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   2015| January-April  | Volume 3 | Issue 1  
    Online since March 29, 2016

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360° laser retinopexy in preventing retinal re-detachment after 23-gauge vitrectomy for primary repair of retinal detachment
Omar A Barrada, Mostafa H Nabih, Ayman M Khattabm, Ashraf A Nosseir
January-April 2015, 3(1):1-9
Aims: To evaluate the role of intraoperative 360° laser retinopexy in the prevention of retinal re-detachment in cases of primary rhegmatogenous retinal detachment (RRD). Settings and Design: Prospective randomized controlled trial, 80 eyes of 80 patients with primary RRD. Subjects and Methods: Totally, 80 eyes of 80 patients with primary RRD will be divided into two groups. In Group (A), laser will be applied to all existing breaks as well as 360° laser retinopexy anterior to the equator will be performed while Group (B) laser will be applied only to the retinal breaks and will not receive the 360° laser treatment. Follow-up was for 3 months after clearance of the tamponading agent. Statistical Analysis Used: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474): Duration of detachment and preoperative visual acuity. Specifically, for every day more of duration of detachment, the odds of re-detachment increased by a factor of 1.007 (P < 0.01). Likewise, for every day more of duration of detachment, the odds of re-detachment was increased by a factor of 8.840 if a preoperative visual acuity of hand motion with bad projection (HMBP) or worse was present (P = 0.05). Conclusions: We concluded that prophylactic intraoperative 360° laser retinopexy did not have a statistically significant role in the prevention of retinal re-detachment after primary retinal repair. The statistically significant preoperative risk factors that have a poor prognostic effect on surgical outcomes are preoperative visual acuity of ≤ HMBP or worse and a longer duration of the retinal detachment.
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Optical coherence tomogram and demographic profile in central retinal artery occlusion: A South Indian study
YD Shilpa, BN Kalpana, Mohammed Sadiqulla
January-April 2015, 3(1):10-14
Aim: To describe the demographic profile and optical coherence tomography (OCT) findings in patients with central retinal artery occlusion (CRAO). Materials and Methods: Thirty-eight patients with CRAO who presented to Vitreo Retina Department at Minto Ophthalmic Hospital between January 2009 and December 2013 were studied. All the patients underwent detailed ophthalmic examination including OCT and routine laboratory investigations. All patients were subjected to cardiac evaluation. Results: In our study, 27 (71%) were males and 11 (29%) were females. The average age of our patients was 44.8 years (range 25-65 years). Seven patients had diabetes, and six had hypertension. Seven (18%) patients had CRAO with sparing of the cilioretinal artery. History of smoking was present in 15 (56%) of males with an average duration of 16.9 years. OCT showed average central macular thickness of 288.2 mm in acute stage and 163.75 mm in chronic stage. Conclusion: CRAO had varying etiologies but had similar clinical findings and OCT features. In our study, smoking was found to be the most common association in males. CRAO was also seen in younger age groups too. In all cases, OCT in acute stage shows increased reflectivity of inner retina and a hyporeflective band and in chronic stage thinning of sensory retinal layer. OCT findings were similar irrespective of the etiology.
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The role of matrix metalloproteinases in retinal pigment epithelial cell-induced gel contraction and collapse
Usama Ahmed Shalaby, Ahmed Mohammed Saeed, Mohamed Fathy Farid
January-April 2015, 3(1):15-22
Purpose: To determine the role of matrix metalloproteinases (MMP)-1, -2, and -9 in directing the behavior of human retinal pigment epithelial (HRPE) cells during contraction of three-dimensional collagen gels. Materials and Methods: The effect of HRPE cells on collagen gel invasion and contraction were quantified by using phase contrast microscopy. Immunohistochemistry of the gel using monoclonal antibodies against MMP-1, -2, and -9 was performed. The effects of MMP inhibitor, Batimastat (BB-94) on cultured HRPE cells, and gel contraction were observed. Results: HRPE cells mostly proliferated as sheets of cells on the surface of the collagen gel and only minimally invaded the gel. However, some HRPE cells were seen to invade the gel as single cells detaching from the surface sheets. Surface-located sheets of cells exerted a dose-dependent contraction on the gel and generally failed to express MMPs. Single cells invading the gel expressed MMP-2 and -9. No expression of MMP-1 was observed by HRPE cells. BB-94, at a dose of 500 nM and 5 μM, reduced the amount of gel contraction. Conclusions: These data indicate that MMPs are selectively involved in HRPE invasion and collagen gel contraction. Both these processes may be implicated in the pathogenesis of similar conditions in vivo in which contraction of collagen gel is a feature, for example, proliferative vitreoretinopathy.
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Primary intravitreal bevacizumab injection as a monotherapy versus combined intravitreal bevacizumab with argon laser photocoagulation in management of diabetic macular edema: A comparative study
Yomna Amr Alahmadawy, Rasha Mounir Eltanamly, M Ayman Khattab, Mosatafa Hamed Nabih
January-April 2015, 3(1):23-28
Purpose: To assess the effectiveness of bevacizumab versus bevacizumab with macular laser photocoagulation in diabetic macular edema. Patients and Methods: Forty eyes of 31 patients with macular edema were enrolled in this study; Group A, twenty eyes received baseline three monthly injections of bevacizumab (1.25 mg/0.05 ml), then monthly reinjection according to pro re nata (PRN) regimen, and Group B, twenty eyes received one injection plus laser 1 month later, then monthly injections according to PRN regimen (? according to PRN also). Results: In Group A, no significant change in mean best-corrected visual acuity (BCVA) throughout 1 year (P = 0.165), as compared to Group B (P < 0.001). Mean BCVA in Group B at 12 months was 0.46 ± 0.30 compared with 0.75 ± 0.33 in Group A (P = 0.041).The mean number of injections in Group A was 5.55 times while in Group B was 1.4 times (P < 0.001). Conclusion: Combined treatment resulted in marked reduction of the number of injections required to control edema.
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Endogenous endophthalmitis following prolong use of methotrexate
Vishal Katiyar, Ankur Yadav, Prateep Phadikar, Sanjiv Kumar Gupta
January-April 2015, 3(1):29-32
A 46 yr old male presented to us with a 2 day history of pain, redness and discharge in left eye. The patient was on oral Methotrexate (12.5 mg) weekly with folic acid supplement for the last 1 year for recurrent Uveitis (LE). There was a history of three previous episodes of acute anterior uveitis in left eye 2 years back for which he was prescribed oral steroids. The uveitis attack use to flare up on tapering the steroids. In the hope to reduce the recurrences and to prevent long-term complications, the patient was shifted to oral methotrexate (12.5 mg) weekly with folic acid supplementation. On the basis of clinical examination and B- scan a presumptive diagnosis of endogenous endophthalmitis was made. Vitreous tap revealed a straw colored sample and the culture subsequently grew methicillin sensitive Staphylococcus epidermidis. Intravitreal injection of (Piperacillin+Tazobactum) 225 microgram in 0.1 ml was administered. In addition, intravenous (piperacillin+tazobactum) 4.5 gram BD was given for 3 days. Post intra vitreal injection the symtoms and signs resolved remarkably. Methotrexate has not been previously implicated with endogenous endophthalmitis. Besides, Endogenous endophthalmitis is an ongoing diagnostic and therapeutic dilemma for ophthalmologists as it is relatively rare and often presents like uveitis. It requires a high index of suspicion for prompt diagnosis and treatment. The treatment of EE is still controversial due to a lack of clinical trials. Future large group studies need to be done for validation of the above therapeutic regime.
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A rare case of Wolfram syndrome
Anubhav Chauhan, Shashi Datt Sharma, Ranesh Kumar
January-April 2015, 3(1):33-37
A 19-year-old male with type 1 diabetes mellitus and juvenile rheumatoid arthritis (JRA) presented to a secondary care institute with painless, progressive diminution of vision. Ocular examination revealed bilateral optic atrophy. A suspicion of Wolfram syndrome (WFS) led to a battery of investigations for known association of many entities with this syndrome. Positive associations with this syndrome such as short stature, hydronephrosis, seizures, and color vision deficiency were present in our case. To the best of our knowledge and after undergoing extensive literature search on the internet, this is probably the first reported case of WFS with JRA and without diabetes insipidus as a whole.
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