Retinal re-detachments after removal of silicone oil: Frequency and timings in a retrospective clinical study.

OBJECTIVE: To analyse anatomical outcome after removal of silicone oil endotamponade in complicated cases of retinal detachment with reference to frequency and timings, and to study factors affecting the outcome. METHODS: The retrospective study was conducted at one public-sector and one private-sector hospital in Karachi, and comprised data related to patients who underwent pars plana vitrectomy with silicone oil endotamponade for complicated retinal detachment and subsequent removal of silicone oil between 1996 and 2015. The surgery had been carried out by both active and passive methods. Outcome variable was retinal re-detachment. Timings and frequency of re-detachment were noted and regression analysis for pre-dictive factors was carried out. RESULTS: The study comprised 355 eyes relayed to as many patients. Of the total, 239(67.30%) were males and 116(32.70 %) were females. Overall mean age was 43.29} 17.15years. Mean duration of silicone oil endotamponade was 5}1.34 months. Indications of injection were retinal detachment complicated by proliferative vitreoretinopathy in 290(81.69%) eyes and proliferative diabetic retinopathy in 65(18.31%). Retinal re-detachment was seen in 51(14.36%) cases. Among them, 15(29.41%) were seen on the table, and 40(78%) within the first 3 months. Duration of silicone oil tamponade, technique of removal, type of silicone oil used and number of previous surgeries had no predictive value on anatomical outcome (p>0.05 each). CONCLUSIONS: Re-detachment of retina is still a major clinical issue after the removal of silicone oil despite current advances in vitreoretinal surgery.

Clinical pattern of Retinoblastoma in Pakistani population: Review of 403 eyes in 295 patients.

OBJECTIVE: To document clinical pattern of retinoblastoma in Pakistani population. METHODS: This retrospective study, which was conducted at Department of Ophthalmology, Dow University of Health Sciences, Karachi, reviewed clinical records of patients with retinoblastoma from 1997 to 2012. Staging of disease was done by referring to retinal diagrams, RetCam images, and first magnetic resonance imaging. Ophthalmic notes, imaging reports and histopathology reports of enucleated eyes established optic nerve involvement. SPSS 21 was used for statistical analysis. RESULTS: Clinical records of 295 patients with retinoblastoma in 403 eyes were reviewed, and male to female ratio was 1.3:1. Retinoblastoma was bilateral in 106(35.93%) patients, while 118(40%) patients had hereditary pattern. Mean age at presentation was 35.98+27.63 months, while mean follow-up was 3±2 months. Leucokoria was the most common presenting feature 173(58.64%) followed by proptosis 72(24.41%). Optic nerve involvement was seen on magnetic resonance imaging or histopathology in 81(20.10%) eyes. Distant metastasis was noted in 32(10.85%) patients on first presentation. Chemotherapy with or without adjuvant treatment was given to 238(80.68%) patients. Enucleation and exentration were performed in 164(40.69%) and 12(2.98%) eyes, respectively. CONCLUSIONS: Most common presenting symptom was leucokoria followed by proptosis. Hereditary retinoblastoma was frequently seen in Pakistani children. .

Anatomical and functional outcomes of retinectomies in retinal detachments complicated by proliferative vitreoretinopathy.

PURPOSE: To study anatomical and functional outcomes of retinectomies in rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy. METHODS: This is a retrospective interventional consecutive case series of eyes with rhegmatogenous retinal detachments complicated by advanced proliferative vitreoretinopathy and managed by relaxing retinectomy over a period of seventeen years. Three-port pars plana vitrectomy included core vitrectomy and removal of all epi-retinal membranes. On failure to flatten, retina was cut and excised. Basal vitrectomy and removal of anterior flap of retina then followed. Silicone oil was used as temponade in majority of cases. The dependent variables were anatomical and functional outcomes. The statistical analysis was performed on SPSS 21. RESULTS: Series included 370 eyes of 337 patients. Mean follow up was 39 months. Scleral explant was used in 90(24.39%) cases. Two hundred and nine (56.49%) eyes were operated with trans conjunctival sutureless vitrectomy technique. Procedure was bilateral in 33 patients (09.79%). Retina attached in 311(84.05%) eyes after initial surgery. Final re-attachment after one or more surgeries was achieved in 344(92.97%) eyes. Two hundred and eleven (57.02%) cases achieved visual acuity of 6/60 or better. CONCLUSION: Relaxing retinectomies have good and encouraging anatomical and functional outcomes. This surgery can be effectively carried out with trans conjunctival sutureless vitrectomy technique.

Outcome of focal treatment to residual retinoblastoma after chemotherapy (Experience with Focal Treatment of Retinoblastoma).

We report a prospective case series on the anatomical, and functional outcomes, and complications of focal treatment of retinoblastoma to residual tumors in patients who had already received chemotherapy. We examined the patients of retinoblastoma under general anaesthesia with Ret Cam II. Patients with lesions from Group 1 to Group 5 of Reese Ellsworth classification at presentation. They were first given chemotherapy according to VEC (Vincristine, Etoposide and Carboplatin) protocol and then focal treatment. Solid State Green laser photocoagulation and/or cryotherapy were applied to the lesions with help of indirect ophthalmoscope. Thirty one eyes of 26 children were treated. The mean age at presentation was 35.5 ± 6.4 (median = 24, IQR = 36) months. Fourteen (57.7%) were male and 12 (42.3%) were female. Twenty three (88.5%) children had bilateral retinoblastoma and 3 (11.5%) had unilateral involvement. Complete regression was achieved in 25 (80.6%) eyes. Only 6 (19.4%) eyes had to be enucleated. Final mean LogMAR visual acuity after treatment was0.6 ± 0.64. Transient Corneal oedema was the most commonly observed adverse effect seen immediately after laser photocoagulation in 12 (38.7%) eyes. Focal treatment is a good and effective adjuvant to systemic treatment and ophthalmologists should be aware of this modality of treatment and competent enough to use these modalities appropriately to improve the outcome of RB patients in our population.

Passive removal of silicone oil through 23 gauge transconjunctival sutureless vitrectomy system.

OBJECTIVE: To study the outcomes of passive removal of silicone oil by 23 Gauge Transconjunctival Sutureless Vitrectomy System. METHODS: This prospective, consecutive case series study was conducted at Ophthalmology Department Unit I, Dow University of Health Sciences, Civil Hospital Karachi from January 2011 to December 2014. Only psuedophakic eyes with silicone oil temponade were selected. Main outcome measures were intra ocular pressure, time taken for removal of silicone oil, per operative and post operative complications. Pre and post operative IOP was compared by using two-tailed paired t-test and mean values with standard deviation were computed using difference of 95% confidence interval. Chi square test was applied for correlation of different variables. P-value of less than 0.05 was considered statistically significant. RESULTS: Out of 79 patients who underwent passive ROSO, 38 (48.1%) were males. Mean age of patients was 47.5±7.1 (sd) years. Mean time taken for passive ROSO was 7.31±2.41 (sd) minutes. Pre and post operative intra ocular pressure shows statistically significant (p=0.000) decrease in IOP. Retinal redetachment found in 13 (16.5%) cases during follow up period. CONCLUSION: Passive removal of silicone oil with 23 G suture less vitrectomy system is safe and effective in terms of less per operative and post operative complications. In this simple technique, there is less tissue trauma and little time consumed so it provides more comfort to patients and surgeons as well.

Comparison of efficacy of storage of amniotic membrane at -20 and -80 degrees centigrade.

OBJECTIVE: To compare the efficacy of storage of amniotic membrane at -20 and -80 degrees centigrade. STUDY DESIGN: Interventional quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Unit 1, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2009 to December 2010. METHODOLOGY: Amniotic membrane was obtained from patients undergoing elective Caesarean section screened for HIV, Hepatitis B and C and gave informed consent. It was washed with solutions containing benzyl penicillin, streptomycin and amphotericin B and frozen at -20 degrees centigrade for upto 6 weeks or at -80 degrees centigrade for upto 6 months. Fisher's exact test was used to check significance. P-value less than 0.05 was considered as significant. RESULTS: Amniotic membrane was stored at -20 degrees centigrade on four occasions and was used in 25 (48.07%) patients. On 3 other occasions it was stored at -80 degrees centigrade and was successfully used in 27 (51.92%) patients. The association between different degrees of storage of graft and type of cases is insignificant (p = 0.99). CONCLUSION: Compared to use of fresh amniotic membrane use of amniotic membrane stored at -20 and -80 degrees is safe and cost effective. It also excludes the chances of disease transmission. Although freezing at both temperatures is equally efficacious, freezing at -80 degrees centigrade can preserve the graft upto 6 months compared to -20 degrees centigrade which can be used only for 6 weeks.