Visual Outcomes With Intraocular Trifocal Lens Implant.

BACKGROUND: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges. METHODS: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA). RESULTS: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively. CONCLUSIONS: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.

AMNIOTIC MEMBRANE GRAFT FOR THE TREATMENT OF LARGE REFRACTORY MACULAR HOLE.

PURPOSE: Study off-label human amniotic membrane use outcomes for giant refractory macular hole closure. MATERIALS AND METHODS: The study was performed at Lahore General Hospital, Lahore, over 52 months on patients who had undergone standard macular hole surgical procedures for treatment, but the hole failed to close. Refractory macular hole dimensions ranged from 824 µ m to 1,568 µ m. Before surgery, patients underwent slit-lamp examination, fundus photography, and optical coherence tomography for macular scan. Amniotic membrane graft (AMG) used in surgery was harvested from a human placenta 24 hours before. Before AMG application, enough internal limiting membrane peeling was performed to ensure perfect fitting and recovery. All holes were plugged with AMG and SF6 gas tamponade. RESULTS: Twenty-nine patients, 20 men and nine women, were included in this study. Mean age of patients was 58 ± 6. Patients had refractory holes of average 1,237.48 ± 151.25 µ m. Post-op, 100% macular hole closure was achieved in all patients. Type 1 closure was found in patients (37.93%) who underwent AMG surgery within 3 months after primary surgical failure. Type 2 closure was found in patients (62.07%) who were operated on 3 months after primary surgical failure. CONCLUSION: Refractory macular holes treated by AMG with SF6 gas tamponade achieve anatomical Type 1 closure if performed within 3 months of primary surgical repair.

Automated feature detection in dental periapical radiographs by using deep learning.

OBJECTIVE: The aim of this study was to investigate automated feature detection, segmentation, and quantification of common findings in periapical radiographs (PRs) by using deep learning (DL)-based computer vision techniques. STUDY DESIGN: Caries, alveolar bone recession, and interradicular radiolucencies were labeled on 206 digital PRs by 3 specialists (2 oral pathologists and 1 endodontist). The PRs were divided into "Training and Validation" and "Test" data sets consisting of 176 and 30 PRs, respectively. Multiple transformations of image data were used as input to deep neural networks during training. Outcomes of existing and purpose-built DL architectures were compared to identify the most suitable architecture for automated analysis. RESULTS: The U-Net architecture and its variant significantly outperformed Xnet and SegNet in all metrics. The overall best performing architecture on the validation data set was "U-Net+Densenet121" (mean intersection over union [mIoU] = 0.501; Dice coefficient = 0.569). Performance of all architectures degraded on the "Test" data set; "U-Net" delivered the best performance (mIoU = 0.402; Dice coefficient = 0.453). Interradicular radiolucencies were the most difficult to segment. CONCLUSIONS: DL has potential for automated analysis of PRs but warrants further research. Among existing off-the-shelf architectures, U-Net and its variants delivered the best performance. Further performance gains can be obtained via purpose-built architectures and a larger multicentric cohort.

Incidence of acute endophthalmitis after office based intravitreal bevacizumab injection.

The burden of intravitreal injections has increased tremendously over the past few years. Since traditionally the operation theatre setup is currently used for this procedure, it is increasingly becoming difficult to manage such a patient load in the theatres. To overcome this challenge, office-based setup for intravitreal injection was started. This study was planned to determine the incidence of endophthalmitis after office-based intravitreal bevacizumab injection and to compare it with previously reported incidence of endophthalmitis after operation theatre-based intravitreal injections. The study was conducted at Al-Ehsan Eye Hospital, Lahore, Pakistan, from July 2015 to June 2016, and comprised patients who received intravitreal injections of bevacizumab (Avastin) for different ocular indications. A total of 1,047 intravitreal injections were given in an office-based set-up. Of them, 2(0.19%) cases of clinically suspected endophthalmitis were identified. Office-based set-up for intravitreal bevacizumab injection was found to have comparable safety profile with traditional operation theatre-based set-up.

Axial myopia and its influence on diabetic retinopathy.

OBJECTIVE: To evaluate the correlation between axial myopia and diabetic retinopathy. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Eye Department of Postgraduate Medical Institute, Lahore General Hospital, from August 2012 to February 2013. METHODOLOGY: A total of 258 participants suffering from type-2 diabetic retinopathy were included. Axial length was measured by two optometrists using contact type ultrasound biometer. Colored retinal photographs, red free retinal photographs and Fundus Fluorescein Angiography (FFA) were performed on all patients using standard fundus camera. All fundus photographs and angiograms were independently reviewed and graded by two qualified vitreoretinal fellows. RESULTS: Out of 258 patients, 163 were males (63.2%) and 95 (36.8%) were females. Average age of patients was 56.30±7.57 years. Average axial length of right and left eyes were 23.16 mm and 23.15 mm respectively. There was statistically significant negative correlation between axial length and severity of diabetic retinopathy in the right eye, (Spearman correlation=-0.511, p=0.0001) as well as the left eye (Spearman correlation=-0.522, p=0.0001). CONCLUSION: There is a protective influence of longer axial length of globe on the stage and severity of diabetic retinopathy. This study may help in modifying the screening protocol for diabetic retinopathy amongst patients of differing axial lengths.