Lalit Verma

Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks.

Background: The purpose of the present paper was to compare the techniques of conventional scleral buckling and combined pars plana vitrectomy and scleral buckling procedures in rhegmatogenous retinal detachments with unseen retinal breaks.

A Prospective Controlled Trial to Evaluate the Adjunctive Role of Posterior Subtenon Triamcinolone in the Treatment of Diffuse Diabetic Macular Edema

The aim of the present prospective controlled trial was to evaluate the adjuvant role of posterior subtenon triamcinolone in the treatment of diffuse diabetic macular edema (DDME). Thirty one (31) eyes with DDME were divided into an interventional group subjected to grid laser photocoagulation and 0.5 mL of 40 mg/mL posterior subtenon triamcinolone, and a noninterventional group subjected to grid laser photocoagulation only. Best-corrected visual acuity, contrast sensitivity, and intraocular pressures were assessed at presentation, and at 6, 12, and 24 weeks after intervention. The interventional group showed a statistically significant (p < 0.05) change in both mean best corrected visual acuity, from 20/160 to 20/100 (two-line increase on Early Treatment Diabetic Retinopathy Study (ETDRS)) (p = 0.024), and mean contrast sensitivity, from 0.9 to 1.09 (p = 0.01), at the end of 24 weeks. A significant rise in intraocular pressure was not described in any of the patients in either group. Posterior subtenon triamcinolone injection is a useful and safe adjunct to the conventional management of diabetic macular edema.

Comparative evaluation of diode laser versus argon laser photocoagulation in patients with central serous retinopathy: a pilot, randomized controlled trial [ISRCTN84128484].

BackgroundTo evaluate the efficacy of diode laser photocoagulation in patients with central serous retinopathy (CSR) and to compare it with the effects of argon green laser.MethodsThirty patients with type 1 unilateral CSR were enrolled and evaluated on parameters like best corrected visual acuity (BCVA), direct and indirect ophthalmoscopy, amsler grid for recording scotoma and metamorphopsia, contrast sensitivity using Cambridge low contrast gratings and fluorescein angiography to determine the site of leakage.Patients were randomly assigned into 2 groups according to the statistical random table using sequence generation. In Group 1 (n = 15), diode laser (810 nm) photocoagulation was performed at the site of leakage while in Group 2 (n = 15), eyes were treated with argon green laser (514 nm) using the same laser parameters. Patients were followed up at 4, 8 and 12 weeks after laser.ResultsThe mean BCVA in group 1 improved from a pre-laser decimal value of 0.29 ± 0.14 to 0.84 ± 0.23 at 4 weeks and 1.06 ± 0.09 at 12 weeks following laser. In group 2, the same improved from 0.32 ± 0.16 to 0.67 ± 0.18 at 4 weeks and 0.98 ± 0.14 at 12 weeks following laser. The improvement in BCVA was significantly better in group 1 (p < 0.0001) at 4 weeks. At 4 weeks following laser, all the patients in group1 were free of scotoma while 6 patients in group 2 had residual scotoma (p < 0.05). The mean contrast sensitivity in group 1 improved from pre-laser value of 98.4 ± 24.77 to 231.33 ± 48.97 at 4 weeks and 306.00 ± 46.57 at 12 weeks following laser. In group 2, the same improved from 130.66 ± 31.95 to 190.66 ± 23.44 at 4 weeks and 215.33 ± 23.25 at 12 weeks. On comparative evaluation, a significantly better (p < 0.001) improvement was noted in group 1.ConclusionDiode laser may be a better alternative to argon green laser whenever laser treatment becomes indicated in patients with central serous retinopathy in terms of faster visual rehabilitation and better contrast sensitivity. In addition, diode laser also has the well-recognized ergonomic and economic advantages.

Role of daunorubicin in inhibiting proliferative vitreoretinopathy after retinal detachment surgery.

Purpose: To study the role of daunorubicin in inhibiting proliferative vitreoretinopathy after retinal detachment surgery.

Ultrasonography in optic nerve head avulsion.

Abstract The diagnosis of post traumatic optic nerve avulsion is often obscured by the presence of concomitant vitreous haemorrhage. Electrodiagnostic tests, CT scan and fluorescein angiography have not proved helpful in substantiating the diagnosis of this entity in the early stages. We herein present the echographic features in a case of post traumatic optic nerve avulsion that, to the best of our knowledge, have not been previously described. The role of ultrasonography in the diagnosis of suspected optic nerve head avulsion has been highlighted.

Temporary conduction block of optic nerve after retrobulbar anesthesia.

Three patients who experienced temporary visual loss after retrobulbar anesthesia with 2% lidocaine (Xylocaine) are described. Visual evoked potentials (VEPs) consistently increased in latency and decreased in amplitude. Abnormal VEPs such as these recorded for humans after retrobulbar anesthesia are, to our knowledge, reported here for the first time.

Orbital cysticercosis ‐ an ultrasonic diagnosis

Abstract Ocular cysticercosis, a platyhelminth infection, involves various ocular and adnexal sites. Orbital cysticercosis is a relatively rare site of presentation. We illustrate that this parasitic cyst, when present in the orbit, mimics an orbital pseudotumour. We have used ultrasound as an effective pre‐operative diagnostic modality.

Dermatological side effects of brimonidine: a report of three cases.

Brimonidine is a potential first line therapy for primary open angle glaucoma (OAG) and ocular hypertension (OHT). It is known to cause various ocular and systemic side effects. Being a newer drug, the whole spectrum of its adverse effects is not known. The dermatological side effects caused by brimonidine have rarely been reported before. We present three OAG patients who presented to us with contact dermatitis of periorbital skin and lichen planus of nail following the use of topical brimonidine (0.2% twice a day) for more than six months. These side effects slowly disappeared on discontinuing the drug but reappeared on reintroducing topical formulation. Such side effects from the use of brimonidine have not been reported before.

Diabetic retinopathy: time for action. No complacency please!

Editor – The importance of diabetic retinopathy as a cause of blindness has increased because of longevity and decline in the other preventable causes of blindness in developing countries (1). A diabetic can have a serious eye disease and not even know it until irreversible vision loss has occurred. It is estimated that by the year 2010 the world diabetic population will have doubled, reaching an estimated 221 million (2). The timely diagnosis and referral for management of diabetic retinopathy can prevent 98% of severe visual loss (3). Early diagnosis and treatment of diabetic retinopathy in Sweden has resulted in the virtual elimination of blindness due to diabetic retinopathy (4). An estimated 2–5% of diabetics have proliferative diabetic retinopathy (5) which, if not treated, causes blindness in more than 50% (6). Therefore it would be correct to state that the underlying cause of blindness in the majority of diabetic patients is not diabetic retinopathy but the misdiagnosis of diabetic retinopathy. To achieve near universal coverage, the screening method should be community-based and the point of delivery within easy reach of the population. Currently, yearly dilated direct ophthalmoscopic examination seems the best approach but the number of ophthalmologists available is the limiting factor in initiating an ophthalmologistbased screening service inmost countries. Because of this, screening will have to be organized in an ‘‘ophthalmologist-led’’ system rather than an ‘‘ophthalmologistbased’’ one in most communities. It is a sad state of affairs that a strategy which is cost-effective and has proved its worth (4) is not being implemented by many countries. Despite the fact that most diabetic patients attend some sort of health facility, their eye disease remains undetected because it is not looked for until the patient is symptomatic. Clearly, a ‘‘team’’ approach to screening, detecting, managing and monitoring the complex facets of this disease will serve the best interests of the patient. The present need is to make screening for diabetic retinopathy mandatory by all sufficiently trained health care providers, at least for all diabetic patients attending any sort of health care clinic. We must respond now, not with excuses but with action. n

Corneal topographic changes following retinal surgery

BackgroundTo study the effect of retinal/ vitreoretinal surgeries on corneal elevations.MethodsPatients who underwent retinal/ vitreoretinal surgeries were divided into 3 groups. Scleral buckling was performed in 11 eyes (Group 1). In 8 (25%) eyes, vitreoretinal surgery was performed along with scleral buckling (Group 2). In 12 eyes, pars plana vitrectomy was performed for vitreous hemorrhage (Group 3). An encircling element was used in all the eyes. The parameters evaluated were best-corrected visual acuity (BCVA), change in axial length, and corneal topographic changes on Orbscan topography system II, preoperative and at 12 weeks following surgery.ResultsThere was a statistically significant increase in anterior corneal elevation in all the three groups after surgery (p = 0.003, p = 0.008 & p = 0.003 respectively). The increase in posterior corneal elevation was highly significant in all the three groups after surgery (p = 0.0000, p = 0.0001 & p = 0.0001 respectively). The increase in the posterior corneal elevation was more than the increase in the anterior elevation and was significant statistically in all the three groups (group I: p = 0.02; group II: p = 0.01; group III: p = 0.008).ConclusionsRetinal/ vitreoretinal surgeries cause a significant increase in the corneal elevations and have a greater effect on the posterior corneal surface.