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.

Comparison of 1000-Centistoke versus 5000-Centistoke Silicone Oil in Complex Retinal Detachment Surgery.

OBJECTIVE: To compare the efficacy and complications of using 1000-centistoke versus 5000-centistoke silicone oil for complex retinal detachment repair. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: LRBT Tertiary Eye Hospital, Karachi, from January 2007 to June 2013. METHODOLOGY: Eighty-five eyes (85 patients) presenting with superior rhegmatogenous retinal detachments associated with PVR grades B and C (involving not more than 3 clock hours) were randomized to either 1000 centistokes (n=44) or 5000 centistokes (n=41) silicone oil group. All patients underwent 23-gauge pars plana vitrectomy surgery with silicone oil intraocular tamponade. Patient data was analysed at 18 months post-operatively. IBM SPSS 21 was used for data analysis. RESULTS: There were 52 male and 33 female patients aged between 22 and 70 years (45.2 ±16.2). After the first surgery, successful reattachment of the retina was achieved in 67 eyes (78.8%); of which 35 eyes were in 1000-centistoke and 32 eyes in 5000-centistoke groups. Mean pre-operative Best Corrected Visual Acuity (BCVA) was 1.63 ±0.54 which was improved to a mean post-operative BCVAof 1.46 ±0.78 (1.42 ±0.74 in 1000-centistoke group; 1.49 ±0.78 in 5000 centistoke group). The 1000-centistoke group had a significantly higher frequency of oil emulsification which necessitated early removal of silicone oil. There were 66 eyes (77%) with at least one complication (34 eyes in 1000-centistoke group; 32 eyes in 5000-centistoke group) including cataract, corneal abnormalities, raised IOP, hypotony, vitreous haemorrhage and retinal redetachment. CONCLUSION: Although visual and anatomical outcomes were comparable between the two groups, the 1000-centistoke silicone oil group developed early oil emulsification necessitating its early removal.

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.

Outcomes of silicone oil removal.

OBJECTIVE: To evaluate the outcome and complications of removal of silicone oil after pars plana vitrectomy. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rahmatullah Benevolent Trust (L.R.B.T), Free Base Eye Hospital, Karachi, from February 2008 to January 2011. METHODOLOGY: Ninety five eyes of 95 patients with a history of undergoing three-port pars plana vitrectomy were included in this study that subsequently underwent removal of silicone oil. Silicone oil was removed after ophthalmoscopically determining retina attachment or when the duration of silicone oil tamponade was atleast of 6 months. Patients were followed for a period of 12 months. RESULTS: Retinal re-detachment was seen in 19 (20%) out of 95 eyes, vitreous haemorrhage in 2 (2.1%) out of 95 eyes, corneal decompensation in 6 (6.3%) out of 95 eyes, hypotony in 7 (7.3%) out of 95 eyes, phthisis bulbi in 2 (2.1%) out of 95 eyes and lens opacification in 9 (9.4%) out of 95 eyes. CONCLUSION: In this study, silicone oil removal resulted in various complications among which retinal re-detachment was the most frequent.

Combined trabeculotomy and augmented trabeculectomy in primary congenital glaucoma.

OBJECTIVE: To evaluate the results of combined trabeculotomy and augmented trabeculectomy as a primary procedure on intraocular pressure and corneal clarity in uncomplicated congenital glaucoma. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: L.R.B.T Free Base Eye Hospital, Karachi, from January 2007 to December 2010. METHODOLOGY: Twenty eyes of 14 consecutive children with primary congenital glaucoma who had primary trabeculotomy and augmented trabeculectomy were observed from January 2007 to December 2010 at LRBT Free Base Eye Hospital, Karachi. Main outcome measures were pre-operative and postoperative intraocular pressure, corneal clarity and complications. RESULTS: Out of 14 patients, 9 patients (64.2%) were male and 5 patients (35.7%) were female with age ranging between 5 months to 6 years. Mean duration of follow-up was 8.25 months. Seventeen eyes (85%) showed improvement in corneal clarity from baseline at their last follow-up. Mean intraocular pressure decreased from 32 ± 2.5 mmHg pre-operatively to 13 ± 2.5 mmHg postoperatively at the last follow-up (p < 0.001). Complete success (intraocular pressure < 20 mmHg) was obtained in 16 (80%) out of 20 eyes. Complications encountered were vitreous loss per-operatively while performing iridectomy in 1 eye (5%), shallow anterior chamber on the first postoperative day in 1 eye (5%) and hyphema in 1 eye (5%). CONCLUSION: Combined trabeculotomy and augmented trabeculectomy for primary congenital glaucoma resulted in improvement in reduction of intraocular pressure as well as improvement in corneal clarity. Hence, combined trabeculotomy and augmented trabeculectomy is a safe and effective procedure for primary congenital glaucoma.

Visual outcome of pars plana vitrectomy for dropped nucleus after phacoemulsification.

OBJECTIVE: To determine the visual outcome of patients who underwent pars plana vitrectomy for dropped nucleus after phacoemulsification. STUDY DESIGN: Interventional case series. PLACE AND DURATION OF STUDY: LRBT Free Base Eye Hospital, Karachi, from February 2008 to January 2011. METHODOLOGY: Forty-eight eyes of forty eight patients having history of dropped nucleus (soft remnant, half nucleus or complete nucleus) underwent 20 gauge pars plana vitrectomy within 24 days of phacoemulsification. After complete vitrectomy nucleus was lifted with the help of perfluorocarbon and removed either through a limbal incision or by using phacofragmenter, whereas small lens remnants were removed with a vitreous cutter. Intraocular lens was implanted at the end of surgery. Postoperative visual acuity, and any complications were assessed. Patients were followed for a period of 12 months. RESULTS: Final visual acuity ranged from 6/9 to 6/18 in 34 eyes (70.83%), 6/24 to 6/36 in 8 eyes (16.66%) and 6/60 or less in 6 of 48 eyes (12.5%). Complications included raised intraocular pressure in 6 eyes (12.5%) and retinal detachment in 2 eyes (4.1%), corneal oedema and decompensation in 3 eyes (6.25%) and cystoids macular oedema in 4 cases (8.33%) out of 48 cases. CONCLUSION: The loss of crystalline lens in the vitreous during phacoemulsification is a severe complication, but appropriate and timely management can restore good visual outcome and minimize complications.