Features of retinopathy of prematurity in a tertiary care hospital in Lahore.

OBJECTIVE: To study the demographic and clinical features of Retinopathy of Prematurity in urban Punjab. METHODS: The cross-sectional study was performed at Hameed Latif Hospital, Lahore, from April 2010 to October 2013 and comprised neonates born with birth weight less than 2000 g, gestational age less than 37 weeks, or those who were considered high risk for Retinopathy of Prematurity. Variables recorded included history, birth weight, gestational age, oxygen supplementation, development of Retinopathy of Prematurity, and laser treatment. Data was analysed using SPSS 17. RESULTS: There were 285 neonates in the study with a mean birth weight of 1280.34 ± 350.43 g and mean gestational age being 29.38 ± 3.14 weeks. Overall, 167 (58.6%) received supplemental oxygen, 86(30.2%) were anaemic and 44 (15.4%) received blood transfusion. Besides, 47 (16.5%) premature babies were product of multiple gestation, 34 (11.9%) were having respiratory distress, 25 (8.8%) had sepsis and received intravenous antibiotics, 70(24.6%) developed Retinopathy of Prematurity, and 22 (7.7%) developed threshold disease and received laser treatment at mean gestational age of 32.11 ± 2.53 weeks. CONCLUSION: Screening is key to preventing childhood blindness caused by Retinopathy of Prematurity. Prematurity, low birth weight and supplemental oxygen therapy are significant risk factors for the condition.

Spontaneous closure of macular hole.

We report a case of spontaneous closure of stage-II macular hole. A 66 years old lady presented with decreased vision in her left eye for the last 3 months. Her vision was 6/18 in right eye and finger counting at 3 feet in left eye. Optical coherence tomography showed stage-II macular hole in left eye. There was attachment of vitreous at the edge of the hole. Minimal hole diameter was 119 µ. Macular hole surgery was planned. During follow-up, hole started closing spontaneously. Nine months later, the hole closed and posterior hyaloid membrane separated from the macula. Visual acuity improved to 6/24. The purpose of this case report is to show that stage-II macular hole may close spontaneously with relief of vitreomacular traction.

Effect of intracameral use of dexamethasone on corneal endothelial cells.

OBJECTIVE: To evaluate the effect of intracameral dexamethasone on corneal endothelium. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Layton Rehmatulla Benevolent Trust Eye Hospital, Lahore, from May 2011 to January 2012. METHODOLOGY: Study subjects were adults of either gender with senile cataract who underwent phacoemulsification. They were divided in two groups, each had 110 patients. Group-A received subconjunctival injection of dexamethasone (2 mg/0.5 ml) at the end of surgery while group-B received intracameral injection of dexamethasone (0.4 mg/0.1 ml) at the end of surgery. Endothelial cell count was performed by specular microscopy pre-operatively and postoperatively at first week, first month and three months. Outcome measures included changes in endothelial cell count. Results were compared using t-test for means. RESULTS: There were 55 (50%) males and 55 (50%) females in group-A and 44 (40%) males and 66 (60%) females in group-B. In group-A, there were 66 (60%) right and 44 (40%) left eyes while group-B had 62 (56.36%) right and 48 (43.63%) left eyes. Mean age in group-A was 55.17 ± 5.93 years and 54.87 ± 5.55 years in group-B. Mean phacoemulsification time in group-A was 1.92 ± 0.63 minutes and 1.82 ± 0.54 minutes in group-B. After 3 months, in group-A, there was 7.55 ± 1.19% endothelial cell loss while in group-B, there was 7.63 ± 1.10% endothelial cell loss. The difference between the two groups was not statistically significant (p=0.614). CONCLUSION: Use of intracameral dexamethasone at the end of cataract surgery is safe for corneal endothelium.

Features of central serous chorioretinopathy presenting at a tertiary care hospital in Lahore.

OBJECTIVE: To evaluate the clinical, angiographic and optical coherence tomographic features of central serous chorioretinopathy in patients presenting at a tertiary care centre in Lahore. METHODS: The observational study was conducted at the Layton Rehmatulla Benevolent Trust Eye and Cancer Hospital Lahore from July 15, 2010 to December 15, 2011. Patients who had received prior treatment for the condition and allergy to fluorescein were excluded. There were 86 eyes of 64 adult patients with central serous chorioretinopathy. The following data was recorded: history, signs and symptoms, best corrected visual acuity, fundus fluorescein angiography, and central macular thickness measurement with optical coherence tomography. Data was analyzed using SPSS 17. RESULTS: Mean age of patients who presented during the study duration was 39.52 +/- 8.85 years.There were 53 (82.8%) males and 11(17.2%) females. Of the total, 42 (65.6%) cases had unilateral and 22 (34.4%) cases had bilateral involvement. Chronic central serous chorioretinopathy was seen in 27 (42.2%) cases while 37 (57.8%) cases were acute presentations. Retinal pigment epithelial detachment was observed in 29 (45.3%) cases. On fundus fluorescein angiography, there were 62 (72.1%) eyes that showed ink blot pattern. Median visual acuity at presentation was 0.25. Median central macular thickness at presentation was 550.5micro. CONCLUSION: Central serous chorioretinopathy in the study sample was associated with pigment epithelial detachment, bilateral involvement, and presence of systemic diseases.

Bilateral loss of light reflex and accommodation following 360° peripheral retinal laser therapy.

We report a case of bilateral loss of pupillary light reflex and accommodation following 360° peripheral retinal laser therapy. A 24 years old male underwent prophylactic laser barrage for peripheral retinal lattice degenerations. Soon after the procedure, he developed bilateral loss of pupillary light reflex and accommodation. The patient faced difficulty while doing near work. On instillation of 0.125% pilocarpine, both pupils demonstrated the phenomenon of denervation supersensitivity. Damage to the short ciliary nerves was the most likely mechanism responsible for this adverse outcome.

Intravitreal bevacizumab in central serous chorioretinopathy.

OBJECTIVE: To evaluate the effect of intravitreal bevacizumab injection in patients with central serous chorioretinopathy (CSCR). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Layton Rehmatullah Benevolent Trust Eye and Cancer Hospital, Lahore, from July 2010 to April 2011. METHODOLOGY: There were 43 eyes of 32 adult patients with CSCR. Patients with choroidal neovascularization, prior treatment for CSCR, history of thromboembolism, intraocular pressure more than 21 mmHg, history of retinal detachment, intraocular inflammation, and allergy to fluorescence were excluded from study. All patients had intravitreal injection of off label bevacizumab. At baseline and follow-up visits, patients had best corrected visual acuity (BCVA) and central macular thickness (CMT) measurement with optical coherence tomography. They were followed-up for 6 months. Outcome measures included BCVA and CMT. Wilcoxon Signed Ranks test was used for evaluation of BCVA and CMT. RESULTS: There were 26 (81.3%) males and 6 (18.7%) females with 21 (65.5%) cases of unilateral and 11 (34.5%) cases of bilateral involvement. Mean age was 39.09 ± 8.49 years. Nineteen (59.4%) eyes showed less than 6 months involvement and 13 (40.6%) eyes showed more than 6 months involvement. Mean number of injections required was 2.37 ± 1.24 in acute cases and 3.05 ± 1.39 in chronic cases. Overall mean of required injections was 2.67 ± 1.34. Median visual acuity at baseline was 0.25 and at 6 months was 0.7 (p < 0.001). Median CMT at baseline was 557 µ and at 6 months was 286 µ (p < 0.001). CONCLUSION: Intravitreal bevacizumab injection was associated with visual improvement and reduced neurosensory detachment.

Brown-McLean syndrome with keratoconus.

We report a case of unilateral Brown-McLean syndrome (peripheral corneal oedema) with bilateral keratoconus. A 30 years old lady presented with decreased vision in her right eye for the last 2 years. There was no history of surgery or trauma. Patient had no systemic illness. There was peripheral concentric corneal oedema extending 2.5-3.5 mm from the limbus involving right eye. On topography, we found bilateral keratoconus. To the best of our knowledge, this combination of Brown-McLean syndrome and keratoconus has not been reported before.

Effect of phacoemulsification on intraocular pressure.

OBJECTIVE: To evaluate the effect of phacoemulsification on intraocular pressure in normal eyes and glaucomatous eyes. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Layton Rehmatulla Benevolent Trust, Eye and Cancer Hospital, Lahore, from September 2009 to August 2010. METHODOLOGY: The study subjects were adult patients with cataract and open or occludable angle, with or without raised intraocular pressure, who underwent phacoemulsification. Patients having any corneal pathology, synecheal angle closure more than 180 degrees, inflammatory eye disease, previous ocular surgery including YAG iridotomy and endothelial cell density less than 1500/mm2 were excluded from the study. They were followed-up for one year. Outcome measures included intraocular pressure, angle width, visual acuity and number of antiglaucoma medicines. Results were compared using chi-square test for proportions and t-test for mean values. RESULTS: There were 50 (41%) males and 72 (59%) females with 80 (65.6%) right and 42 (34.4%) left eyes. Mean age was 56.4±8.57 years. Pre-operatively 52 patients had open angles while 70 patients had occludable angles. Postoperatively 96 patients had open angles and 26 patients had occludable angles. Mean pre-operative IOP was 25.70±7.79 mmHg, which was decreased to 17.44±2.8 mmHg (p < 0.001) at final follow-up visit. Number of mean antiglaucoma agents decreased from 1.12±1.30 pre-operatively to 0.62±0.92 at final follow-up visit. Mean pre-operative visual acuity was 0.4±0.19 that increased to 0.86±0.15. CONCLUSION: Phacoemulsification resulted in reduction in intraocular pressure in normal as well as glaucomatous eyes and it significantly reduced the need for anti-glaucoma medicines.