Tewari Hk

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.

Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders

Purpose To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. Methods This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. Results Mean preinjection central macular thickness was 531.84±132 μm in Group I, 458.4±149 μm in Group II, and 750.81±148 μm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7±119 μM in Group I, 218.2±99 μm in Group II, and 210.5 ±56 μm in Group III) and 3 months (253.19±109 μm in Group I, 187±47 μm in Group II, and 182±50 μm in Group III) after injection (p<0.05). Mean follow-up was 22±2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2±0.4 logMAR units; Group II, 1.24±0.5 logMAR units; Group III, 1.1 ±0.4 logMAR units; 1 month postinjection in Group I, 0.88±0.3 logMAR units; Group II, 0.67±0.3 logMAR units; Group III, 0.86±0.4 logMAR units; 3 months postinjection in Group I, 0.84±0.4 logMAR units; Group II, 0.59±0.3 logMAR units; Group III, 0.82±0.5 logMAR units) (p<0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. Conclusions Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.

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.

Contrast Sensitivity in Diabetic Retinopathy After Panretinal Photocoagulation

Reports of changes in contrast sensitivity in proliferative diabetic retinopathy (PDR) patients after panretinal photocoagulation (PRP) have considered only relatively short-term results, and these have been conflicting. We evaluated contrast sensitivity changes in 30 eyes of 29 PDR patients after PRP. The patients were divided into two groups. One, group A, received PRP at one sitting, and the other, group B, at two sittings. Before and at regular intervals after PRP, all of the patients underwent a battery of macular function tests for best-corrected visual acuity, color vision, contrast sensitivity, and photostress. Contrast sensitivity was significantly affected (P < .001) in both groups immediately after PRP, but stabilized to prelaser levels by the end of 3 months. Color-vision-error scores also were significantly higher (P < .001) immediately after PRP. Best-corrected Snellen visual acuity, however, remained stable at prelaser levels. Contrast sensitivity appears to provide a more sensitive measurement of visual acuity than the Snellen chart for monitoring foveal integrity in patients undergoing PRP.

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.

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

Congenital porphyria with necrotizing scleritis in a 9‐year‐old child

Porphyria is a rare metabolic disorder that is characterized by the accumulation of photosensitive, toxic intermediates of the heme metabolic pathway in various organs of the body including the skin, eye and neural tissue. Porphyria as a potential cause for bilateral necrotizing scleritis in children is very infrequently emphasized in literature, probably due to the relatively rare occurrence and lack of well‐documented cases. A case of a 9‐year‐old child with congenital porphyria who had developed necrotizing scleral ulceration in both eyes in addition to severe cutaneous hypersensitivity and facial disfigurement is herein presented.

Posterior subtenon injection of corticosteroids using polytetrafluoroethylene (PTFE) intravenous cannula

Injection of corticosteroids into the posterior subtenon space is a well established and highly effective modality in the treatment of intermediate uveitis. The conventional technique of posterior subtenon injection involves the use of a sharp tipped 26‐gauge, 5/8 inch needle that must be inserted up to its hub to obtain adequate placement of the drug into the posterior subtenon space. With this technique the risk of perforation of the globe, although minimal, remains a potential complication. Herein is described a new technique for injection of corticosteroids into the posterior subtenon space using an intravenous cannula made of polytetrafluoroethylene (PFTE) that allows safer delivery of the drug into the posterior subtenon space.