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   2014| May-August  | Volume 2 | Issue 2  
    Online since June 5, 2015

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Chronic alcoholism and central serous chorioretinopathy
Vishal Katiyar, Sanjiv K Gupta, Arun Kumar Sharma, Vinita Singh
May-August 2014, 2(2):79-82
A 36-year-old alcoholic male suffered from central serous chorioretinopathy (CSCR). Morning serum cortisol was 293.3 ng/ml (normal range: 50-250 ng/ml), which was elevated. After 1-week of treatment with mineralo-corticoid antagonist eplerenone at 25 mg/day, patients witnessed visual acuity in the left eye increased to 6/12, which corroborated with optical coherence tomography showing substantial decrease of sub-retinal fluid. It is first documented case of CSCR associated with chronic use of alcohol that exhibited response to mineralo-corticoid antagonist eplerenone. In this study, though the exact role of alcohol intake in the pathogenesis could not be established, a disturbed the hypothalamic-pituitary-adrenal axis as a connecting link between the two conditions are observed. This will pave the way for larger, controlled studies directed to establish an association between alcohol intake and CSCR.
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Combined phacoemulsification and sutureless vitrectomy for treatment of rhegmatogenous retinal detachment
Ahmed Hosni Abd Elhamid
May-August 2014, 2(2):68-73
Purpose: To report the success rate and possible complications of combined phacoemulsification and sutureless 23 gauge vitrectomy for treatment of rhegmatogenous retinal detachment (RRD). Patients and Methods: Thirty patients with RRD were included in the study. All patients were examined for the extent of detachment, number and location of retinal breaks, and degree of proliferative vitreoretinopathy (PVR). Combined phacoemulsification, intraocular lens implantation, 23 gauge vitrectomy, laser retinopexy, and 12% C3F8 injection were done for all patients. All eyes were followed for 3 months. The primary outcome measures were single operation success rate and change in best-corrected visual acuity (BCVA). Any intraoperative and postoperative complications were reported and analyzed. Results: The mean age of the patients was 43.9 ± 10.11 years; mean duration of detachment was 17.3 ± 5.53 days while mean preoperative BCVA measured by logarithm of the minimum angle of resolution (Log MAR) was 2.1 ± 0.71. Single operation success rate was achieved in 25 eyes (83.3%), 5 eyes (16.7%) showed failure of complete attachment after absorption of gas bubble. The mean postoperative BCVA was significantly better than the preoperative value (1.00, 1.1 after 6 weeks and 3 months, respectively, P < 0.01). The most common postoperative complications were reversible corneal edema that occurred in 11 eyes (36.6%), fibrinous uveitis in 8 eyes (26.6%) and posterior capsular opacification in 16 eyes (53.3%). Preoperatively, 1 eye (3.3%) had BCVA ≤1 (Log MAR) in comparison to 17 eyes (56.7%) and 18 eyes (60%) after 6 weeks and 3 months respectively. Conclusion: Combined phacoemulsification and sutureless vitrectomy with gas tamponade is safe and effective single surgical procedure for selected patients with RRD.
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A comparative study between intravitreal ranibizumab and peripheral laser ablation in cases of prethreshold type I retinopathy of prematurity
Ahmed Mahmoud Abdel Hadi
May-August 2014, 2(2):63-67
Purpose: The aim was to evaluate the efficacy and safety of intravitreal injection of ranibizumab for treatment of prethreshold type 1 retinopathy of prematurity (ROP) with conventional laser photocoagulation given for the same disease level. Subjects and Methods: In this retrospective comparative study, the charts of 16 premature babies, presenting from July 2009 to May 2014, were reviewed. All infants were diagnosed with prethreshold ROP (type 1). Patients received either intravitreal ranibizumab (0.625 mg/0.025 ml of solution) (group A, 12 eyes of 6 infants) or conventional diode laser (group B, 28 eyes of 14 infants), bilaterally. The main evaluated outcomes included time of regression, decrease of plus signs and incidence of recurrence. Infants were followed till 55 weeks postmenstrual age. The confidentiality of the patients was respected. Results: The mean age of the studied infants was 35.63 ± 1.58 weeks ranging from 33 to 39 weeks. The stage of ROP in the studied infants was either stage 2 in 7 cases (43.8%) or stage 3 in 9 cases (56.3%). The zones of ROP were zone I in 3 cases (18.8%) and zone II in 13 cases (81.3%). Group A had a mean gestational age (GA) of 36.6 ± 1.5 weeks, while cases in group B had mean GA of 35 ± 1.3 weeks. This was statistically significant (P = 0.037). The stage did not significantly affect the choice of treatment (P = 0.09). Looking at the subgroup analysis 66.7% (two cases) of cases with zone I disease were treated with intravitreal ranibizumab, whereas 69.2% (nine cases) with zone II disease were treated with conventional laser. The incidence of recurrence was not affected by the zone of the disease (P = 0.71) nor by the stage of the ROP or by the presence of plus sign (P = 0.29, P = 0.68, respectively). There was no statistically significant difference between the two treatment groups about the incidence of recurrence (P = 0.701). The mean GA for cases with recurrence of ROP (35.25 ± 2.6 weeks), did not differ significantly with the mean GA of the infants who did not suffer from recurrence 35.75 ± 1.2 weeks (P = 0.7). Conclusion: Both intravitreal ranibizumab and conventional laser were proven effective in the treatment of prethreshold type 1 ROP. Long-term favorable structural outcome may require extended observation and retreatment. Further large-scale studies are needed to address the long-term safety and efficacy.
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Use of the scleral buckle for the management of inferior break retinal detachment associated with proliferative vitreoretinopathy
Faiz I Al-Shakarchi, Riyadh K Lafta
May-August 2014, 2(2):74-78
Objective: The aim was to compare the surgical success rates of pars plana vitrectomy (PPV) with and without scleral buckling (SB) in the management of inferior break retinal detachments (RDs) associated with proliferative vitreoretinopathy (PVR). Methods: This retrospective analysis included all cases of inferior break RD with PVR (grade B, C) that underwent PPV by the same surgeon, from March 2008 to March 2012. Patients were divided into two groups: Group A for whom scleral buckle was inserted, and group B for whom no scleral buckle was used. Results: A total of 78 eyes with inferior break RD were enrolled in this study. Primary retinal attachment was achieved in 26/36 cases (72.2%) in group A. While it was achieved in 30/42 cases (71.4%) in group B (P = 0.861 - not significant). Primary success rate (retinal attachment) in cases with PVR grade B was 18/21 (85.7%) in group A, and 21/24 (87.5%) in group B. While primary success rate in cases with PVR grade C was 8/15 (53.3%) in group A, and 9/18 (50%) in group B. Conclusion: In the management of inferior breaks RD by PPV with PVR (grade B, C) adjunct use of SB does not alter the reattachment success rate.
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Temporary complete vision loss after intracameral lignocaine in a post-vitrectomy eye: A single case report
Sanjiv Kumar Gupta, Ajai Kumar
May-August 2014, 2(2):83-85
We report a case of temporary complete vision loss in a phakic patient after intracameral lignocaine solution injection percolated to the posterior segment of the eye and anesthetized the retina. The main reason of this seepage of lignocaine solution from the anterior chamber to the posterior segment was presumably the hypotony and absence of the vitreous body as the patient had undergone pars plana vitrectomy for intravitreal cysticercus. Once the duration of anesthesia effect of lignocaine elapsed, the patient gained good vision with no obvious retinal damage as seen on fundus imaging and ocular coherence tomography. Thus, one should keep the possibility of intracameral medications to reach the posterior segment in therapeutic/toxic concentrations, especially in postvitrectomy eyes with hypotony.
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Peripapillary exudative retinal detachment: An unusual manifestation of hypertensive choroidopathy
Sangeetha Sriram, Suneetha Nithyanandam, Vani Ramkumar, Jerry Joseph
May-August 2014, 2(2):86-87
We report a case of hypertensive choroidopathy presenting with peripapillary serous detachment in a patient with chronic hypertension with super imposed pre-eclampsia. The fundus evaluation showed grade 4 hypertensive retinopathy changes with peripapillary serous detachment which was confirmed on Optical coherence tomography. This is an unusual presentation, as these changes are commonly seen in the macular region.
  2,443 72 -