Long-term peripheral retinal vascular behavior in retinopathy of prematurity patients treated with ranibizumab intravitreal injection as monotherapy using fluorescein angiography.

BACKGROUND: Few challenges are faced with the introduction of anti-VEGF agents as a modality of treatment for retinopathy of prematurity. The clinical behavior and time course of regression post injection differ compared to post laser ablation. This study aims to evaluate the long-term peripheral retinal vascularization outcome of Ranibizumab intravitreal injections monotherapy in the treatment of retinopathy of prematurity. METHOD: Hospital-based quasi-experimental study. Include ROP patients who received intravitreal ranibizumab (IVR), as primary treatment for type 1 ROP. Patients were examined under general anaesthesia to ensure documentation of all junctions of vascular and avascular zones. Images were taken by RetCam III, Phoenix ICON and fluorescein angiography was performed to describe vascular behaviors. RESULTS: The mean gestational age was 24.67 weeks and the mean postmenstrual age at the time of intravitreal ranibizumab treatment was 36.3 weeks. Fluorescein angiography was performed at 155-288 weeks; most eyes showed two disk diameters of avascular peripheral retina. Only eyes with original aggressive ROP who required a second injection (six eyes) showed extensive peripheral avascular retina reaching zone I (13.64%). Neovascularization was evident in five eyes (11.36%), all with an original aggressive ROP and received multiple injections. CONCLUSIONS: Ranibizumab treated babies with incomplete retinal vascularization require close and long-term follow-up visits to assess post injection vascular behavior. Peripheral retinal avascular zone of more than two-disc diameters was present in most of the patients evidenced by fluorescein angiography. Babies with initial diagnosis of aggressive ROP are more likely to have persistent peripheral neovascularization.

Novel coronavirus disease pandemic and ophthalmologist's perspectives.

Ophthalmologists are among those healers facing a higher risk of acquiring novel coronavirus disease 2019, called COVID-19, during their professional duties since they have close physical contact with their patients. Some patients with COVID-19 may present with or may develop conjunctivitis during the course of the illness. The ocular secretions and tears have been identified to have positive results to COVID-19 tests and as such could be a source of spread. This review aims at providing the useful guidelines to ophthalmic professionals for their own safety, and safety of their patients based on the available current literature, and also based on personal experience and observations. Literature search was made on PubMed for COVID-19 in relation to ophthalmology in the limited period of the last quarter of 2019 and first quarter of 2020. Research also included access to current guidelines published by various ophthalmic societies. Accordingly, present and future ophthalmic practice patterns need to be modified.

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.

Fungal endophthalmitis in a case of granulomatosis with polyangitis.

A 70-year-old immuno-compromised man, due to multiple comorbidities, particularly granulomatosis with polyangitis (GPA) and its related treatment, presented with generalized weakness, odynophagia and loss of taste sensation. After a complete evaluation, a diagnosis of right frontal lobe brain abscess was made. The patient then developed headache and sudden painful loss of vision in the right eye. Clinical examination revealed anterior chamber cells and flare, vitreous haze and cells, and hemorrhagic chorioretinitis with severe vasculitis in the right eye. Culture from the drained pus of the frontal brain abscess came positive for Aspergillus fumigatus. Incidental echocardiogram showed large vegetation in the mitral valve. Pars plana vitrectomy was done and a specimen was sent for culture that came positive for Aspergillus fumigatus. Although all the necessary medical and surgical interventions were timely carried out in the affected right eye, the patient's vision worsened due to retinal damage.

Student perception and post-exam analysis of one best MCQs and one correct MCQs: A comparative study.

OBJECTIVE: To find differences between One-Correct and One-Best multiple-choice questions with relation to student scores, post-exam item analyses results and student perception. METHODS: This comparative cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from November 2010 to April 2011, and comprised medical students. Data was analysed using SPSS 18. RESULTS: Of the 207 participants, 16(7.7%) were boys and 191(92.3%) were girls. The mean score in Paper I was 18.62±4.7, while in Paper II it was 19.58±6.1. One-Best multiple-choice questions performed better than One-Correct. There was no statistically significant difference in the mean scores of the two papers or in the difficulty indices. Difficulty and discrimination indices correlated well in both papers. Cronbach's alpha of paper I was 0.584 and that of paper II was 0.696. Point-biserial values were better for paper II than for paper I. Most students expressed dissatisfaction with paper II. CONCLUSIONS: One-Best multiple-choice questions showed better scores, higher reliability, better item performance and correlation values.

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.

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.