Outcomes Of Microincision Pars Plana Vitrectomy In Rhegmatogenous Retinal Detachment.

BACKGROUND: With the technological advances, microincision pars plana vitrectomy is commonly used method for primary treatment of eyes with rhegmatogenous retinal detachment. Objective of this study is to evaluate anatomical and visual outcomes of microincision pars plana vitrectomy in eyes with rhegmatogenous retinal detachment. METHODS: This was a hospital based prospective observational study done in Tilganga Institute of Ophthalmology, Kathmandu, Nepal. All consecutive cases of rhegmatogenous retinal detachment who underwent primary microincision pars plana vitrectomy from October 2020 to March 2021 were included in the study. Patients were evaluated at baseline, postoperative day 1, 1 week, 6 weeks and 3 months. Outcome measures evaluated were anatomical results, visual outcomes and complications of the surgery. RESULTS: Forty-nine eyes with rhegmatogenous retinal detachment treated with primary microincision pars plana vitrectomy with minimum follow up of at least 3 months were evaluated. Anatomical success was achieved in 91.8% of cases (45/49). Baseline mean best corrected visual acuity was logMAR 1.63±0.88 and median best corrected visual acuity was 2.00 (range 0.00 to 2.70) while at 3 months follow up mean best corrected visual acuity was logMAR 1.22±0.66 and median BCVA was 1.00 ( range 0.00 to 2.70). There was significant improvement in median BCVA ( p= 0.005). There were no cases of postoperative hypotony and endophthalmitis. Other complications were also minimal such as silicon oil in anterior chamber in 1 eye, epiretinal membrane in 3 eyes and macular hole in 2 eyes. CONCLUSIONS: Microincision pars plana vitrectomy is an effective surgical method of primary treatment for rhegmatogenous retinal detachment with good anatomical and visual outcomes with minimal complications.

Clinical profile and management of vitreous hemorrhage in tertiary eye care centre in Nepal.

INTRODUCTION: Vitreous hemorrhage is one of the most common diseases presenting to emergency department and leading cause of painless vision loss. OBJECTIVES: To determine the profile of vitreous hemorrhage in patients presented to Outpatient Department (OPD) and emergency Department of Tilganga Institute of Ophthalmology (TIO). MATERIALS AND METHODS: This is a hospital based observational non interventional descriptive study. Total 198 patients were enrolled who visited OPD and Emergency department of TIO from August 1st 2012 to July 30th 2013. RESULT: Total 198 patients (201 eyes) were enrolled for the study, out of which 144 were male and 54 females. 195 were unilateral and 3 bilateral cases. Most common age group of presentation of vitreous hemorrhage was 51-60 years (24.75%). Most common presenting complaint was sudden onset of decreased vision (95%). Most common etiology of vitreous hemorrhage was branch retinal vein occlusion (22.38%). Among the total subjects, 57.7% of the patient were managed with medical therapy, 35.8% surgically and 6.47 % with combined medical and surgical treatment. CONCLUSION: Branch retinal vein occlusion (BRVO) is the most common cause of vitreous hemorrhage. Diabetes and hypertension are the most commonly associated systemic illnesses.

Clinical characteristics and visual outcome, prognostic factor, visual acuity and globe survival in posterior segment intraocular foreign body at Tilganga Institute of Ophthalmology.

PURPOSE: To evaluate clinical characteristics, visual outcomes and globe survival after intraocular foreign body removal from posterior segment via pars plana approach. METHODS: A hospital based retrospective study. All the patients of penetrating eye injury with intraocular foreign body in posterior segment as detected by computed tomography were enrolled from 2012 to 2014. RESULTS: Thirty patients of 30 eyes were included. The mean age was 27.7 years. (2-52). Twenty-four (80%) were male. Out of 30 eyes 19 (63.3%) eyes had injury at Zone 1 and 11 (36.7%) eyes had injury at Zone 2. The mean time spent between primary repair following surgery and intra ocular foreign body removal, was 15.47 days. Retinal detachment and endophthalmitis prior to intraocular foreign body removal was present in 9/30 of eyes. We looked for correlation between post operative Phthisis bulbi with zone of injury and pre operative endophthalmitis and preoperative retinal detachment. However, p value for the above correlation was more than 0.552 and 0.815 respectively, which was statistically not significant. CONCLUSIONS: The eyes with posterior segment intraocular foreign bodies showing clinical features of preoperative endophthalmitis, retinal detachment and the zone of injury also did not have any direct significance with globe survival.

Is laser photocoagulation still effective in diabetic macular edema? Assessment with optical coherence tomography in Nepal.

AIM: To find out the outcome of laser photocoagulation in clinically significant macular edema (CSME) by optical coherence tomography (OCT) METHODS: It was a prospective, non-controlled, case series study enrolling 81 eyes of 64 patients with CSME between August 2008 and January 2010. All patients received modified grid photocoagulation with frequency doubled Nd: YAG laser. Each patient was evaluated in terms of best-corrected visual acuity (BCVA) and regression or progression of maculopathy after laser therapy at 1, 3 and 6 months. Spearman's correlation test was used to show the correlation between BCVA and total macular volume (TMV). Analysis of variance (ANOVA) was used to compare among groups and independent t-test was used to compare in each group. RESULTS: There is high correlation between BCVA and TMV (P≤0.001). BCVA improved in 50.6 %, remained static in 39.5% and deteriorated in 9.9% patients after 6 month of treatment. The Baseline TMV (mean and SD) were 9.26±1.83, 10.4±2.38), 11.5±3.05), 8.89±0.75 and 9.47±1.98mm(3) for different OCT patterns, ST (sponge like thickening), CMO (cystoid macular edema), SFD (subfoveal detachment), VMIA (Vitreo macular interface abnormality) and average TMV respectively (P=0.04). After 6 months of laser treatment, the mean TMV decreased from 9.47±1.98mm(3) to 8.77±1.31mm(3) (P=0.01). In ST there was significant decrease in TMV, P=0.01, Further within these groups at 6 months, they were significantly different, P=0.01. CONCLUSION: OCT showed the different morphological variant of CSME while the response of treatment is different. TMV decreased the most and hence showed the improvement in vision after 6 months of laser treatment. In the era of Anti vascular endothelial growth factors (VEGFs), efficacy of laser seems to be in shadow but it is still first line of treatment in developing nation like Nepal where antiVEGFs may not be easily available and affordable.