The Outcome Of The Inverted Internal Limiting Membrane Flap Technique For The Repair Of Large Idiopathic Macular Holes.

Background: Full-thickness macular hole is defined as an anatomical defect in the fovea that spans from the internal limiting membrane to the retinal pigment epithelium, assessed by spectral domain optical coherence tomography. The Objectives of the study are to determine the anatomical and visual outcome in patients undergoing pars plana vitrectomy along with inverted internal limiting flap closure in large idiopathic full-thickness macular holes (>400 µm). Methods: A prospective interventional study was conducted at a tertiary teaching eye hospital in Karachi, where patients of either gender and having macular holes greater than >400 µm were recruited. The study was conducted From January 9 to July 8, 2022, and all patients underwent pre-operative fundus examination and pars plana vitrectomy with inverted ILM flap closure. Data was entered and analyzed using SPSS 23. Follow-ups were conducted at 1 and 3 months. Results: A total of 94 patients were enrolled with a mean age of 49.17±13.8 years. The mean duration of symptoms was 3.1±1.4 months. The mean pre-operative macular hole diameter was 854.31±08.36 µm and Stage 3 and 4 MH was present in 36.2% and 63.8% of patients, respectively. Anatomical closure was achieved in 93.6% of eyes (n=88/94). Pre-operative mean BCVA was LogMAR 0.90±0.24, which improved to LogMAR mean 0.70±0.27 at the final follow-up. As of the last follow-up, 92.6% of patients showed improved visual outcomes, with a mean three-line improvement in Snellen lines. After data stratification, no statistically significant result was obtained. Conclusion: The use of the inverted ILM flap technique resulted in improved anatomical and visual outcomes, in cases of large idiopathic macular holes.

Optic Disc Pit Associated With Choroidal Coloboma: Case Report And Short Review.

Optic disc pits are hypothesized to form because of failure of embryonic fissure closure, which can also present with congenital defects in the choroid, RPE, and neurosensory retina. It is also associated with serous macular detachment. We present a case report of a 32-year-old man with an optic disc pit and independent choroidal coloboma below the inferior peripapillary area in the left eye, associated with macular retinoschisis with serous detachment.

Efficacy of Ganciclovir in Cytomegalovirus Retinitis via Intravitreal Route in AIDS Patients.

A series of nine eyes of five patients at LRBT Tertiary Teaching Eye Hospital, from July 2020 to June 2021 is reported. Five patients with high clinical suspicion of CMV Retinitis were treated with weekly intravitreal injections of 2.0 mg ganciclovir for 3 weeks. Pre- and post-injection visual acuity and clinical findings were noted. After 3 injections, clinical signs of CMV retinitis started to resolve in all eyes (100%). Visual acuity improved in seven eyes (77.7%) and remained stable in two eyes (22.2%). Two of the seven eyes which initially showed improvement, later on developed retinal detachment. Patients were followed up for a minimum duration of 1 year. Intravitreal ganciclovir is effective for CMV retinitis but follow- up for a longer duration is needed as these patients are prone to develop peripheral retinal tractions and detachments. Key Words: Ganciclovir, CMV retinitis, AIDS.

Outcomes of Using Perfluorocarbon Liquid as Postoperative Tamponade in Complex Inferior Retinal Detachments.

OBJECTIVE: To determine the outcomes of using perfluorocarbon liquid (PFCL) as postoperative tamponade in complex inferior retinal detachments. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Karachi, Pakistan, from January 2020 to December 2021. METHODOLOGY: This study was carried out on forty eyes of forty patients from the surgical retina clinic with rhegmatogenous inferior retinal detachment involving macula having proliferative vitreoretinopathy grade C (PVR grade-C). All eyes underwent 25G pars plana vitrectomy with PFCL as postoperative tamponade for 15 to 21 days. All patients were advised to maintain supine position postoperatively. PFCL-Silicon oil exchange was done after 15-21 days. The outcomes were measured as complete retinal reattachment between the neurosensory retina (NSR) and retinal pigment epithelium (RPE), changes in postoperative visual acuity and complications. Patients were followed up for a minimum duration of 6 months. Data were analysed using SPSS version 23. RESULTS: In 39 out of 40 eyes (97.5%) retina was completely attached. Postoperative visual acuity was improved in 24 eyes (60%), while in 16 eyes (40%) it remained stable. Worsening of visual acuity was not noted in any case. During follow-ups, uveitis was detected in 2 eyes (5%), cataract in 4 eyes (10%), optic atrophy in 2 eyes (5%) and endophthalmitis and subsequently redetachment in 1 eye (2.5%). CONCLUSION: In complex inferior retinal detachments, PFCL is safe and effective postoperative tamponade provided it is used for a short-term period, especially in those patients who are noncompliant with postoperative face-down position. KEY WORDS: Perfluorocarbon liquid (PFCL), Postoperative tamponade, Complex inferior retinal detachments.

Long-term Visual and Anatomical Outcome after Surgical Management of Epiretinal Membrane.

OBJECTIVE: To assess the functional and surgical long-term outcomes following epiretinal membrane surgery. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rahmatulla Benevolent Trust Tertiary Care Eye Hospital, Karachi, from January 2016 to December 2020. METHODOLOGY: A medical record review was carried out of patients, who had undergone surgical management of ERM and had presented for follow-up for at least three years. Best corrected visual acuity (BCVA) and Optical Coherence Tomography (OCT) parameter [(integrity of ellipsoid zone (EZ)] was evaluated. BCVA, using Snellen's chart, is performed routinely on each visit, which was converted to logMAR chart for analysis in this study. OCT was also performed to evaluate the integrity of outer retinal layers using Heidelberg OCT. RESULTS: Sixty-five eyes of 54 patients were included in the study, including 41 eyes of 36 men (63%) and 24 eyes of 18 women (37%). Mean age was 46.2 ± 8.9 years. The mean BCVA significantly improved from 0.88 ± 0.28 logMAR (6/45 Snellen) preoperatively to 0.64 ± 0.21 (6/27) at the end of first year (p <0.001), which improved to 0.54 ± 0.19 (6/21) at the end of second year, and 0.53 ± 0.20 (6/20) after three years of follow-up. The post-op vision at three years was stratified according to the integrity of EZ on OCT performed at the same follow-up; and a significant difference was observed. EZ was intact in 52 eyes with a mean BCVA of 0.49 ± 0.16 logMAR (6/18 Snellen); while it was found disrupted in 13 eyes, where the BCVA was 0.68 ± 0.26 (6/29). CONCLUSION: Anatomically intact outer retinal layer significantly correlated with improved BCVA. Key Words: Epiretinal membrane, Optical coherence tomograghy, Best corrected visual acuity.

Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital.

OBJECTIVE: To assess the anatomical and functional outcomes of treating chronic persistent large macular hole by macular hole hydrodissection technique in a tertiary eye care hospital. METHODS: This interventional case series study was conducted in the Vitreoretinal department of LRBT Tertiary Teaching Eye Hospital, Karachi, from October 2017 to March 2018, with follow-ups till February 2019. The study included eighteen cases of chronic (symptoms of loss of central vision ≥ 2years), persistent (previously failed macular hole surgery), large (aperture diameter of ≥ 400µm) macular hole. Out of the eighteen patients, eight (44.4%) were males and ten (55.6%) were females. All operated patients underwent macular hole hydrodissection by balanced salt solution using a silicone soft tip extrusion cannula. Patients were followed up post operatively to assess post-operative complications and surgical results. RESULTS: Among eighteen patients with a mean aperture diameter of 477.1±102.9 µm and basal diameter of 849.4± 92.6µm, complete anatomical closure was achieved in sixteen (88.8%). Five (27.7%) out of the eighteen patients achieved best corrected visual acuity improvement of 6/36, whereas seven (38.8%) patients reached up to a BCVA of 6/60, with maximum improvement of two lines. The mean post-operative follow-up was 332.3± 46.7 days. CONCLUSION: Macular hole hydrodissection is a relatively new emerging technique with promising results for the closure of chronic persistent large macular hole.

Outcome Of Recurrent Macular Hole Closure With Amniotic Membrane Plug.

BACKGROUND: The surgery of macular hole is a complex and intricate micro-surgery and chances of recurrence of macular hole are always high. Therefore, in order to provide a medium to close this hole, we carried out this research on subjects using amniotic membrane, in light of the studies being conducted around the world. This in turn led to benefitting the patients by improving their vision over time. PURPOSE: To assess the rate of recurrent macular hole closure with amniotic membrane plug. It was a Quasi-experimental study, conducted at Layton Rahmatullah Benevolent Trust (LRBT) Free Eye Hospital Karachi, from January 2019 to January 2020. METHODS: This study was conducted using 13 eyes of 13 patients with recurrent macular hole who underwent amniotic membrane plugging via pars plana approach. Outcomes measured were changes in best corrected visual acuity (BCVA) and change in hole size with the help of optical coherence tomography (OCT). RESULTS: Anatomic closure was attained in 100% of the cases whereas BCVA improved from 1.7±0.33 (6/300) to 0.9±0.15 (6/48). CONCLUSIONS: The use of AM is a functional method for management of large RMH.

Role of Concomitant Internal Limiting Membrane (ILM) Peeling During Rhegmatogenous Retinal Detachment (RRD) Surgery in Preventing Postoperative Epiretinal Membrane (ERM) Formation.

OBJECTIVE: To investigate the role of concomitant Internal Limiting Membrane (ILM) peeling during surgery for macula off Rhegmatogenous Retinal Detachment (RRD) in preventing postoperative Epiretinal Membrane (ERM) formation; and its effect on the visual acuity. METHODS: This was a prospective, quasi-experimental study conducted from August 2018 to July 2019 at LRBT Tertiary Eye Care hospital, Karachi. Fifty-six patients with macula off RRD were divided into groups A (with ILM peeling) and B (without ILM peeling) via non-probability convenience sampling. All patients underwent standard 3 ports pars plana vitrectomy with silicon oil tamponade. In Group-A, ILM was stained using 0.5% ICG. Patients were evaluated clinically and by spectral domain optical coherence tomography (SD-OCT), pre- and post-operatively. Main outcomes recorded were best corrected visual acuity (BCVA) and occurrence of ERM on SD-OCT. RESULTS: There were 26 patients in Group-A and 30 patients in Group-B. At six months' follow-up, ERM had not developed in any case in Group-A compared to five patients (16.7%) in Group-B. There was no statistical difference in mean BCVA change from baseline. CONCLUSION: ILM peeling during vitrectomy for RRD prevents the formation of macular ERM post-operatively. This may reduce the need of a second vitrectomy. However, visual outcomes were comparable to the non-ILM peeling vitrectomy.

Pre-operative predicting factor in visual outcome after macular hole surgery.

OBJECTIVE: To determine the effectiveness of macular hole index (MHI) as a predicting factor of visual outcome after full thickness macular hole surgery. METHODS: This quasi-experimental study was conducted at LRBT Free Base Eye Hospital, Karachi from January 2018 to March 2019. Total 45 eyes of 45 patients with full thickness macular hole (FTMH) underwent preoperative Best Corrected Visual Acuity (BCVA) assessment with logMar chart and Optical Coherence Tomography (OCT) scanning, with measurement of base diameter and macular hole height. Values were calculated for the macular hole index (MHI), which was taken as the predictive factor. All patients had undergone 25+G trans-conjunctival three ports pars plana vitrectomy, internal limiting membrane peeling, and endo-tamponade of C3F8(14%). The final visual outcome of all the patients was noted. RESULTS: Forty-five patients were included for the study, out of which 10 (22.2%) were male and 35 (77.7%) were female. Age ranged from 45-70 years (mean age 57.20±6.47 years). The mean pre-operative visual acuity was 2.46±1.15 logMar and was 3.88±2.00 logMar, post-operatively. Moreover, 27(60.0%) out of 45 patients achieved BCVA (gain of 2 lines of the logMar chart). The average macular hole index was 1.55±0.50 and out of 45, 25 patients had MHI ≥0.5. It was found that patients with macular hole index ≥0.50 showed clinically significant improvement in BCVA in comparison to those who have macular hole index <0.50. CONCLUSION: Macular hole index can be used to predict functional success in macular hole surgery.

A comparative study of post-operative endophthalmitis between immediate versus delayed management of eventful cataract extraction.

OBJECTIVE: To compare the incidence of postoperative endophthalmitis after eventful cataract surgery i.e. posterior capsular rupture, in patients managed with anterior vitrectomy and intra ocular lens implantation intraoperatively to patients managed with anterior vitrectomy and intraocular lens implantation two weeks after the posterior capsule rupture. METHODS: This comparative study was conducted at Layton Rahamatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 to December 2018. The study included two groups, group A had patients with intra ocular lens implanted after posterior capsule rupture intraoperatively, while Group B had patients with intra ocular lens implanted after two weeks of initial surgery. Incidence rate of post-operative endophthalmitis was compared between two groups, which happened within six weeks after intra ocular lens implantation surgery. RESULTS: Total number of cataract surgeries that were performed during the study was 37,969. Incidence of postoperative endophthalmitis was 0.0019%. The study enrolled patients with complicated cataract surgeries that were 3508 (0.09%). Out of which incidence of post-operative endophthalmitis that occurred in group A was 0.007% and group B was 0.002%. (p value <0.05). The study also found that complicated extracapsular cataract extraction with intraocular lens implantation had more cases of endophthalmitis compared to phacoemulsification with intraocular lens. CONCLUSION: This study showed that management of posterior capsular rupture through anterior vitrectomy and secondary intraocular lens implantation after two weeks has less chances of postoperative endophthalmitis.

Axial length, a risk factor for retinal vein occlusion: A case control study.

OBJECTIVE: To evaluate the role of axial length in cases of retinal vein occlusion. METHODS: The case-control study was conducted at Layton Rahmatullah Benevolent Trust Eye Hospital, Karachi, from March to August 2018, and comprised patients with retinal vein occlusion and age-matched controls. Axial length of both eyes of all the subjects was calculated. The length of the affected eye was compared with that of the contralateral unaffected eye and also with the controls. Data was analysed using SPSS 21. RESULTS: There were 70 subjects; 35(50%) in each of the two groups. Among the cases, 16(46%) were males and 19(54%) were females. The overall mean age of the group was 37}4.2 years. Among the controls, 21(60%) were males and 14(40%) were females. The mean age of the group was 36.5}4.5 years. Also, among the cases, 23(66%) had unilateral central retinal vein occlusion and 12(34%) had branch retinal vein occlusion. Mean axial length was 0.80mm shorter in central retinal vein occlusion patients and controls (p=0.01). Branch retinal vein occlusion group did not show statistical significance on comparing with fellow eyes (p=0.18) and with controls (p=0.07). CONCLUSIONS: Axial length was found to be a local predisposing factor to develop retinal vein occlusion.

Effect of altering the regime of oral rifampicin therapy in the treatment of persistent central serous chorioretinopathy.

OBJECTIVE: To study the effect of reducing the duration of rifampicin therapy in the treatment of Chronic Central Serous Chorioretinopathy. METHODS: This is interventional study conducted in Layton Rahmatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 - December 2018. This randomized controlled comparative study included two groups, Groups-A comprised of 48 eyes of 40 cases with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 600mg for one month, and Group-B consisted of 43 eyes of 40 controls with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 300mg once daily for three months as previously stated in literature. To access the effect of therapy in both the groups, pre-treatment visual acuity on the logMAR and Optical Coherent Tomography (OCT, Heidelberg spectralis) for CMT were performed and repeated on the 1st and 3rd month post-treatment. Patients were also followed for 6 months to access any recurrence. RESULTS: On comparing the two groups, Group-A had improvement in VA and CMT after one month therapy of Rifampicin, Pre-treatment mean VA in Group-A was 0.85 ± 0.19 as compared to the pre-treatment mean VA in Group-B i.e. 0.74+/- 0.208, while the pre-treatment mean CMT was 609.0 ± 178.29 µm in Group-A, and 600.0 +/- 155.09 µm in Group-B respectively. After 1 month of therapy, the visual status, and CMT in Group-A was 0.29+/- 0.21 and 311.6 +/- 89.9, while Group-B, VA was 0.598 +/- 0.23 (p value 0.001%) and CMT was 512.30 +/- 148.37 (p-value 0.001%). Rifampicin was continued in Group-B till three months, and patients were re-accessed but there was no difference in VA and CMT statically. During the 3rd and 6th months of follow up no relapses were reported. CONCLUSION: This comparative study showed that the group receiving oral rifampicin 600mg for one month showed better outcome at one month and third month than the group receiving oral rifampicin at a dose of 300mg once daily for three months. This gives a better compliance and lower the risk of drug induced side effects.

Clinical application of multicolor optical coherence tomography in the diagnosis of retinal pathologies.

OBJECTIVE: To assess the clinical application of multicolor optical coherence tomography (OCT) using confocal scanning laser ophthalmoscopy (cSLO) in different retinal pathologies. METHODS: This observational study was conducted at the Layton Rahmatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Karachi, from April 2018 to June 2018. It includes 36 patients suffering from different retinal pathologies including diabetic retinopathy, age related macular degeneration, and vitreomacular interface disorders using multicolor optical coherence tomography as a screening tool. RESULTS: It was found that automated eye tracking system of this new version tool enables ophthalmologists to take high-resolution cSLO reflectance images. The light scatter can be avoided with the use of confocal optics. Appearances of pigment changes and hemorrhages were some of the differences found when compared to the conventional CFP. About 20% in AMD, 37.5% with diabetes and 100% patients with vitreomacular interface disorders could have be easily missed by CFP. CONCLUSIONS: Multicolor OCT can provide information and figures far more authoritatively than the conventional CFP, which is highly affected by media opacities. To interpret Multicolor OCT ophthalmologists should be watchful with plenty of understanding.

Outcomes of Retinectomy in Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy.

OBJECTIVE: To evaluate the anatomical and functional outcomes of retinectomy in the management of primary rhegmatogenous retinal detachments with inferior retinal breaks and advanced proliferative vitreoretinopathy (PVR C). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: LRBT, Free Base Eye Hospital, Karachi, from July 2015 to June 2017. METHODOLOGY: Forty eyes of 40 patients with primary inferior retinal breaks macula off detachments and advanced proliferative vitreoretinopathy (grade C) in which retinectomy was performed were included. Primary outcome measured was anatomic success, defined as complete retinal reattachment between neurosensory retina and retinal pigment epithelium at six months follow-up. Secondary outcomes included changes in best corrected visual acuity and postoperative complications. The follow-up period was up to six months after the last surgery. Association was determined between the retinectomy extension and the best corrected visual acuity postoperatively. RESULTS: Retina was reattached after single operation in 29 eyes (72.5%), after the second operation in eight eyes (20%), and after the third operation in two eyes (5%). Final retinal reattachment was achieved in 39 out of 40 eyes (97.5%). The preoperative visual acuity was counting fingers CF in eight eyes (20%), hand motion HM in 28 eyes (70%), and light perception PL in four eyes (10%). The postoperative visual acuity improved in 27 eyes (67.5%), remained stable in 11 eyes (27.5%), and worsened in 2 eyes (5%). There was no statistically significant association between the retinectomy extension and maximum postoperative best corrected visual acuity (p=0.098). The significant postoperative complications were retinal redetachment and hypotony. CONCLUSION: Retinectomies are effective in managing primary rhegmatogenous retinal detachment with severe PVR (PVR C), and Increase the final retinal reattachment rate.

Anatomical Outcome Following Indocyanine Green Assisted Internal Limiting Membrane Peeling for Stage 3 and 4 Macular Hole Surgery.

OBJECTIVE: To evaluate the anatomical success of stage 3 and 4 macular hole surgery after removal of internal limiting membrane (ILM) with the help of Indocyanine green (ICG). STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: LRBTTertiary Care Eye Hospital, Karachi, October 2015 to August 2016. METHODOLOGY: Twenty patients with stage 3 and 4 macular hole (confirmed by spectral domain optical coherence tomography) underwent standard 3 ports pars plana vitrectomy. Staining of ILM was performed with the help of 0.5% ICG to aid in visualization. ILM was removed by using intraocular forceps in circular fashion. Finally, gas fluid exchange with internal tamponade of SF6 20% was performed. Postoperative face down posture was maintained for seven days. Patients were followed-up for 8 months and assessment of macular hole closure was done using SD-OCT. RESULTS: After a follow-up of 8 months, macular hole was closed in 17 eyes (85%) and vision had improved in 6 patients. Postoperative complications included cataract, hyphema and vitreous hemorrhage. CONCLUSION: Surgery for stage 3 and 4 macular hole with ILM peeling has high anatomical success rate. Final visual acuity is dependent on preoperative macular hole stage and visual acuity at presentation.

Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery.

OBJECTIVE: To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery (MIVS) for diabetic vitreous haemorrhage. METHODS: One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab (Avastin) which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis. RESULT: A total of 122 patients were included; 78 (63.9%) males and 44 (36.1%) females. Mean age at the time of surgery was 51.4 ± 13.66 years. The mean preoperative BCVA was 1.64 ± 0.427 logMAR which improved to 0.57 ± 0.253 logMAR at 12 months post-operatively (p-value < 0.001). Recurrent vitreous haemorrhage was seen in four patients (3.28%). one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients.

Visual and Anatomical Outcomes Following Idiopathic Macular Epiretinal Membrane Surgery.

OBJECTIVE: To assess the visual and anatomical outcomes following idiopathic macular epiretinal membrane (IERM) surgery. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rehmatulla Benevolent Trust (L.R.B.T), Free Base Eye Hospital, Karachi, from January 2015 to June 2016. METHODOLOGY: Thirty eyes of thirty patients affected with idiopathic macular epiretinal membrane stage 2 were enrolled in this study. They subsequently underwent 23-gauge pars plana vitrectomy (PPV) with epiretinal membrane removal without internal limiting membrane peeling. The visual outcome was measured as improvement in best corrected visual acuity (BCVA) of at least two or more lines on ETDRS chart as compared to preoperative BCVA. The anatomical outcome was measured as decrease in foveal thickness on Spectral Domain-Optical Coherence Tomography (SD-OCT). Patients were followed for a period of 06 months. RESULTS: At the end of follow-ups, 23 (76%) eyes out of 30 gained 2 or more lines of vision. In 05 (16%) eyes, BCVA remained same and only 02 (6.6%) eyes showed worsening of vision. Mean preoperative foveal thickness was 392 ±20 µm, whereas mean postoperative thickness was 305 ±16 µm with an average decrease of 87 µm, in foveal thickness. Recurrence of ERM was found to be the most frequent complication. CONCLUSION: IERM surgery is a safe procedure and beneficial in achieving significant visual acuity improvement and anatomical recovery in the majority of cases.

Visual outcome of 25-gauge microincision vitrectomy surgery in diabetic vitreous haemorrhage.

OBJECTIVE: To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage. METHODS: This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 - 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively. RESULT: Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis. CONCLUSION: 25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications.

Visual acuity after trans-scleral sutured posterior chamber intraocular lens.

OBJECTIVE: To determine the changes in visual acuity in patients undergoing Trans-Scleral Sutured Posterior Chamber Intra-Ocular Lens (TSSPCIOL) implantation at a tertiary care hospital in Karachi, Pakistan. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: LRBT Tertiary Eye Hospital, Karachi, from January 2006 to December 2010. METHODOLOGY: Records of all patients undergoing implantation of TSSPCIOL were reviewed. Patients with diagnosed glaucoma, diabetic retinopathy, macular degeneration, history of recurrent uveitis, corneal haze or central corneal scars were excluded. For the final analysis, 70 eyes out of a total of 75 were selected. Main outcomes of interest were pre and postoperative visual acuities and surgical complications. SPSS 21 was used for data analysis. RESULTS: Pre-operatively, the average Best Spectacle-Corrected Visual Acuity (BSCVA) was 6/36 on the Snellen chart. This improved to 6/12 postoperatively. The mean improvement seen was 2.4 lines on the Snellen chart (p < 0.05). Complications include transient intraocular pressure elevation in 25 eyes (36%), IOL tilt in 4 eyes (7.1%), Cystoid Macular Edema (CME) in 4 eyes (5.7%), vitreous haemorrhage in 2 eyes (2.9%), hyphema in 2 eyes (2.9%), uveitis in 1 eye (1.4%), and retinal detachment 1 eye (1.4%). No IOL subluxation, suture erosion, iris capture, choroidal effusion or endophthalmitis was encountered and no re-operations were needed. CONCLUSION: TSSPCIOLs are a good management option for patients with aphakia in whom PC IOLs cannot be placed.

23-gauge sutureless vitreo-retinal surgery for superior rhegmatogenous retinal detachment.

OBJECTIVE: To determine the results of 23-gauge sutureless vitreo-retinal surgery for superior/supero-temporal rhegmatogenous retinal detachment (RRD). STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: LRBT, Free Base Eye Hospital, Karachi, from January 2010 to December 2011. METHODOLOGY: Adult patients who underwent 23-gauge sutureless vitreo-retinal surgery along with use of Perfluoropropane (C3F8) gas as internal tamponading agent for fresh (upto 3 weeks) superior/supero-temporal RRD was reviewed. Major outcome measures were anatomical success, best corrected visual acuity (BCVA) with Log Mar and complications during and after surgery. Postoperative follow-up was done on 1st day and at 1st, 4th, 8th and finally at 12th week. RESULTS: Sixty eyes of 60 patients, age between 30 - 60 years including 37 (61.67%) males and 23 (38.33%) females having superior or superatemporal RRD underwent 23-guage sutureless vitreo-retinal surgery with the use of perfluoropropane (C3 F8) gas as internal temponade at the end of procedure. Anatomical success rate was 81.66% (49 out of 60 eyes) with first surgery and raised to 90% (54 cases) with second surgery. Log Mar BCVA significantly improved from mean baseline 0.93 to 0.49 with mean difference of 0.43 (p < 0.001), 95% confidence interval. Postoperative complications were sub-conjunctival haemorrhage in 11 eyes (18.33%), wound leak in 7 eyes (11.66%), anterior chamber became shallow in 6 eyes (10%), cataract developed in 5 eyes (8.33%), re-retinal detachment in 4 eyes (6.66%), ocular hypotony and sterile inflammatory reaction in 3 eyes (5%) each, while iatrogenic breaks developed in 2 eyes (3.33%). CONCLUSION: The 23-gauge sutureless vitreo-retinal surgery for superior rhegmatogenous retinal detachment achieved high anatomical success and significant visual improvement. Sub-conjunctival haemorrhage was the most frequent procedural complication.