Khalid Al Sabti

Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy.

Purpose To study the difference in the amount of vitreous incarceration between conventional pars plana vitrectomy (PPV) and PPV with vitreous shaving around sclerotomy sites. Methods A dynamic in vivo examination using ultrasound biomicroscopy (UBM) was performed on the sclerotomy sites of 22 eyes after PPV. Patients were divided into two groups. In the study group (n = 11), the vitreous was completely shaved from the internal initial sclerotomy by cotton-tip depressed vitrectomy under coaxial illumination. In the control group (n = 11), no vitreous shaving was performed. Results Vitreous incarceration into sclerotomy sites was significantly less in the study group compared with the control group (P <0.001). No difference was seen among the three sclerotomy sites regarding vitreous incarceration within individual eyes. No difference was seen between eyes operated by right- and left-handed surgeons. Conclusions Vitreous shaving of sclerotomy sites using depressed vitrectomy significantly reduces vitreous incarceration. This may reduce the rate of sclerotomy-related complications following PPV in selected cases.

Endoscope-assisted pars plana vitrectomy in severe ocular trauma

Purpose To report the results of pars plana vitrectomy (PPV) assisted by ophthalmic endoscope (OE) in severe ocular trauma cases which are unsuitable for PPV using wide-angle contact/non-contact lens due to media haze and/or disorganised anterior segment. Methods Prospective, non-comparative, interventional case series. Main outcome measured was anatomic status of the retina postoperatively, secondary outcome measured was functional status regarding vision, intraocular pressure and control of inflammation in cases of endophthalmitis. Results Fifty trauma cases were included in the study. Out of these, 43 eyes had open globe injuries (32 eyes without intraocular foreign body (IOFB), and 11 eyes with retained IOFB), and seven eyes had post-traumatic endophthalmitis. In the open globe injury group, 36 (83.7%) eyes reported improvement in vision. In endophthalmitis group, five eyes showed improvement in vision. Conclusions OE provided a clear view to conduct PPV in select trauma cases where delay in surgery due to hazy media or due to non-availability of donor cornea for simultaneous penetrating keratoplasty can lead to severe proliferative vitreoretinopathy changes.

Applications of endoscopy in vitreoretinal surgery.

Applications of Endoscopy in Vitreoretinal Surgery The first prototype of an ocular endoscope was reported in 1934 for removing nonmagnetic intravitreal foreign bodies.1 This initial prototype needed further technological improvements in miniature optics, charge coupled device (CCD), video cameras, and advances in flexible optical fiber to make the ocular endoscope a useful adjunct in ophthalmic surgery.2–6 The presence of corneal opacity, small pupil, hyphema, opacified or contracted anterior, and posterior capsule obscure or prevent the view of the retina during vitreoretinal surgery through conventional viewing systems; and therefore, in such cases, the ophthalmic microendoscope has been claimed to be useful.7 It can also be useful in the removal of membranes from the peripheral retina and ciliary body areas which are otherwise difficult to visualize by conventional viewing systems during vitrectomy.7,8 Other uses of ocular endoscopes include photocoagulation of ciliary processes,9,10 subretinal surgery,11 fluorescein angiography of the peripheral retina,12 visualization of intravitreal ganciclovir implants,13 removal of dislocated nuclear fragments situated in the periphery of the retina,14 surgery for sulcus fixation of posterior chamber intraocular lens (PCIOL),15 removal of intraocular foreign bodies,16 and for the surgical management of complex retinal detachment (RD).17 The objective of this study is to present our experience in the use of endoscopic vitreoretinal surgery (EndoVRS) in Kuwait. To the best of our knowledge, this is the first report regarding the use of endoscope in vitreoretinal surgery from the Middle East. Subjects and Methods

Will the BEAT-ROP Study Results Really Beat ROP?

Recently, many scientific journals have published articles regarding the role of intravitreal injection of anti-vascular endothelial growth factor (VEGF) in retinopathy of prematurity (ROP). The BEAT-ROP cooperative group have now reported their results. By far, their study seems to be the largest and best executed. In addition, the results are no less than spectacular, and if they can be repeated in other centers worldwide, it may lead to a paradigm shift in the present standard of care for ROP. We are members of a team of vitreoretinal surgeons who oversee the ROP program in Kuwait. We would like to put forth some points that warrant researchers ’ attention and may augment our understanding of the disease.

Uveal effusion after cataract surgery : An Echographic study

PURPOSE To determine the incidence of uveal effusion after cataract surgery and to relate its presence to selected preoperative, intraoperative, and postoperative variables. DESIGN Prospective consecutive observational case series. PARTICIPANTS Two hundred seven eyes of 205 subjects undergoing cataract surgery. METHODS Several preoperative, intraoperative, and postoperative variables of potential significance in uveal effusion after cataract surgery were studied. On the first postoperative day and within 2 weeks after the surgery, subjects were examined clinically and echographically with B-scan for evidence of suprachoroidal (uveal) effusion. When effusion was present, follow-up examinations were performed until complete resolution was documented. MAIN OUTCOME MEASURES Echographic presence of uveal effusion in the postoperative period. RESULTS Uveal effusion was documented echographically in 12 patients (5.8%). Only one of these cases was clinically evident. All effusions were small and resolved with no intervention. The presence of postoperative hypotony related to wound leak (intraocular pressure <10 mmHg) was significantly correlated with uveal effusion after cataract surgery (P<0.0001). The combination of oral acetazolamide and topical pilocarpine gel given after the surgery also correlated with effusion (P<0.02). Intraoperative complications and prolonged phacoemulsification time were not shown to be risk factors for effusion. CONCLUSIONS Uveal effusion is rarely seen after modern, small-incision, closed-system cataract surgery. It is correlated with postoperative hypotony related to wound leak and with the administration of both oral acetazolamide and topical pilocarpine after surgery.

Management of optic disk pit-associated macular detachment with tisseel fibrin sealant.

BACKGROUND Optic disk pit-associated macular detachment is a challenging condition to treat. Many surgical methods have been used to treat this condition with varying degrees of success. METHODS We managed optic disk pit-associated macular detachment in three cases with pars plana vitrectomy, fluid-air exchange, drainage of subretinal fluid through the optic disk pit, application of Tisseel fibrin sealant (Baxter Healthcare Corporation, CA) to the optic disk pit, C3F8 gas injection, and postoperative prone positioning. RESULTS All three patients maintained flat maculae and had improved vision. Patient 3 had postoperative macular hole formation. This was managed successfully with pars plana vitrectomy, internal limiting membrane peeling, fluid-air exchange, and C3F8 gas injection. CONCLUSION Our case series suggest that Tisseel fibrin sealant in conjunction with pars plana vitrectomy can be used successfully for management of optic pit disk-associated macular detachments.

Incidence of Endophthalmitis after Intravitreal Bevacizumab using Aliquots Prepared On-site in 2 Operating Rooms in Kuwait.

Purpose: To report the incidence of endophthalmitis after intravitreal injection of bevacizumab and the outcomes of treatment of endophthalmitis at two centers in Kuwait. Subjects and Methods: The aliquots of bevacizumab were prepared under aseptic precautions and administered in the operating theater on the same day at both centers. All patients received antibiotic drops after injection of bevacizumab. Data were collected on the number of cases that received intravitreal bevacizumab (IVB) and those that developed endophthalmitis were identified at the two centers. All cases of endophthalmitis received an intravitreal antibiotic injection and additional treatments as warranted. Data were collected on the outcomes of endophthalmitis treatment. Results: There were 5 cases of endophthalmitis among a total of 5429 injections (0.09%: Confidence interval: 0.084–0.1). The incidence was 3 cases among 4690 (0.06%) and 2 cases among 739 injections (0.027%) at each center, respectively (P = 0.08). Four cases of endophthalmitis were culture-positive and organisms isolated were, coagulase negative Staphylococcus in 2 cases, Staphylococcus lugdunensis and Streptococcus pneumoniae in 1 case each. The final visual acuity was better than pre-IVB in 3 cases, same as pre-IVB in 1 case and worse in 1 case with streptococcal infection. No eyes developed phthisis bulbi or required enucleation. Conclusions: The incidence of endophthalmitis after intravitreal injection of bevacizumab using aliquots prepared in the operating room is comparable to other studies. There were no clusters of endophthalmitis cases.

Structural and functional results of indirect diode laser treatment for retinopathy of prematurity from 1999 to 2003 in Kuwait

Purpose The purpose was to report the structural, visual, and refractive outcomes of infants treated for retinopathy of prematurity (ROP) with laser and to identify the risk factors for unfavorable outcomes. Materials and methods The charts of infants with severe ROP treated by diode laser in a tertiary center during the period April 1999 to November 2003 were reviewed. Treated infants were followed up for fundus examination, visual acuity assessment, and cycloplegic refraction. Data regarding ocular risk factors, like zones of ROP and the extent of extraretinal proliferations, and data regarding various systemic risk factors were collected. A minimum follow up of 6 months was needed for inclusion in the study of structural outcome. A minimum follow up of 24 months was needed for the study of visual and refractive outcomes. The outcomes measured were: rate of unfavorable structural outcome, unfavorable visual outcome (visual acuity < 20/40), and high myopia (myopia ≥ 5 diopters). The ocular and systemic risk factors were studied for their significance in the development of unfavorable outcomes. Results Two hundred seventy eyes of 148 infants were treated for severe ROP, out of which 20 eyes (7.4%) had unfavorable structural outcome. Visual data were available for 149 eyes of 81 infants, of which 70 eyes (47%) had unfavorable visual outcome. Refractive data were available for 131 eyes of 72 infants, and high myopia was present in 23 (17.6%) eyes. Zone I disease was the significant risk factor for unfavorable structural (P < 0.0001), unfavorable visual outcome (P = 0.03), and for high myopia (P < 0.0001). Lower post-conceptional age at treatment was significant for unfavorable structural outcome (P = 0.03) and high myopia (P < 0.0001). Presence of sepsis (P = 0.029) and extraretinal proliferation ≥ 6 hours were significant for unfavorable structural outcome (P = 0.002). Conclusion ROP in zone I was the most significant risk factor for all the unfavorable outcomes. Laser-treated ROP infants need long term follow up.

Partial-thickness macular hole in vitreomacular traction syndrome: a case report and review of the literature

IntroductionVitreomacular traction syndrome has recently been recognized as a distinct clinical condition. It may lead to many complications, such as cystoid macular edema, macular pucker formation, tractional macular detachment, and full-thickness macular hole formation.Case presentationWe report a case of vitreomacular traction syndrome with eccentric traction at the macula and a partial-thickness macular hole in a 63-year-old Pakistani Punjabi man. The patient was evaluated using optical coherence tomography, and he underwent a successful pars plana vitrectomy. After the operation, his foveal contour regained normal configuration, and his visual acuity improved from 20/60 to 20/30.ConclusionsPars plana vitrectomy prevents the progression of a partial thickness macular hole in vitreomacular traction syndrome. The relief of traction by vitrectomy restores foveal anatomy and visual acuity in this condition.

Extended internal limiting membrane peeling in the management of unusually large macular holes.

This study was conducted to determine the feasibility, efficacy, and safety of internal limiting membrane peeling in the management of large macular moles. Two patients whose eyes had macular holes measuring 1,147 and 773 microns in diameter, respectively, were treated by pars plana vitrectomy with extended internal limiting membrane peeling and the injection of long-acting gas. Preoperative and postoperative assessment of the macular holes was done by optical coherence tomography. Postoperatively, the macular holes closed and there was improvement in visual acuity. Extended internal limiting membrane peeling can be performed to achieve surgical success in very large macular holes.