Age-related cataract and its types in patients with and without type 2 diabetes mellitus: A Hospital-based comparative study.

OBJECTIVE: To determine the frequency and types of age-related cataract in type 2 diabetic patients compared to non-diabetics. METHODS: This comparative, cross-sectional study was carried out at Al-Ibrahim Eye Hospital, Karachi, from July 2014 to June 2015, and comprised both diabetics and non-diabetics. All patients were selected from the out-patient department and had their full ocular examination done, including retinal screening of diabetic patients with non-mydriatic fundus camera. The criterion for diagnosis of cataract was sufficiently advanced lens opacity that caused impaired vision/un-gradable images. Cataract was classified on a morphological basis into cortical, nuclear, posterior sub-capsular and mixed types. RESULTS: Of the 49,384 patients, 4,556(9.2%) were diabetics and 44,828(90.8%) were non-diabetics. Among the diabetics, cataract was found in 1,956(42.9%) compared to 7,050(15.7%) in non-diabetics. Adjusted odds ratio (95% confidence interval) between the two groups was 4.40 (range: 4.11-4.71) (p<0.001). Male-to-female adjusted odds ratio (95% confidence interval) was 2.05 (range: 1.95-2.15) (p<0.001). Nuclear sclerosis was the commonest type in 2,123(46.6%) cataract cases in diabetics whereas posterior sub-capsular cataract was the commonest type in 14,480(32.3%) cases among the non-diabetics. CONCLUSIONS: Cataract was four times more common in diabetics and twice more frequent in men. Nuclear sclerosis was the commonest type of cataract in diabetic patients.

Intravitreal Avastin as an adjunct in patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy.

OBJECTIVE: Intravitreal Bevacizumab (Avastin, Genentech Inc., San Francisco, CA) (IVB) has been shown to cause regression of neovessels in proliferative diabetic retinopathy due to its anti-angiogenic effects. This study was performed to investigate the role of Avastin as an adjunct to the management of patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy. METHODOLOGY: Fifty four eyes of 54 patients with proliferative diabetic retinopathy scheduled for surgery were included in the study. They were randomized to vitrectomy with preoperative IVB (group one) or standard vitrectomy (group 2). Group one underwent a single intravitreal injection of bevacizumab 1.25 mg /0.05ml one week prior to vitrectomy. Main outcome measures were best corrected visual acuity (BCVA) after surgery, post-operative complications. RESULTS: Mean age of the patients was 52.07±5.54 years (range 39-67). At 6 months, 20 patients in group one had BCVA better than baseline as compared to 12 patients in group 2. In group one, only one patient had early post-operative vitreous hemorrhage, whereas 11 patients in group two had early vitreous hemorrhage. CONCLUSION: Preoperative IVB is helpful in improving BCVA post operatively, reducing the time of surgery, decreasing the incidence of intraoperative and postoperative bleeding and reducing the frequency of rubeosis and hyphaema.

Surgical Outcomes of Idiopathic Macular Epiretinal Membrane Peeling.

OBJECTIVE: To evaluate the surgical outcomes of idiopathic macular epiretinal membrane (IERM) peeling in terms of visual acuity and macular thickness. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Al-Ibrahim Eye Hospital, Karachi, from June 2017 to February 2018. METHODOLOGY: Patients aged >50 years having IERM confirmed with optical coherence tomography (OCT) were included in the study. All patients underwent 3-port pars plana vitrectomy (PPV) followed by epiretinal membrane peeling. Log Mar visual acuity chart was used for documenting visual acuity pre- and postoperatively. OCT was performed for documenting changes in macular thickness pre- and postoperatively. Every patient completed their follow-up of six months. RESULTS: Mean age of the 43 patients was found to be 59.98 ±6.1 years. Mean pre- and postoperative visual acuity of Log Mar showed 0.59 ±0.21 and 0.33 ±0.21, respectively (p<0.001). Mean macular thickness on OCT pre- and postoperatively were 479 ±82.5 and 315 ±82.4 m, respectively (p<0.001). In thirty-one (72.1%) eyes, there was improvement in best corrected visual acuity (BCVA) postoperatively, 9 (20.9%) eyes remained stable; whereas, 3 (7%) eyes had decreased visual acuity at final follow-up of six months. CONCLUSION: Peeling of IERM is a safe surgical procedure. It is associated with significant improvement in best corrected visual acuity postoperatively along with improvement in anatomical outcomes in terms of decrease macular thickness as measured by OCT.