Comparison of efficacy of storage of amniotic membrane at -20 and -80 degrees centigrade.

OBJECTIVE: To compare the efficacy of storage of amniotic membrane at -20 and -80 degrees centigrade. STUDY DESIGN: Interventional quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Unit 1, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2009 to December 2010. METHODOLOGY: Amniotic membrane was obtained from patients undergoing elective Caesarean section screened for HIV, Hepatitis B and C and gave informed consent. It was washed with solutions containing benzyl penicillin, streptomycin and amphotericin B and frozen at -20 degrees centigrade for upto 6 weeks or at -80 degrees centigrade for upto 6 months. Fisher's exact test was used to check significance. P-value less than 0.05 was considered as significant. RESULTS: Amniotic membrane was stored at -20 degrees centigrade on four occasions and was used in 25 (48.07%) patients. On 3 other occasions it was stored at -80 degrees centigrade and was successfully used in 27 (51.92%) patients. The association between different degrees of storage of graft and type of cases is insignificant (p = 0.99). CONCLUSION: Compared to use of fresh amniotic membrane use of amniotic membrane stored at -20 and -80 degrees is safe and cost effective. It also excludes the chances of disease transmission. Although freezing at both temperatures is equally efficacious, freezing at -80 degrees centigrade can preserve the graft upto 6 months compared to -20 degrees centigrade which can be used only for 6 weeks.

A one-year follow-up study of ocular and systemic complications of intravitreal injection of bevacizumab (Avastin).

OBJECTIVES: To report systemic and ocular complications within a year of intravitreal injection of bevacizumab (Avastin) in ocular neovascularisation. METHODS: The quasi-experimental (randomized without control) study was carried out at the Eye Department of Abbasi Shaheed Hospital, Karachi, from July 2008 to June 2010. It comprised 150 patients selected from the outpatient department with ocular neovascularisation through non-probability purposive sampling. After detailed history and examination, the patients were counseled for intravitreal injection Avastin (bevacjzumab) which was injected into the vitreous cavity in sterile environment in the operation theatre using fully aseptic technique. The injection site was compressed for several seconds to avoid reflux when the needle was removed. Paracentesis was done following the injection as soon as possible. Patients were discharged on moxifloxcin eye drops and steroid antibiotic combination ointment at night time. They were followed up the very next day, after 2 weeks, 6 weeks, 3 months, 6 months and 1 year. Injection was repeated after 6 weeks if required and further repetition was done again after 6 weeks according to the need of the patient. RESULTS: Of the 150 patients, 93 (62%) were males and 57 (38%) were females. Most commonly presenting age group was between 50-60 years (n=51; 34%) followed by 41-50 years (n=41; 27.4%). Most common indication for intravitreal injection Avastin (bevacizumab) was proliferative diabetic retinopathy in 134 (89.33%) patients, followed by age-related macular degeneration (wet type) in 5 (3.3%) patients. Most frequently presenting ocular complication was subconjunctival haemorrhage seen in 35 (23%) patients, followed by regurgitation of drug from the site of injection in 8 (5.3%) patients, transient rise of intraocular pressure in 7 (4.7%) patients, mild uveitiS in 4 (2.7%) patients, lens injury in 3 (2%) patients, conjunctival chemosis and iatrogenic vitreous haemorrhage in 1 (0.7%) patients. Among the systemic complications were acute rise of blood pressure in 4 (2.7%) patients, and mild irritation and allergic reaction on skin in 1 (0.7%) patient. CONCLUSION: Avastin is generally a safe drug for treatment of ocular neovascularization. The complications reported were more associated with the technique of the procedure and not the drug itself and were easily manageable. Drug-related complications were limited, transient and easily managed with treatment.