Intravitreal versus Oral Steroids for Inflammation Control in Uveitic Patients Undergoing Cataract Surgery.

BACKGROUND: This prospective experimental study was conducted on 40 eyes of 40 patients with complicated uveitic cataracts to compare a single intraoperative intravitreal injection of triamcinolone acetonide (IVTA) with oral steroids for inflammation control after cataract extraction. METHODS: The IVTA group (19 eyes) received an intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide intraoperatively, and the oral steroid group (19 eyes) received oral steroids peri-operatively. Two patients had to be excluded from the study because they underwent extracapsular cataract extraction (ECCE), instead of phacoemulsification. RESULTS: A statistically significant difference was observed in the anterior chamber cell and flare response between both groups initially, but by the last follow-up, this became insignificant. None of the patients in each group experienced a recurrence of uveitis nor developed cystoid macular edema. Five patients in the oral steroid group had IOP >21 mmHg post-operatively. CONCLUSION: A single injection of 4 mg IVTA has similar efficacy to peri-operative oral steroid administration.

Efficacy of Ganciclovir in Cytomegalovirus Retinitis via Intravitreal Route in AIDS Patients.

A series of nine eyes of five patients at LRBT Tertiary Teaching Eye Hospital, from July 2020 to June 2021 is reported. Five patients with high clinical suspicion of CMV Retinitis were treated with weekly intravitreal injections of 2.0 mg ganciclovir for 3 weeks. Pre- and post-injection visual acuity and clinical findings were noted. After 3 injections, clinical signs of CMV retinitis started to resolve in all eyes (100%). Visual acuity improved in seven eyes (77.7%) and remained stable in two eyes (22.2%). Two of the seven eyes which initially showed improvement, later on developed retinal detachment. Patients were followed up for a minimum duration of 1 year. Intravitreal ganciclovir is effective for CMV retinitis but follow- up for a longer duration is needed as these patients are prone to develop peripheral retinal tractions and detachments. Key Words: Ganciclovir, CMV retinitis, AIDS.

Outcomes of Using Perfluorocarbon Liquid as Postoperative Tamponade in Complex Inferior Retinal Detachments.

OBJECTIVE: To determine the outcomes of using perfluorocarbon liquid (PFCL) as postoperative tamponade in complex inferior retinal detachments. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Karachi, Pakistan, from January 2020 to December 2021. METHODOLOGY: This study was carried out on forty eyes of forty patients from the surgical retina clinic with rhegmatogenous inferior retinal detachment involving macula having proliferative vitreoretinopathy grade C (PVR grade-C). All eyes underwent 25G pars plana vitrectomy with PFCL as postoperative tamponade for 15 to 21 days. All patients were advised to maintain supine position postoperatively. PFCL-Silicon oil exchange was done after 15-21 days. The outcomes were measured as complete retinal reattachment between the neurosensory retina (NSR) and retinal pigment epithelium (RPE), changes in postoperative visual acuity and complications. Patients were followed up for a minimum duration of 6 months. Data were analysed using SPSS version 23. RESULTS: In 39 out of 40 eyes (97.5%) retina was completely attached. Postoperative visual acuity was improved in 24 eyes (60%), while in 16 eyes (40%) it remained stable. Worsening of visual acuity was not noted in any case. During follow-ups, uveitis was detected in 2 eyes (5%), cataract in 4 eyes (10%), optic atrophy in 2 eyes (5%) and endophthalmitis and subsequently redetachment in 1 eye (2.5%). CONCLUSION: In complex inferior retinal detachments, PFCL is safe and effective postoperative tamponade provided it is used for a short-term period, especially in those patients who are noncompliant with postoperative face-down position. KEY WORDS: Perfluorocarbon liquid (PFCL), Postoperative tamponade, Complex inferior retinal detachments.

Long-term Visual and Anatomical Outcome after Surgical Management of Epiretinal Membrane.

OBJECTIVE: To assess the functional and surgical long-term outcomes following epiretinal membrane surgery. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rahmatulla Benevolent Trust Tertiary Care Eye Hospital, Karachi, from January 2016 to December 2020. METHODOLOGY: A medical record review was carried out of patients, who had undergone surgical management of ERM and had presented for follow-up for at least three years. Best corrected visual acuity (BCVA) and Optical Coherence Tomography (OCT) parameter [(integrity of ellipsoid zone (EZ)] was evaluated. BCVA, using Snellen's chart, is performed routinely on each visit, which was converted to logMAR chart for analysis in this study. OCT was also performed to evaluate the integrity of outer retinal layers using Heidelberg OCT. RESULTS: Sixty-five eyes of 54 patients were included in the study, including 41 eyes of 36 men (63%) and 24 eyes of 18 women (37%). Mean age was 46.2 ± 8.9 years. The mean BCVA significantly improved from 0.88 ± 0.28 logMAR (6/45 Snellen) preoperatively to 0.64 ± 0.21 (6/27) at the end of first year (p <0.001), which improved to 0.54 ± 0.19 (6/21) at the end of second year, and 0.53 ± 0.20 (6/20) after three years of follow-up. The post-op vision at three years was stratified according to the integrity of EZ on OCT performed at the same follow-up; and a significant difference was observed. EZ was intact in 52 eyes with a mean BCVA of 0.49 ± 0.16 logMAR (6/18 Snellen); while it was found disrupted in 13 eyes, where the BCVA was 0.68 ± 0.26 (6/29). CONCLUSION: Anatomically intact outer retinal layer significantly correlated with improved BCVA. Key Words: Epiretinal membrane, Optical coherence tomograghy, Best corrected visual acuity.

Agreement between visual inspection with acetic acid and Papanicolaou's smear as screening methods for cervical cancer.

OBJECTIVE: To determine degree of agreement between visual inspection with acetic acid (VIA) and Papanicolaou's (Pap) smear as screening methods for cervical cancer. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to December 2012. METHODOLOGY: Two hundred and fifty women in reproductive age group presenting with various gynaecological complaints were included in the study. A Papanicolaou's smear was taken and visual inspection with 5% acetic acid was done. VIA was reported as positive or negative according to acetowhite changes and cytology result was graded as CIN 1, 2, 3 and squamous carcinoma. Those women who showed positive result with either VIA or Pap smear or both were further subjected to colposcopic directed biopsy which was taken as gold standard. Results were computed using Statistical Package for Social Sciences (SPSS) version 16 and statistical test used was kappa. RESULTS: Out of 250 women, VIA was positive in 55 (22%) patients and Pap smear was abnormal in 27 (10.8%). Histological diagnosis of CIN/cancer was made in 36 out of a total 62 patients who underwent biopsy. CONCLUSION: There was a fair agreement between VIA and Pap smear, with VIA detecting more abnormalities than cytology. In the absence of Pap smear availability, VIA may be a reasonable cervical cancer screening method, especially in low resource settings.

Comparison of obstetric outcome in terms of the risk of low birth weight, preterm delivery, cesarean section rate and anemia in primigravid adolescents and older primigravida.

OBJECTIVE: To compare the obstetric outcome in terms of risk of low birth weight, preterm delivery, cesarean section rate and anemia in primigravid adolescents and older primigravida. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to December 2012. METHODOLOGY: Three hundred primigravid women presenting to department of obstetrics and gynecology of Sir Ganga Ram Hospital, Lahore, having live singleton pregnancy, including 150 adolescents (² 19 years) and 150 adults (³ 20 years) were studied. Obstetric outcome in terms of gestational age at delivery, infant's birth weight, presence of anemia and cesarean section rate was compared between two groups. Results were analyzed using Statistical Package for Social Sciences (SPSS) version 16. Chi-square test was applied with 0.05 as level of significance. RESULTS: The mean age of adolescent subjects was 17.3 + 1.5 years and of adults 25.6 + 3.4 years. Mean gestational age at delivery was similar in two groups (39.2 weeks and 39.4 weeks, p = 0.37). Adolescents were more likely to have a preterm delivery (11.2% vs. 4.9%, p = 0.04) and low birth weight infants (19.3% vs. 8.2%, p = 0.005) than adults. Adolescents were more likely to be anemic (46% vs. 32%, p = 0.01) than adults. However, cesarean section rate was not statistically different between two groups. CONCLUSION: This study showed that primiparous adolescents have significantly higher risk of adverse pregnancy outcomes such as preterm delivery, low birth weight infants and anemia as compared to adult primiparas.