RE-INVENTING CYANOACRYLATE RETINOPEXY IN THE 21ST CENTURY: LITERATURE REVIEW AND CASE SERIES.

PURPOSE: We report use of cyanoacrylate (N-butyl-Cyanoacrylate) in previously failed retinal reattachment surgeries for chorio-retinal colobomas. We report the surgical technique, its challenges, and long-term outcomes in three patients who underwent the surgery. METHODS: A chart review of patients with chorio-retinal colobomas and retinal detachment repair with cyanoacrylate at a tertiary eye care center in Nepal. Cyanoacrylate was used to seal colobomatous retinal breaks in eyes which had undergone multiple retinal surgeries with failed outcome. RESULTS: Three eyes that were operated using cyanoacrylate were included. All three patients had attached retina and none of the patients required a long-term tamponading agent. None of the patients underwent head positioning following the surgery. All of the patients had a visual acuity gain of 3/60 or more at the end of 8 months. No adverse or inflammatory reactions were noted. CONCLUSION: We demonstrate that cyanoacrylate is safe and less resource-demanding without a requirement of second surgery to remove a tamponading agent. It could be helpful in eyes with persistent retinal detachment in colobomatous eyes. Because we were able to achieve favorable outcomes without head positioning, we believe it may also be helpful in patients who are not suitable for positioning because of bodily or bony deformities and in retinal detachment with other coexisting trauma.

Causes and Managements of Early-Onset Ocular Hypertension Following Pars Plana Vitrectomy with Silicone Oil for Retinal Detachment and Exploration of Trabeculectomy as a Viable Alternative Management: A Pilot Study.

INTRODUCTION: This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy with silicone oil (PPV with SO) procedure for retinal detachment. Additionally, to explore the outcome of trabeculectomy in managing such patients. MATERIALS AND METHODS: This is a retrospective exploratory pilot study. We studied 23 patients who underwent the procedure then subsequently developed ocular hypertension within a month of the procedure. The probable causes for their early-onset ocular hypertension were identified and addressed with medicine, peripheral iridotomy (PI), complete or partial silicone removal. Trabeculoplasty was done in irretractable causes. This study aimed to evaluate the causes of early onset ocular hypertension after pars plana vitrectomy with silicone oil and explore the outcome of different managements including trabeculectomy. RESULTS: Inflammation (n=11, 47.8%) was the most common cause of early-onset ocular hypertension. Other causes were overfilling/spilling of silicone oil in anterior chamber (n=5, 21.7%), pupillary block (n=4, 17.4%) and angle-recession glaucoma (n=2, 8.69%). Majority of the cases responded to intraocular pressure (IOP) lowering medications (n=11). Three eyes with persistently high intraocular pressure underwent trabeculectomy after which the intraocular pressure was controlled. CONCLUSION: Even though prior studies have reported that trabeculectomy does not address late-onset ocular hypertension, our study shows that the procedure might be helpful in early-onset ocular hypertension. This is probably because at the time of presentation for early-onset ocular hypertension, silicone has not emulsified, which will not be the case in late-onset ocular hypertension. If a large study also shows that trabeculectomy can correct early-onset ocular hypertension, this information can guide the practices of ophthalmologists whose patients cannot afford expensive glaucoma drainage devices.

Redefining response in wet AMD to anti VEGF therapy based on non-OCTA versus OCTA evaluation.

PURPOSE: Anti vascular endothelial growth factor (anti VEGF) has been the mainstay of treatment in wet age-related macular degeneration (AMD). Subsequent decision to continue anti VEGF therapy depends on the treatment response quantified by functional (visual acuity) and morphological (optical coherence tomography) parameters then categorized from good to poor. METHODS: This study evaluates the agreement between OCT angiography (OCTA) and non-OCTA (logMAR VA plus OCT) to decide anti-VEGF treatment's continuity. After an anti VEGF treatment, on a follow up visit, a patient underwent non-OCTA evaluation (decision A) then OCTA evaluation (decision B) to judge the necessity of future anti VEGF application. RESULTS: Out of 129 eyes, on 72 eyes (49%), there were agreements on both decision arms, but on 55 eyes (42%) there was disagreement. Particularly, disagreement on 47/55 eyes was important, where OCTA advised "continue anti VEGF" and non-OCTA advised "Stop anti VEGF" therapy. Cohen's Kappa for probability of agreement to continue anti VEGF was fair (0.33) and to stop anti VEGF therapy was none (0.1). CONCLUSIONS: Based on resulting disagreements between the two modalities on deciding the continuity of anti VEGF, we conclude that OCTA must be considered in the conventional decision making algorithm in patients with wet AMD under anti VEGF therapy.

Post typhoid fever neuroretinitis with serous retinal detachment and choroidal involvement-A case report.

PURPOSE: To report post typhoid fever neuroretinitis with Serous Retinal Detachment and choroidal involvement. OBSERVATION: Patients with diminished vision post typhoid fever can present with neuroretinitis with serous retinal detachment. CONCLUSION AND IMPORTANCE: With help from noninvasive imaging such as optical coherence tomography angiography(OCTA) and Deep Range Imaging(DRI), we were able to conclude choroidal involvement - which has not been discussed in literatures yet.OCTA and choroidal thicknessboth served as agood indicators for monitoring the response of treatment in this case.

Penetrating Keratoplasty - Indications in a tertiary care center in Nepal.

INTRODUCTION: Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. MATERIAL AND METHODS: A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. RESULTS: Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Introduction: Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. MATERIAL AND METHODS: A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. RESULTS: Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Conclusion: Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision. CONCLUSION: Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision.

Traumatic Orbital Compartment Syndrome: A Sight Threatening Emergency.

Orbital compartment syndrome is a rare presentation of orbital trauma and is an ophthalmic emergency. Delay in clinical diagnosis and subsequent surgical intervention will lead to loss of vision in nick of time. We presented a case series of orbital compartment syndrome secondary to trauma who presented to the emergency department of Tribhuvan University Teaching Hospital during the devastating earthquake in April 2015. Clinical diagnosis of orbital compartment syndrome was made in the bedside and all the patients underwent emergency lateral canthotomy and inferior cantholysis. This case series was aimed to describe clinical features and management of orbital compartment syndrome.