Pneumatic Retinopexy in Patients with Primary Rhegmatogenous Retinal Detachment Meeting PIVOT Trial Criteria.

PURPOSE: To identify the proportion of patients with primary rhegmatogenous retinal detachment (RRD) presenting to a retina practice that meet 'Pneumatic Retinopexy versus Vitrectomy for the Management of Primary RRD' (PIVOT) trial criteria and to assess anatomic and functional outcomes of pneumatic retinopexy (PnR) in this population. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Patients with primary RRD treated between October 2009 and November 2017 at an academic vitreoretinal practice in Canada. METHODS: Medical records of all cases >18 years old with primary RRD were reviewed and the proportion of patients meeting PIVOT criteria was determined. Patients that met PIVOT criteria who underwent PnR with a follow-up >3 months were included for further analysis. MAIN OUTCOME MEASURES: The primary outcome was the primary retinal reattachment rate at 12 months among patients meeting PIVOT criteria undergoing PnR. RESULTS: A total of 1,091 patients were identified, of which 577 (52.9%) met PIVOT criteria. Of these, 482/577 (83.5%) underwent PnR, but 54/482 (11.2%) were excluded as these had been enrolled in the PIVOT trial, and another 40/482 (8.3%) were excluded due to short follow-up (<3 months). Therefore, data pertaining to 388 patients is included in our analysis. 79.4% (308/388), 78.2% (280/358), 76.5% (241/315) and 73.9% (178/241) of patients who followed up at 3, 6, 12, and 24 months, respectively, had primary anatomic reattachment. A total of 20.6% (80/388) of patients did not reattach with the initial PnR or re-detached in the early post-procedure period (3 months), 2.1% (8/388) of patients re-detached between 3-12 months, and 1.3% (5/388) re-detached after 1 year. Phakic lens status was the only significant predictor of PnR success at 12 months in a multivariate logistic regression analysis (P = 0.006). Mean logMAR VA improved from 0.90 ± 0.90 (Snellen 20/159) at baseline t 0.34 ± 0.40 (Snellen 20/44) at 12 months (P < 0.001). CONCLUSIONS: Over 50% of patients presenting to an academic tertiary retina practice with primary RRD met PIVOT criteria and were eligible for PnR. Evidence from this study demonstrates a durable primary anatomic retinal reattachment rate with PnR in patients fulfilling PIVOT criteria, with similar results to those encountered in the PIVOT trial.

Recurrence rate with use of intraoperative Mitomycin C versus Conjunctival Autograft following pterygium excision.

UNLABELLED: Objective s : To determine the recurrence rate following Conjunctival Autograft versus Mitomycin C for pterygium excision. METHODS: Fifty Patients in this Randomized Clinical Trial who underwent pterygium excision from July 2013 to October 2013 at Department of Ophthalmology, Ziauddin University Hospital, Keamari, Karachi were included. All patients underwent detailed ophthalmic examination before surgery. Few drops of lidocaine were instilled, subconjunctival xylocaine 2% was injected. The pterygium was then excised from bulabar conjunctiva and peeled off from the corneal surface. Mitomycin C was applied to bare sclera in group A and Conjunctival autograft taken from superior bulbar conjunctiva of same eye was sutured to the bare sclera in group B. Data for pterygium recurrence was collected and analyzed using SPSS version 17. RESULTS: Among the 50 patients operated 64% (n=32) were male and 36% (n=18) female. Their age ranged from 28 -58 years with mean age 44.8yrs. Right eye was affected in 54% (n= 27) patients and left in 46% (n= 23). In group "A" (intraoperative MMC) conjunctival granuloma was noted in 1(4%), pterygium recurrence 4(16%) and ocular irritation was experienced by 5 (20%) patients. In group "B" (CAG) graft retraction was seen in 2(8%), patients, 1(4%) patients experienced persistent redness over the grafted tissue and pterygium recurrence was seen in 2(8%) patient. All of them were followed at day 1, week1, week 4 and week 12. CONCLUSION: Both Conjunctival Autograft and Mitomycin C are effective in reducing the recurrence of pterygium but CAG gives better cosmetic results, the only drawback with it is the duration of the procedure.

Cataract surgery at Marie Adelaide Leprosy Centre Karachi: an audit.

OBJECTIVE: To determine the outcome of cataract surgery in terms of visual results, intra and postoperative complications at Marie Adelaide Leprosy Centre. METHODS: The study was carried out at Marie Adelaide Leprosy Centre Karachi from May 2005 to December 2007. Surgical results of all outpatients operated for cataract from May 2005 to December 2007 were assessed. The data was collected using the CBM guidelines based on WHO monitoring systems for quality monitoring. Patients having uncomplicated cataract were included. Postoperative follow up was done at discharge, 1 week, 4 weeks and after 12 weeks, visual acuity was recorded as good (6/6-6/18), borderline (6/18-6/60) and poor (< 6/60), intraoperative and postoperative complications were also noted. RESULTS: During the study period a total of 1457 patients underwent cataract surgery. There were 826 male patients and 631 female patients, their age ranged from 20 to over 80 years. Preoperatively 1023 (70.2%) patients had poor, 362 (24.8%) patients had borderline while only 73 (5%) patients had good visual acuity while at discharge 962 (66%) patients had good, 392 (26.9%) patients had borderline and 104 (7.1%) patients had poor visual acuity. On an average among all the best corrected visual acuity was good in 97.2%, borderline in 2.2% and poor in 0.6% patients at 1 week, 4 weeks and >12 weeks follow up respectively. A large number of patients, 565 (38.7%) did not turn up after discharge for follow up, presumed reasons were: good vision, unable to return because of socioeconomic reasons, ill health and few of the patients expired. Intraoperative complications seen were posterior capsular rent with vitreous loss 70 (4.8%), zonular dehiscence 3 (0.2%), posterior loss of cortical matter 2 (0.1%) and iris prolapse in 4 (0.2%) cases. Immediate postoperative complication was striate keratopathy 157(10.7%), late were chronic anterior uveitis 3 (0.2%), corneal decompensation 2 (0.1%) choroidal and retinal detachment 1 (0.06%) each, Intraocular Lens (IOL) subluxation 4 (0.2%) and Posterior capsular opacification 40 (2.7%). CONCLUSION: In our study visual outcome achieved was comparable to the standards set by World Health Organization. In complicated cases functional vision can be achieved with timely management.