Short-Term Efficacy Of Intravitreal Patizra® (Ranibizumab) In Treatment Naive Patients- Real World Evidence In Pakistan.

Background: : Macular oedema is a final common pathway of a multitude of both ocular and systemic insults. This study was conducted to evaluate the short-term efficacy and safety of intraocular Ranibizumab in patients with macular oedema in a 'real-world' setting in Pakistan. Methods: A prospective multicenter study conducted at Amanat Eye Hospitals in Islamabad and Rawalpindi from 1st August 2018 to 1st November 2019. Forty-four eyes of 34 patients with macular oedema were treated with monthly intravitreal Ranibizumab (Patizra® ) injections for three consecutive months. Best-corrected visual acuity (BCVA), and optical coherence tomography (OCT) parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared. Results: BCVA improved from logMAR 0.61±0.40 at baseline to 0.27±0.35 four weeks after the third intravitreal injection. CRT decreased from 428.54±187.06 µm at baseline to 364.50±170.49 µm. Macular volume showed a non-significant decrease from 9.97±3.19 mm3 at baseline to 9.22±2.68 mm3 four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study. Conclusion: Treatment with intravitreal Patizra® injections was found safe and resulted in clinically and statistically significant improvement in visual acuity and the SD-OCT parameter of central retinal thickness in patients with macular oedema secondary to various retinal pathologies. There was no significant decrease in the macular volume.

A Rare Cause Of High Astigmatism In Pseudophakia.

We present a case of a 65-year-old Pakistani woman who underwent an uneventful standard left phacoemulsification with posterior chamber intra-ocular lens placement for a mature senile cataract. She was observed to develop post-operative astigmatism secondary to a tilted intra-ocular lens and required repeat surgical intervention to correct the malposition. Per-operatively, the lens was found to be defective with a fixed bend at the haptic-optic junction which necessitated the need for an intra-ocular lens exchange procedure that restored adequate vision. The study highlighted defects in the structural integrity of intra-ocular lenses as an important differential to consider in such cases, and established lens replacement as a successful intervention to improve visual outcome.

Short-Term Efficacy Of Intravitreal Bevacizumab In Treatment Naive Patients- Real World Evidence In Pakistan.

BACKGROUND: Anti-VEGF agents have been proven to be effective in treating macular oedema secondary to a multitude of pathological conditions. However, in large clinical trial settings, the results may be overstated. This study aimed to evaluate the short-term efficacy of intraocular Bevacizumab in consecutive patients with macular oedema being treated in a 'real-world' setting in Pakistan. METHODS: A prospective study was conducted at Amanat Eye Hospital, Rawalpindi from August 2018 to November 2019. Thirty-five eyes of 29 patients with macular oedema were treated with monthly intravitreal Bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA), and OCT parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared. RESULTS: BCVA improved from 1.00±0.44 at baseline to 0.83±0.48 four weeks after the third intravitreal injection. CRT decreased significantly from 492.77±192.31 at baseline to 362.91±126.11 (p<0.05), and macular volume decreased significantly from 11.61±2.39 at baseline to 9.87±1.68 (p<0.05) four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study. CONCLUSIONS: Treatment with intravitreal Bevacizumab injections was found safe and resulted in clinically and statistically significant improvement in SD-OCT parameters and visual acuity in patients with macular oedema secondary to various retinal pathologies. However, the improvement in a real-world setting was sub-optimal in comparison to larger clinical trials for specific diseases in the developed world.

A Case Of Descemet Membrane Detachment Postcataract Surgery.

Descemet Membrane Detachment is a vision-threatening complication of Cataract Surgery. If not treated promptly it can lead to serious vision impairment with the possible need for corneal transplantation. We present a case report of a 60 years old female who presented with blurry vision post phacoemulsification and lens placement after a cataract in the left eye. She was diagnosed with Descemet membrane detachment on slit-lamp examination that was confirmed on Anterior-segment Optical Coherence Tomography and treated with intracameral 20% SF6 injection. There was a marked improvement in her vision with complete resolution of corneal oedema. Conclusion: Anterior Segment OCT can be used as a diagnostic tool to accurately ascertain the site and extent of detachment and monitor disease progress. 20% Sulfur-hexafluoride intracameral injection can be used as a surgical option for large, central detachments.

A Comparison of Complications and Success Rates after PCNL in Younger and Elderly Patients.

OBJECTIVE: To compare the outcomes of percutaneous nephrolithotomy (PCNL) across younger and elderly, especially PCNL complications in terms of modified Clavian grading system. STUDY DESIGN:  Cros-sectional comparative study. PLACE AND DURATION OF STUDY: Department of Urology, Shifa International Hospital, Islamabad, from 2010 till 2018 December at a tertiary care hospital. METHODOLOGY: Patients who underwent unilateral PCNL were reviewed group 1 (younger, age < 60 years) had 594 patients; while group 2 (elderly, age >60 years) had 137 patents. Information regarding complication and success rate were recorded by residents in proforma and then processed for statistical computations. RESULTS: There were total of 731 subjects. The mean age in group 1 was 39.7±11.2 years and that of group B was 65.66±4.55 years. The mean size for calculi in group 1 was 2.83±1.32 cm while in group 2 stone size reached 2.81±1.04 cm. A total of 174 (23.8%) complications and stone free rate of 81.8% (598/731) was recorded in this study. Overall when compared, no notable difference in complications, hospital duration and success rates was observed between the young and elderly age group. CONCLUSION: Despite old age, the success rates and complications were not remarkably different from that of the younger subjects for prone PCNL. Key Words: Percutaneous nephrolithotomy, Geriatrics, Renal stone, Complications.

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.

OBJECTIVE: To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. MATERIAL AND METHODS: We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. RESULTS: The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). CONCLUSION: The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.