Purpose: To compare the success between single-step pars plana vitrectomy (PPV) + Endolaser (EL) + Trabeculectomy + mitomycin C (MMC) and 2-step approach, i.e., pan-retinal photocoagulation (PRP) followed by Trabeculectomy + MMC in cases of stage IV neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR). Methods: Prospective, interventional study including 16 eyes of 16 patients with stage 4 NVG in cases of PDR between July 2019 and December 2020. Depending on the type of surgery, patients were divided into two groups. Group I: PRP followed by Trabeculectomy + MMC (n = 8), Group II: Combined PPV + EL + Trabeculectomy + MMC (n = 8). All patients received intravitreal bevacizumab 3 days before the surgery in both groups. Success criteria were postoperative intraocular pressure (IOP) of <20 mm Hg with or without antiglaucoma medication. Results: Postoperative IOP decreased significantly in both groups, but the mean IOP after 6 months was lower in combined group (17 mm Hg) than trabeculectomy group (22.25 mm Hg; P = 0.204). Combined group required fewer anti-glaucoma medications (mean: 0.88) than trabeculectomy group (mean: 1.38). Cumulative surgical success rates for combined group and Trabeculectomy groups were 100% and 75% respectively. No significant differences in intraoperative complications were observed between the groups. Conclusion: In stage 4, NVG secondary to PDR, single step combined approach including PPV + EL + Trabeculectomy + MMC could be more effective in controlling IOP with better visual outcome than Trabeculectomy + MMC.

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Aim: The aim was to report the phenotypic expression of chronic Leber's hereditary optic neuropathy (LHON) patients with primary and secondary mitochondrial mutations presenting at a tertiary eye care center in South India. Materials and Methods: Of 51 patients suspected to have LHON, 15 patients turned out to be positive for mitochondrial mutations. All 15 patients with LHON are in the chronic phase of the disease and have undergone clinical examination that included visual acuity, fundus examination, visual fields, and optical coherence tomography. Clinical data were compared among the LHON patients with primary mutations of G11778A and T14484C and grouped secondary mutations. Descriptive analysis was reported. Results: There was no significant difference found in visual acuities in both the eyes of the three genotypic groups (G11778A, T14484C, and secondary mutations) (P > 0.05). Retinal nerve fiber layer (RNFL) analysis showed that nine patients carrying G11778A and three patients carrying secondary mutations were similar, while two patients with T14484C showed severe thinning of RNFL in all four quadrants. Conclusions: Among a small percentage of patients who were positive for LHON mutations, severe RNFL thinning was the most prominent finding in the T14484C mutation that differentiates from G11778A and secondary mutations. Other clinical features seem to be similar among all genotypic groups examined.

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A 43-year-old housewife presented to the retina clinic with a 5-year history of poor vision in the left eye. There was no antecedent history of trauma. At presentation, the best-corrected visual acuity was 6/5 and counting fingers in the right and left eye, respectively. Examination of the anterior segment was essentially normal in both eyes. Fundus examination with binocular indirect ophthalmoscopy of the right eye revealed a normal fundus, whereas the left eye had a pale optic disc, widespread hyperpigmented scars some located subvascular, subretinal fibrosis, occluded vessels, and macular atrophic changes. The systemic examination was essentially normal. There was a positive history of previous treatment for pulmonary tuberculosis (TB) about 5 years before presentation at the retina clinic. Due to the ocular findings in the left eye and a history of pulmonary TB, a diagnosis of left-healed presumed tuberculous choroiditis was made.

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