Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema.

OBJECTIVE: To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. METHODOLOGY: Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema (CSME), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. RESULTS: The male to female ratio was 1:1.44. Out of 218 patients; 129 (59.2%) were males and 89 (40.8%) were females. CSME was found in 82 patients (37.6%) at first postoperative week which declined to 29 cases (13.3%) at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity (BCVA) gradually improved in each subsequent follow-up visit. CONCLUSION: Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed.

Outcome of dual infusion through irrigating chopper in conventional phacoemulsification.

OBJECTIVE: To determine the operative advantage in terms of minimizing the complications following conventional phaco surgery with dual infusion through irrigating chopper. METHODS: A Randomized Controlled Clinical Trial (RCCT) was conducted in the Ophthalmology Unit-III, Sindh Government Lyari General Hospital and DUHS and Al-Noor Eye Hospital Karachi, from March 2008 to February 2009. A total of 200 eyes with nuclear/cortico-nuclear cataract on Lens Opacity Classification System III underwent phacoemulsification. In all 100 eyes in group A were randomized to have conventional phacoemulsification with dual infusion technique through irrigating chopper and another 100 eyes in group B by conventional phaco surgery. Outcomes in two groups were judged by amount of Ringer's Lactate used, stability of anterior chamber and number of complications observed. RESULTS: Rate of intra-operative complications was lower in group A as compared to group B (p=0.002). Anterior chamber depth was maintained in all cases of group A while it collapsed in 9 cases of group B which was highly significant (p=0.003). Mean amount of Ringer's Lactate used in group A was 260.2 +/- 55.07 ml and 195.8 +/- 35.0 ml in group B, which was significantly high (p<0.001). CONCLUSION: Dual infusion through irrigating chopper serves triple function of irrigation, chopping and additional separate distant infusion. It improves anterior chamber stability and compensates surge and operative advantage to surgeon.

Outcome of macular hole surgery.

OBJECTIVE: To document the outcome of macular hole surgery in terms of improvement of visual acuity and the duration of closure of macular hole. DESIGN: Interventional quasi experimental study. PLACE AND DURATION OF STUDY: Ophthalmology Department, Civil Hospital, Karachi. SUBJECTS AND METHODS: Twenty-four eyes of 22 patients with macular hole underwent surgical repair. Vitrectomy with maculorrhexis (internal limiting membrane peeling) and fluid-gas exchange followed by prone positioning for one to two weeks was carried out. Postoperative follow-up was done for one year. Main outcome measures were visual acuity, closure of macular hole and ocular complications. Data was analyzed by using SPSS Version 10. Non-parametric sign test with chi-square statistic was used to compare the pre-operative and postoperative outcome. RESULTS: The macular hole was successfully closed in 17 eyes that revealed high statistical significance regarding improvement in visual acuity. Earlier, significant improvement figured in 17/24 cases was observed at three-month post-operative examination (p<0.0001). An insignificant success figured in 8/24 due to postoperative complications at six-month follow-up. Visual acuity improved upto two or more lines in 17 eyes at one-year follow-up. Twelve cases developed cataract, 7 developed increased intra-ocular pressure (transient), one had glaucoma and one retinal detachment. CONCLUSION: Vitrectomy with maculorrhexis (internal limiting membrane peeling) and fluid-gas exchange can successfully close macular holes and improve vision.