Institute Of Ophthalmology Research Articles

Role of topical beta blockers in regression of infantile capillary hemangioma.

Objective:To observe efficacy of Timolol maleate 0.5% by topical and surface application in infantile superficial capillary hemangioma of eyelid.Methods: This multi-centered clinical case series was carried out at Ophthalmology Department of Bilawal Medical College and Institute of Ophthalmology, LUMHS, Jamshoro from November 2019 to May 2020. We included 14 subjects. All the patients were subjected to detailed clinical examination. Before starting the topical beta blockers, the enrolled subjects had obtained the expert opinion by pediatrician to rule out any preexisting developmental cardio vascular disease. Topical beta blockers 0.5% drops were thus started with, against the ongoing finding of superficial capillary hemangioma of eyelid.Results:There was significant regression in size of infantile hemangioma after treating with topical timolol maleate 0.5%. We included 14 subjects in this study. Mean±SD age of patients was 4.94. Complete regression was seen in 08 subjects at the end of 12 weeks (64%) while 03 were completely cured at 08 weeks (21%) and 01 patient lost follow up with us. No significant ocular and systemic side effects were noted.Conclusion: Topical timolol maleate 0.5% can be the first-line treatment modality for superficial capillary hemangiomas due to its better safety and efficacy.

Idiopathic epiretinal membrane removal with and without internal limiting membrane peeling: a prospective comparative study

Aim This is a prospective comparative study of the macular morphology and visual outcome after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling in cases of idiopathic ERM. The study was carried out in the Research Institute of Ophthalmology, Giza, Egypt from February 2015 to February 2017.Patients and methods A total of 40 eyes of 40 patients with visually significant idiopathic ERM were included in the study. A standard three-port 23-gauge pars plana vitrectomy (PPV) was conducted in all patients. Twenty eyes (Group A) were subjected to ERM removal only, while ILM peeling with ERM removal was performed in the other 20 eyes (Group B). Central macular thickness (CMT) and foveal contour on optical coherence tomography (OCT) in addition to best-corrected visual acuity (BCVA) were obtained at baseline and at 1, 3, 6 and 12months postoperatively.Results The mean BCVA significantly improved in both groups, with no statistically significant difference between the two groups at 12 months postoperatively (P=0.053). The mean preoperative and postoperative BCVA were 0.19 and 0.50 decimal units, respectively, in group A, while in group B, the mean preoperative and postoperative BCVA were 0.13 and 0.44 decimal units, respectively. Despite a statistically significant more reduction of CMT in group A compared with group B at 1 month postoperatively (324.80 and 403.95 µm, respectively, P=0.01), no statistically significant difference was found between the two groups at 12 months postoperatively (277.40 and 306.20 µm, respectively). Normal foveal contour was achieved in 13 (65%) and 6 (30%) eyes in groups A and B, respectively.Conclusion Anatomical and functional improvements could be achieved in both groups, with no statistically significant difference at 12 months postoperatively. Adding ILM peeling to idiopathic ERM removal did not appear to improve the outcome in this cohort. Therefore, ILM should not be routinely peeled as safety remains controversial.

Assessment Of Peripapillary Retinal Nerve Fiber Layer Thickness Post Pars Plana Vitrectomy By Ocular Coherence Tomograghy

Background: Modifications of the inner retinal layer is a frequent observation following pars plana vitectomy. Aim of the Work: To assess early changes of the thickness of Retinal Nerve Fiber Layer after pars plana vitrectomy by ocular coherence tomography. Patients and Methods: This is a non-interventional observational study, in which 30 eyes of 30 patients underwent Examination of Retinal Nerve Fiber Layer after Pars Plana Vitrectomy by OCT. Cases were performed at the Ophthalmology department of Beni-Suef University`s Hospital and Research Institute of Ophthalmology. Results: In the current study we found by using the OCT, there were no changes in the peri-papillary retinal nerve fiber layer that can sound statistically. PPV had no effect on RNFL because of patient Age or Gender or ether eye status like the underlaying pathology, axial length of the eye except at some quadrants of RNFL. Conclusion: Despite RNFL showing changes following vitrectomy, they showed no statistical significance

Outcome of Injection Botulinum Toxin in Blepharospasm.

Blepharospasm is a condition of involuntary spasm of the orbicularis oculi muscle which leads to intermittent or complete closure of the eyelids. Botulinum toxin is the currently recommended first line treatment for such blepharospasm. This study aims to find out the outcome of injection Botulinum toxin Type A in Blepharospasm. It was a hospital based, prospective, interventional study conducted on patients diagnosed as Benign essential blepharospasm (BEB), Meige syndrome (MS) and Hemifacial spasm (HFS) by oculoplastic surgeon at Oculoplasty department OPD, Tilganga Institute of Ophthalmology, from December 2018 to November 2019. After taking all standard precautions for botulinum toxin injections, 6 to 8 sites for injecting 2.5 to 5 IU of the toxin were given. All the patients were evaluated before and after injections according to Jankovic spasm grading and improvement in functional impairment scale and followed on one week, one month, three month and when the symptoms reappeared. A total of 43 cases which included 32 cases of Benign essential Blepharospasm, 9 Hemifacial spasm and 2 Meige syndrome. The mean Jankovic severity score was 3.51 ± 0.51 (range 3-4). The mean improvement in functional score was 2.60 ± 0.54 (range 1-3), was statistically significant (p-value <0.001).The effective period of injection was 130 ± 20.82 (93 - 189) days.38 patients had repeated injections after reappearance of symptoms. 4 patients had side effects of redness and hematoma at one site. This study concludes that Botulinum toxin type A is effective in the management of Benign essential blepharospasm, Hemifacial spasm and Meige syndrome. This along with a good safety profile justifies its role as a first line treatment therapy in blepharospasm. However, it is a temporary treatment option where the effect lasts for a short period of time and repeated injections are required.

Frequency of incidental ocular findings during pre-employment screening at a tertiary care Eye hospital.

Objective:To highlight the prevalence of incidentally discovered ocular findings harvested amongst candidates of different age groups presented for pre-employment screening in a tertiary care eye hospital.Methods:This Cross sectional prospective study was conducted in Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Dec 2019. Data was collected using non-probability consecutive sampling technique. All candidates who appeared for medical fitness examination were included. Candidates belonged to various regions of Pakistan. Complete ophthalmic checkup including visual acuity, best corrected visual acuity, anterior and posterior segment examination was performed. The data analysis was done by IBM SPSS 2.0 software.Results:One thousand and five hundred (1500) candidates underwent ophthalmic medical fitness examination during Jun 2018 to Dec 2019, out of these 86% (1290) were males and 14% (210) were females. Mean age of the candidates was 23.14 ± 5.66 years. The most common incidental ocular findings were amblyopia 24.6% (369), strabismus 10% (150), cataract 7.3% (110), macular scar 6.5% (100) and colour vision deficiencies 5.5% (82).Conclusion:The study demonstrates that out of total patients, 77% (1095) were found to be asymptomatic and 23% (405) were symptomatic. The study provides frequency for prevailing diseases and can help in improvement of eye care screening.

Correlation between Intraocular Pressure and Visual Field Loss in Primary Open Angle and Primary Angle Closure Glaucoma: A Cross-Sectional Study

Introduction: Glaucoma is characterised by structural damage to optic nerve head with corresponding visual field defects and often associated with increased Intraocular Pressure (IOP). It may be broadly classified as Primary Angle Closure Glaucoma (PACG) and Primary Open Angle Glaucoma (POAG). It is one of the leading causes of global blindness, and a major proportion occurs in Indian population. Aim: To study the correlation between pretreatment IOP and extent of visual field loss in PACG and POAG. Materials and Methods: A cross-sectional observational study was carried out in Regional Institute of Ophthalmology, Trivandrum, Kerala, India from April 2016 to May 2017. Newly diagnosed cases of PACG (25 patients-13 males, 12 females, mean age 58.72±10.07 years) and POAG (85 patients- 45 males, 40 females, mean age 60.28±10.42 years) underwent a detailed glaucoma evaluation which included IOP measurement with Goldmann applanation tonometer and visual field testing using Humphrey Field Analysis (HFA) 24-2 pattern. Mean Deviation (MD), Pattern Standard Deviation (PSD) and Advanced Glaucoma Intervention Score (AGIS) score was calculated from reliable visual field test result. All data were coded and entered in to statistical software, Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. The correlation between pretreatment IOP and visual field loss in patients with PACG and POAG was determined by Pearson Correlation of Coefficient. Results: Amongst the total 110 patients of this study, 25 patients were of PACG while POAG were in 85 patients. A significant correlation between pre treatment IOP and the extent of visual field loss in PACG was noted. There was no significant correlation in POAG. Linear regression analysis demonstrated a significant positive correlation between IOP and AGIS score in PACG (Pearson correlation coefficient(r)=0.805, p&lt;0.001), not in POAG (r=0.026, p=0.816). Correlation between IOP and MD is statistically significant in PACG (r=0.812, p&lt;0.001) but not in POAG (r=0.058, p=0.597). The correlation between IOP and PSD is not statistically significant in both groups (p-value &gt;0.450). Conclusion: A significant correlation between IOP and visual field loss in PACG indicates that extent of visual field damage can be controlled by controlling IOP alone in PACG. The correlation between the pretreatment IOP and visual field loss in POAG is not statistically significant which agrees with the current proposed pathophysiology of optic neuropathy in which multiple factors influence in addition to IOP.

Study of the resistance pattern and alteration in the conjunctival flora of patients exposed to repeated antibiotics

AIM: To investigate and analyze the changes in the conjunctival flora of patients exposed to repeated antibiotic usage. In addition, determining the effects of this repeated exposure on the resistance pattern of the conjunctival flora. METHODS: This study included 40 patients, admitted to the Retina Unit of the Research Institute of Ophthalmology. All chosen patients had a minimum of 4 consecutive, monthly intravitreal injections (IVI), some were extended to 6mo or 1y as required. The patients were randomly divided into 3 groups and each group received one kind of antibiotic which was either ofloxacin, moxifloxacin or ceftazidime. All bacterial isolates were tested for antibiotic susceptibility using Kirby-Bauer disc diffusion technique. RESULTS: In this study the conjunctival normal flora at base line culture varied from a predominance of Staphylococcus epidermidis (51.2%), followed by Staphylococcus aureus 14% to Micrococcus species 12.8% and other coagulase negative staphylococci (CONS) 13%. Our results showed an increase in the percentage of Staphylococcus epidermidis among ceftazidime treated eyes during the four visits in comparison to baseline cultures of patients randomized to ceftazidime. In contrast, there was no noticeable increase in Staphylococcus aureus percentage from baseline. In fluoroquinolone treated eyes, we also observed an increase in percentage of Staphylococcus epidermidis from base line. In contrast to ceftazidime treated eyes, the Staphylococcus aureus percentage in fluoroquinolone treated eyes showed an increase from baseline. However, the pattern of the ocular flora composition changed with the exposure to the old and newer generation of fluoroquinolones. We noticed an increase of Staphylococcus epidermidis in moxifloxacin treated eyes than that in ofloxacin treated eyes from baseline. There was no observed difference in the pattern of Staphylococcus aureus regarding exposure to older and newer generations of fluoroquinolones. CONCLUSION: Repeated use of ophthalmic antibiotics not only alters the composition of the normal ocular flora, but also selects for resistant strains.

Wallace Foulds: founding president of the Royal College of Ophthalmologists

Photo credit: Royal College of Ophthalmologists In 1951 Wallace Foulds, who has died aged 96, was appointed registrar at Moorfields Eye Hospital in London, where he relished the wide ranging...

Comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube in elective paediatric ophthalmic procedures

Introduction: The main objective of the study was to assess the benefits of using laryngeal mask airway in place of endotracheal intubation in reducing the intraocular pressure and hemodynamic response in paediatric patients posted for elective ophthalmic procedures. This prospective randomized study was conducted over a period of six months in the Regional institute of Ophthalmology. Materials and Methods: Sixty paediatric patients aged between 2-12 years, belonging to ASA grade 1 & 2 and posted for elective ophthalmic procedures were allocated into two groups, each of 30 patients, by a closed envelope method. Laryngeal mask airway (LMA) insertion for group I and Endotracheal intubation (ETI) for group II were performed. Intraocular pressure measurements at Baseline, pre-insertion, at 30th second and at 2nd minutes between the groups were compared. Corresponding responses in heart rate (HR), and mean arterial pressure (MAP) were also compared. Results: Statistically significant differences were seen at 30th second of intubation between group I and group II in HR [107.8±13.417in group I and 126.2±10.996 in group II], MAP [84.8±4.637 in group I and 98.4±8.6 in group II] and IOP (11.07+1.9 mmHg in group I and 15.76+2.7 mmHg in group II; P = 0.0001)]. Similarly, significant differences were also observed at 2nd minute of intubation. Conclusion: We found that LMA insertion has less influence on intraocular pressure and hemodynamic response and it is associated with less postoperative complications in children undergoing elective ophthalmic procedures under general anaesthesia. Keywords: Laryngeal mask airway, Intubation, Pressor response, Ophthalmic, Intraocular.

A study of modified and economical approach to canalicular tear using intravenous cannula in tertiary care centre

Purpose: Study aims to demonstrate and evaluate a modified and economical way of repairing canalicular tear using intravenous cannula in tertiary care centre. Materials and Methods: 32 patients with canalicular tear admitted in Minto Ophthalmic Hospital, regional institute of ophthalmology were taken in the study. Patients were operated for canalicular tear repair using intravenous cannula of 24G size. Functional and anatomical success of the procedure evaluated during the follow up. Data collected and analysed using descriptive statistics. Results: Out of 32 patients, 24 were males and 8 females. Right eye was involved in 22 patients and left eye in 10 patients. Various mode of injury includes dog bite, Road Traffic Accidents, assault, self-injuries, domestic violence, cooker blast in varying percentages. Functional and anatomical success was seen in 93.75% of the patients. Conclusion: Using intravenous cannula is an economical way of canalicular tear repair with easy availability and no extra cost to the patient. With the least complications, this technique can be adapted in Government set up as this is more economical. Keywords: Canalicular tear, Eye lid injury, Intravenous cannula.

Study of awareness, perception about strabismus and social impact of strabismus in adults attending tertiary care centre

Aim: Strabismus is the common condition seen in children and adults in our society. Strabismus has variety of psychosocial impact that can affect the quality of life of the patients. Proper education and awareness regarding the condition can help to rule out the myths associated with strabismus and also building up the personality of the patients. This study was done to know the level of awareness, knowledge about the strabismus in our population and the social impact of strabismus in patients life. Material and Methods: Cross sectional study conducted on 196 patients with strabismus attending outpatient department of Minto Ophthalmic Hospital, regional institute of ophthalmology were included in the study. After taking informed consent, face to face interview conducted asking questions from structured questionnaire prepared. Data collected and analysed with descriptive statistics. Results: Out of 196 patients included in the patients, 128 were males and 68 females. About 9.6 % of patients, were unaware of the condition of strabismus, 56.3% were unaware that squint can cause visual disturbance, 63% were unaware of that strabismus can be treated, 37% of people felt like surgery is the only mode of treatment for strabismus. 60% of the study population expressed that they were rejected for being married due to strabismus because of cosmetic affect, 42.4% felt like squint can hinder the social leadership, 36 % had difficulty in getting job, 28% of the patients expressed being criticized by their friends that lowered their confidence, 75% of the patients felt that they look ugly because of strabismus. Conclusion: Strabismus apart from causing ocular problems, is associated with many psycho-social impact on life of patients. There is lack of awareness regarding the strabismus in our population. Attitude and perception of society towards patients with strabismus will affect the overall confidence, personality of the patients and hence affect quality of life. Hence awarenes

Efficacy of YAG Laser Embolysis in Retinal Artery Occlusion.

Objective:To compare the anatomical and functional success between conventional medical method and Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) laser embolysis in retinal artery occlusion.Methods:This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi from July 2018 to May 2020. A total of 14 eyes of 14 patients were received with fovea involving branch or hemiretinal artery occlusion within 24 hours of onset of symptoms. They were divided randomly in two groups. Initial treatment was given to all cases, and seven eyes received Nd:YAG laser treatment for embolysis. Both groups were analysed for anatomical success (reperfusion) and functional success (defined as improvement in visual acuity to better than 6/60 on Snellen’s visual acuity chart from baseline visual acuity).Results:In conventional group, anatomical success was achieved in 2 (28.6%) eyes, while significant visual improvement was seen in 3 (42.8%) eyes. In Nd:YAG laser embolysis group, anatomical success was achieved in 5 (71.4%) eyes, while significant visual improvement was seen in 6 (85.7%) eyes. All eyes which showed functional improvement underwent Nd:YAG laser embolysis within 6 hours of onset of symptoms.Conclusions:Nd: YAG laser embolysis is more effective in management of fovea threatening retinal artery occlusion, as compared to conventional medical treatment, if performed within six hours of onset of symptoms.

Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema

Purpose: To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018&#x0D; Methods: Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve &lt; 0.05 was accepted as statistically significant.&#x0D; Results: The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P &lt; 0.001). The decrease in macular edema thickness was more in group II than group I (P &lt; 0.001).&#x0D; Conclusion: Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up.&#x0D; Key Words: Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

Visual outcomes in diabetic macular edema patients after avastin injection

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.

Clinically Verified Hybrid Deep Learning System for Retinal Ganglion Cells Aware Grading of Glaucomatous Progression.

Glaucoma is the second leading cause of blindness worldwide. Glaucomatous progression can be easily monitored by analyzing the degeneration of retinal ganglion cells (RGCs). Many researchers have screened glaucoma by measuring cup-to-disc ratios from fundus and optical coherence tomography scans. However, this paper presents a novel strategy that pays attention to the RGC atrophy for screening glaucomatous pathologies and grading their severity. The proposed framework encompasses a hybrid convolutional network that extracts the retinal nerve fiber layer, ganglion cell with the inner plexiform layer and ganglion cell complex regions, allowing thus a quantitative screening of glaucomatous subjects. Furthermore, the severity of glaucoma in screened cases is objectively graded by analyzing the thickness of these regions. The proposed framework is rigorously tested on publicly available Armed Forces Institute of Ophthalmology (AFIO) dataset, where it achieved the F1 score of 0.9577 for diagnosing glaucoma, a mean dice coefficient score of 0.8697 for extracting the RGC regions and an accuracy of 0.9117 for grading glaucomatous progression. Furthermore, the performance of the proposed framework is clinically verified with the markings of four expert ophthalmologists, achieving a statistically significant Pearson correlation coefficient of 0.9236. An automated assessment of RGC degeneration yields better glaucomatous screening and grading as compared to the state-of-the-art solutions. An RGC-aware system not only screens glaucoma but can also grade its severity and here we present an end-to-end solution that is thoroughly evaluated on a standardized dataset and is clinically validated for analyzing glaucomatous pathologies.

Microbiological patterns of endophthalmitis in a tertiary level hospital of Kathmandu, Nepal.

Endophthalmitis is a serious ocular infection that can result in blindness and therefore is a major ophthalmic concern. The study was conducted to find out the microbial etiology in clinically diagnosed cases of endophthalmitis and to determine the antibacterial susceptibilities of bacterial isolates in vitro. A retrospective analysis was carried out of all patients presenting between 15th January 2012 to 15th January 2013 with clinically diagnosed Endophthalmitis at Tilganga Institute of Ophthalmology (TIO). Intraocular specimens (aqueous or vitreous fluids) were collected from 102 patients. Along with intraocular aspirates, blood and urine specimens, chest X-ray from endogenous endophthalmitis and corneal scrapes from corneal ulcer leading to endophthalmitis were also collected. The intraocular specimens were then subjected to microbiological evaluation. Antibiotic susceptibility of isolates were determined for different ocular antibiotics using the Kirby-Bauer disk-diffusion test. Samples from 102 patients diagnosed with endophthalmitis underwent microbiological analysis, of which culture positive 34(33.33%). Out of 34, 29 (85.29%) had bacterial growth and the remaining 5 (14.70%) had fungal growth. Most of them (40.8%) were secondary to cataract surgery(postoperative). A total of 29 bacterial culture reports, 72.41% were gram-positive and 27.58% were gram-negative. Streptococcus pneumoniae (37.93%) was the most frequently isolated organism. The antimicrobial sensitivity for isolates was as follows: Ofloxacin - 86.2%, Chloramphenicol - 82.75%,Cefazolin- 82.7%, Gentamicin - 75.8%, Ceftazidime - 58.6%, Amikacin - 55.17% and Vancomycin - 51.7%. The data highlights low culture positivity and a predominance of gram positive bacteria as the major causes of infectious endophthalmitis, usually following cataract surgery. The most common isolate was Streptococcus pneumoniae. Ofloxacin and Chloramphenicol demonstrated greatest efficacy against these bacterial isolates.

Cool Crosslinking: Riboflavin at 4°C for Pain Management After Crosslinking for Keratoconus Patients, A Randomized Clinical Trial.

To explore corneal cooling as a method of pain management in corneal-accelerated collagen cross-linking. This was a prospective and interventional randomized clinical trial registered in the National Institutes of Health Clinical Trials through the identifier NCT030760770. The research was conducted at the Institute of Ophthalmology "Conde de Valenciana." A total of 98 patients were randomly assigned to one of the following 2 groups: cold riboflavin (4°C) group or control group (riboflavin at room temperature). The inclusion criteria were patients of any sex, older than 18 years of age with keratoconus diagnosis who needed management with cross-linking in both eyes because of the evidence of progression. The exclusion criteria were patients who had cross-linking without epithelial debridement, unilateral cross-linking, or any other ocular pathologies besides keratoconus and any cognitive incapacity that would make the understanding of the pain test difficult. The main outcome measures were pain, tearing, photophobia, foreign body sensation, and irritation. At 2 hours post-op, pain in the case and control groups was 3.80 ± 3.00 and 8.08 ± 2.21 (P < 0.05), tearing was 1.56 ± 1.96 and 8.29 ± 2.42 (P < 0.05), photophobia was 5.44 ± 3.57 and 7.83 ± 2.64 (P < 0.05), foreign body sensation was 2.20 ± 2.78 and 6.54 ± 2.73 (P < 0.05), and irritation was 3.48 ± 2.98 and 6.79 ± 3.00 (P < 0.05), respectively. A statistical significant difference was maintained in pain values on day 1 (2.79 ± 3.09 and 4.91 ± 3.27 [P < 0.05]), 2 (2.54 ± 2.41 and 4.00 ± 2.43 [P < 0.05]), and 4 (0.45 ± 0.76 and 1.22 ± 1.67 [P < 0.05]). This study demonstrated that pain and associated symptoms decreased significantly in the riboflavin 4°C group.

Influence of Perfluorocarbon Liquids on Peripapillary Retinal Nerve Fiber-Layer Thickness Following Pars Plana Vitrectomy with Silicone Oil-Based Endotamponade.

BackgroundInner retina–layer modifications after pars plana vitrectomy (PPV) can be objectively assessed through spectral domain optical coherence tomography (SD-OCT).MethodsThis study explored prospectively changes in retinal nerve-fiber layer (RNFL) thickness with SD-OCT in eyes undergoing PPV with silicone oil–based tamponade with and without use of perfluorocarbon liquids (PFCLs) during the early postoperative phase (up to 3 months) at the Research Institute of Ophthalmology, Egypt.ResultsThirty patients were recruited who underwent PPV and silicone oil–based tamponade for either retinal detachment or diabetic retinopathy between April 2019 and September 2019. Mean RNFL thickness showed no significant change during follow-up at the first week (102.90±30.68 mm), 1 month (107.30±32.27), or three months (105.90±36.68; p=0.46, 0.68). There were significant correlations noticed between RNFL thinning and axial length of eyes, intraocular pressure, and use of PFCLs during the follow-up period.ConclusionThe RNFL tends to change postvitrectomy, but not significantly. Careful examination and consistent follow-up is required for postvitrectomy patients with larger axial length and intraoperative PFCL use.

Functional and Structural Outcomes at the Foveal Avascular Zone with Optical Coherence Tomography Following Macula off Retinal Detachment Repair.

BackgroundVisual recovery following macula involving rhegmatogenous retinal detachment remains poorly understood. The aim of this work is to correlate the functional and the anatomical changes in retinal vasculature in the foveal avascular zone using optical coherence tomography angiography (OCTA) after successful retinal reattachment repair and correlate this data with retinal thickness and post-operative visual recovery.MethodsA prospective, comparative observational study of 28 eyes of 14 patients with 14 eyes undergoing macula off retinal detachment repair with pars plana vitrectomy, endo-laser and silicone oil-based tamponade compared with 14 fellow healthy eyes at 1, 6 and 12 weeks post-operative period. The study was conducted at the Research Institute of Ophthalmology, Giza, Egypt between February 2018 and August 2018.ResultsThe foveal avascular zone (FAZ) area in the patients group was not significantly different compared to the control group and was found to be negatively correlated with the central retinal thickness in both the study and control group. The superficial capillary plexus (SCP) area at the FAZ was significantly larger than the deep capillary plexus (DCP) area at the FAZ in both the study and control group over the follow-up period. The DCP area at the FAZ was significantly larger at the 3rd follow-up than the 1st follow-up. The SCP FAZ area was significantly larger than the DCP FAZ area in both the study and control group over the follow-up period. BCVA was found to be negatively correlated to the retinal thickness of the temporal 3 mm paracentral quadrant with no correlation with central foveal thickness (CFT) and the FAZ area.ConclusionOptical coherence tomography (OCT) and OCTA are valuable noninvasive imaging tools to monitor and predict the structural changes at the foveal avascular zone during the recovery phase after successful retinal reattachment involving macula.

CHANGES IN RETINAL NERVE FIBER LAYER THICKNESS ON HEIDELBERG RETINAL TOMOGRAPHY IN PATIENTS OF PRIMARY OPEN ANGLE GLAUCOMA AFTER TRABECULECTOMY VERSUS ANTI GLAUCOMA MEDICATION

OBJECTIVE: To compare the retinal nerve fiber layer (RNFL) thickness changes in patients of primary open-angle glaucoma after trabeculectomy versus anti-glaucoma medication. METHODS: This quasi-experimental study was conducted from 10th February, 2017 to 28th February, 2018 on 60 patients presenting to the Institute of Ophthalmology, Mayo Hospital, Lahore, Pakistan using non-probability consecutive sampling. Patients were assigned to two equal groups: group A (n=30) patients underwent trabeculectomy while group B (n=30) patients were put on anti-glaucoma medication. Pre-treatment and three months post-treatment RNFL thickness was recorded and then analyzed using SPPSv.18.0. RESULTS: Out of 60 patients, Group A (n=30) had 14 (46.71%) males and 16 (53.31%) females, while Group B (n=30) had 16 (53.31%) males and 14 (46.71%) females. The mean age was 55.901±4.221 and 55.431±3.971 years in Group A and Group B respectively (p=0.661). In age group, 16 (53.31%) each in Group A and Group B were <55 years. Hypertensive status showed 9 (30.01%) and 5 (16.71%) hypertensive patients in Group A and Group B respectively. Mean change in RNFL thickness was 0.028±0.012μ and 0.013±0.007μ in Group A and Group B respectively (p=<0.001). Pre and post-treatment (pre:post) RNFL thickness (μ) in males, females, hypertensive, non-hypertensive, age <55 years, and age ≥55 years was 0.201±0.175μ:0.226±0.155, 0.205±0.159:0.233±0.019, 0.193±0.015:0.223±0.013, 0.206±0.015:0.233±0.018, 0.208±0.015:0.232±0.021, and 0.196±0.016:0.228±0.015 for Group A and 0.211±0.018:0.224±0.019, 0.201±0.015:0.215±0.014, 0.214±0.015:0.226±0.016, 0.205±0.018:0.218±0.017, 0.206±0.017:0.219±0.015, and 0.209±0.019:0.221±0.020 for group B respectively. CONCLUSION: Trabeculectomy increases thickness of retinal nerve fiber layer more than anti glaucoma medication.