Surgical exposure for vitrectomy in retinopathy of prematurity.

Our purpose was to evaluate the efficacy of lateral canthotomy, sub-tenon anesthesia injection, and the use of modified speculum for gaining adequate surgical exposure during surgery for retinopathy of prematurity (ROP). Fourteen eyes of 10 consecutive patients undergoing microincisional vitrectomy surgery (MIVS) for stage 4 and stage 5 ROP were included. There was a significant widening of the palpebral fissure height and length using this technique. No patient developed a lens injury during the surgery. All the canthotomy incisions completely healed at a four-week follow-up visit. This is a safe and effective technique for increasing surgical exposure in cases of ROP requiring vitrectomy.

Krill's Disease: A Newer Management Option.

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Topical glycerine for corneal clouding during retinal laser photocoagulation for retinopathy of prematurity.

AIM: To document the use of topical glycerine to reduce corneal edema in cases of retinopathy of prematurity (ROP) undergoing laser photocoagulation (PHC). METHODS: Thirty-two eyes of 16 babies (9 males) with a mean gestational age of 30 weeks, mean gestational weight of 1242 grams underwent PHC for Type 1 (zone 1 disease) retinopathy of prematurity. All babies received a single PHC session. Twenty eyes of 10 babies received intravitreal anti-VEGF injection, 1-3 weeks before PHC session. All patients received a single drop of glycerine during the PHC session to clear the corneal clouding. All patients underwent PHC to the avascular area right up to the ora serrata. Patients were seen at one week and one month to assess the adequacy of laser PHC. RESULTS: We were able to complete the PHC for all babies in a single session without any ocular or systemic adverse events. We did not find any skip lesions at follow-up, and the second session of laser PHC was not required in any eyes. CONCLUSION: Topical glycerine is safe and effective to clear corneal clouding in eyes undergoing laser PHC for retinopathy of prematurity.

BEVACIZUMAB FOR POST VITRECTOMY CYSTOID MACULAR EDEMA IN A SILICONE OIL-FILLED EYE.

PURPOSE: To report the safety and efficacy of intravitreal bevacizumab (IVB) in a case of cystoid macular edema (CME) in a silicone oil-filled eye. METHODS: A man, aged 51 years, reported with poor visual improvement in the right eye (RE) after pars plana vitrectomy with oil injection performed 2 months back for a pseudophakic, macula-off rhegmatogenous retinal detachment. His best-corrected visual acuity in the RE was counting fingers 2 m. Fundus examination of the RE showed a silicone oil-filled eye with attached retina, and CME was confirmed on spectral-domain optical coherence tomography. He was advised to undergo IVB injection, which was given a few days later. RESULTS: One week after IVB, the central macular thickness had decreased to 437 µ m. Seven weeks later, the macular edema subsided completely with a final central macular thickness of 219 µ m. His vision improved by seven lines to 6/24 and was stable for another 2 months. He underwent removal of silicone oil after 3 months, wherein his visual acuity improved further by one line to 6/18. DISCUSSION: This case demonstrates the use IVB for CME in a silicone oil-filled eye. It was found that IVB was safe and effective in CME associated with a silicone oil-filled eye.

Prevalence and predictors of myopic macular degeneration among Asian adults: pooled analysis from the Asian Eye Epidemiology Consortium.

AIMS: To determine the prevalence and predictors of myopic macular degeneration (MMD) in a consortium of Asian studies. METHODS: Individual-level data from 19 885 participants from four population-based studies, and 1379 highly myopic participants (defined as axial length (AL) >26.0 mm) from three clinic-based/school-based studies of the Asian Eye Epidemiology Consortium were pooled. MMD was graded from fundus photographs following the meta-analysis for pathologic myopia classification and defined as the presence of diffuse choroidal atrophy, patchy chorioretinal atrophy, macular atrophy, with or without 'plus' lesion (lacquer crack, choroidal neovascularisation or Fuchs' spot). Area under the curve (AUC) evaluation for predictors was performed for the population-based studies. RESULTS: The prevalence of MMD was 0.4%, 0.5%, 1.5% and 5.2% among Asians in rural India, Beijing, Russia and Singapore, respectively. In the population-based studies, older age (per year; OR=1.13), female (OR=2.0), spherical equivalent (SE; per negative diopter; OR=1.7), longer AL (per mm; OR=3.1) and lower education (OR=1.9) were associated with MMD after multivariable adjustment (all p<0.001). Similarly, in the clinic-based/school-based studies, older age (OR=1.07; p<0.001), female (OR=2.1; p<0.001), longer AL (OR=2.1; p<0.001) and lower education (OR=1.7; p=0.005) were associated with MMD after multivariable adjustment. SE had the highest AUC of 0.92, followed by AL (AUC=0.87). The combination of SE, age, education and gender had a marginally higher AUC (0.94). CONCLUSION: In this pooled analysis of multiple Asian studies, older age, female, lower education, greater myopia severity and longer AL were risk factors of MMD, and myopic SE was the strongest single predictor of MMD.

Topical nepafenac 0.1% alone versus prednisolone acetate 1% as postoperative anti-inflammatory agents in small gauge vitrectomy.

AIM: To compare the efficacy of postoperative topical nepafenac (0.1%) with prednisolone acetate (1%) as anti-inflammatory agents in eyes undergoing Transscleral Sutureless Vitrectomy (TSV). SETTINGS AND DESIGN: Prospective, double-blind, randomized, single center clinical study. MATERIALS AND METHODS: Eighty eyes of 76 subjects, who underwent small gauge vitrectomy, were included in the study. The subjects who fulfilled the inclusion criteria were randomized to either topical nepafenac only (Group 1) or prednisolone acetate only (Group 2), to be used as postoperative anti-inflammatory agents. The subjects were reviewed on days 1, 30, and 90. Ocular and adnexal inflammation was appropriately graded using the standardized classification. Grading of ocular pain was done on the Visual Analog Scale (VAS). STATISTICAL ANALYSIS: The Wilcoxon rank-sum test, using two-sided analysis, was used. RESULTS: During the follow-up, both Group 1 and Group 2 did not have a significant difference related to the grade of the anterior chamber inflammation (P > 0.05) or adnexal inflammation (P > 0.05). Pain perception was less in the subjects in Group 1 as compared to subjects in Group 2, but was not statistically significant (P > 0.05). CONCLUSION: Postoperative topical nepafenac was non-inferior to prednisolone acetate in reducing postoperative ocular inflammation in eyes undergoing TSV.

Prevalence and associations of retinal vein occlusions: the Central India Eye and Medical Study.

PURPOSE: To determine the prevalence of retinal vein occlusions (RVOs) in rural central India. METHODS: The population-based Central India Eye and Medical Study was performed in rural central India and included 4,711 subjects (30 years and older). Using fundus photographs, we assessed the prevalence of branch retinal vein occlusions and central retinal vein occlusions. RESULTS: An RVO was detected in 38 eyes (0.42 ± 0.07%; 95% confidence interval: 0.29-0.56) of 35 subjects (0.76 ± 0.13%; 95% confidence interval: 0.50-1.01). Prevalence of branch retinal vein occlusions was 0.66% ± 0.12% per subject (95% confidence interval: 0.42%-0.90%) and of central retinal vein occlusions was 0.11% ± 0.05% per subject (95% confidence interval: 0.01%-0.21%). In binary logistic analysis, presence of RVOs was associated with higher age (P = 0.007), systolic blood pressure (P < 0.001), blood concentration of urea (P = 0.02), and narrower anterior chamber angle (P < 0.03). The RVO prevalence was not significantly (all Ps > 0.10) associated with body mass index; blood concentrations of glucose, cholesterol, high-density lipoproteins, and creatinine; presence of diabetes mellitus, tuberculosis and malaria; nutritional parameters; alcohol consumption; refractive error; and optic disk size. The age-specific prevalence rates of RVOs were 0.18% ± 0.13%, 0.29% ± 0.15%, 0.89% ± 0.34%, 1.07% ± 0.36%, 2.72% ± 0.85%, and 3.64% ± 2.55%, respectively, for decadal age groups. In two (5%) eyes, RVO had caused low vision (visual acuity <20/60 and ≥20/400). CONCLUSION: In the rural agrarian low-income population of Central India, RVOs were detected in 0.8% of adults, with branch retinal vein occlusions being approximately seven times more common than central retinal vein occlusions. Main associated factors were higher age, blood pressure, urea blood concentration, and narrow chamber angle. RVOs were no major reason for visual impairment.