vitrectomy and intraocular lens implantation two weeks after the posterior capsule rupture. METHODS: This comparative study was conducted at Layton Rahamatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 to December 2018. The study included two groups, group A had patients with intra ocular lens implanted after posterior capsule rupture intraoperatively, while Group B had patients with intra ocular lens implanted after two weeks of initial surgery. Incidence rate of post-operative endophthalmitis was compared between two groups, which happened within six weeks after intra ocular lens implantation surgery. RESULTS: Total number of cataract surgeries that were performed during the study was 37,969. Incidence of postoperative endophthalmitis was 0.0019%. The study enrolled patients with complicated cataract surgeries that were 3508 (0.09%). Out of which incidence of post-operative endophthalmitis that occurred in group A was 0.007% and group B was 0.002%. (p value <0.05). The study also found that complicated extracapsular cataract extraction with intraocular lens implantation had more cases of endophthalmitis compared to phacoemulsification with intraocular lens. CONCLUSION: This study showed that management of posterior capsular rupture through anterior vitrectomy and secondary intraocular lens implantation after two weeks has less chances of postoperative endophthalmitis.

Axial length, a risk factor for retinal vein occlusion: A case control study.

OBJECTIVE: To evaluate the role of axial length in cases of retinal vein occlusion. METHODS: The case-control study was conducted at Layton Rahmatullah Benevolent Trust Eye Hospital, Karachi, from March to August 2018, and comprised patients with retinal vein occlusion and age-matched controls. Axial length of both eyes of all the subjects was calculated. The length of the affected eye was compared with that of the contralateral unaffected eye and also with the controls. Data was analysed using SPSS 21. RESULTS: There were 70 subjects; 35(50%) in each of the two groups. Among the cases, 16(46%) were males and 19(54%) were females. The overall mean age of the group was 37}4.2 years. Among the controls, 21(60%) were males and 14(40%) were females. The mean age of the group was 36.5}4.5 years. Also, among the cases, 23(66%) had unilateral central retinal vein occlusion and 12(34%) had branch retinal vein occlusion. Mean axial length was 0.80mm shorter in central retinal vein occlusion patients and controls (p=0.01). Branch retinal vein occlusion group did not show statistical significance on comparing with fellow eyes (p=0.18) and with controls (p=0.07). CONCLUSIONS: Axial length was found to be a local predisposing factor to develop retinal vein occlusion.

Effect of altering the regime of oral rifampicin therapy in the treatment of persistent central serous chorioretinopathy.

OBJECTIVE: To study the effect of reducing the duration of rifampicin therapy in the treatment of Chronic Central Serous Chorioretinopathy. METHODS: This is interventional study conducted in Layton Rahmatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 - December 2018. This randomized controlled comparative study included two groups, Groups-A comprised of 48 eyes of 40 cases with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 600mg for one month, and Group-B consisted of 43 eyes of 40 controls with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 300mg once daily for three months as previously stated in literature. To access the effect of therapy in both the groups, pre-treatment visual acuity on the logMAR and Optical Coherent Tomography (OCT, Heidelberg spectralis) for CMT were performed and repeated on the 1st and 3rd month post-treatment. Patients were also followed for 6 months to access any recurrence. RESULTS: On comparing the two groups, Group-A had improvement in VA and CMT after one month therapy of Rifampicin, Pre-treatment mean VA in Group-A was 0.85 ± 0.19 as compared to the pre-treatment mean VA in Group-B i.e. 0.74+/- 0.208, while the pre-treatment mean CMT was 609.0 ± 178.29 µm in Group-A, and 600.0 +/- 155.09 µm in Group-B respectively. After 1 month of therapy, the visual status, and CMT in Group-A was 0.29+/- 0.21 and 311.6 +/- 89.9, while Group-B, VA was 0.598 +/- 0.23 (p value 0.001%) and CMT was 512.30 +/- 148.37 (p-value 0.001%). Rifampicin was continued in Group-B till three months, and patients were re-accessed but there was no difference in VA and CMT statically. During the 3rd and 6th months of follow up no relapses were reported. CONCLUSION: This comparative study showed that the group receiving oral rifampicin 600mg for one month showed better outcome at one month and third month than the group receiving oral rifampicin at a dose of 300mg once daily for three months. This gives a better compliance and lower the risk of drug induced side effects.

Clinical application of multicolor optical coherence tomography in the diagnosis of retinal pathologies.

OBJECTIVE: To assess the clinical application of multicolor optical coherence tomography (OCT) using confocal scanning laser ophthalmoscopy (cSLO) in different retinal pathologies. METHODS: This observational study was conducted at the Layton Rahmatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Karachi, from April 2018 to June 2018. It includes 36 patients suffering from different retinal pathologies including diabetic retinopathy, age related macular degeneration, and vitreomacular interface disorders using multicolor optical coherence tomography as a screening tool. RESULTS: It was found that automated eye tracking system of this new version tool enables ophthalmologists to take high-resolution cSLO reflectance images. The light scatter can be avoided with the use of confocal optics. Appearances of pigment changes and hemorrhages were some of the differences found when compared to the conventional CFP. About 20% in AMD, 37.5% with diabetes and 100% patients with vitreomacular interface disorders could have be easily missed by CFP. CONCLUSIONS: Multicolor OCT can provide information and figures far more authoritatively than the conventional CFP, which is highly affected by media opacities. To interpret Multicolor OCT ophthalmologists should be watchful with plenty of understanding.