Pakistan Journal of Ophthalmology

Reactivation of Aggressive Retinopathy of Prematurity Following Intravitreal Bevacizumab

2024-10-17T05:19:49+00:00

Aggressive Retinopathy of Prematurity (A-ROP) is a severe and rapidly progressing form of ROP that can lead to blindness if not managed effectively. Intravitreal Bevacizumab injection has emerged as a primary treatment option for A-ROP; however, the risk of recurrence necessitates vigilant follow-up and management. We present a case of 5-week-old premature male infant, diagnosed with bilateral A-ROP during routine screening and received an intravitreal Bevacizumab injection. Initial treatment resulted in clinical improvement, but one month later, the patient developed fibrosis, traction, and retinal neovascularization in the right eye, while the left eye showed signs of regression. Laser photocoagulation therapy was subsequently administered to manage the disease progression. This case report underscores the complexities in managing A-ROP, particularly the potential for reactivation following Bevacizumab treatment. A combined therapeutic approach, including laser photocoagulation, may be necessary to achieve optimal control of A-ROP progression.

Clinical outcomes of Lateral Tarsal Strip Procedure for the correction of entropion and ectropion

2023-09-09T08:29:26+00:00

Purpose: Evaluating the clinical outcomes of Lateral Tarsal Strip Procedure for the correction of entropion and ectropion.

Study Design: Interventional case series.

Place and Duration of Study: Mayo Hospital Lahore, from January 2018 to March 2023.

Methods: Lateral Tarsal Strip Procedure was performed for the correction of Lower lid malposition in 43 patients for entropion or ectropion. Complete ocular assessment was done including palpebral fissure height, amount of inward/outward turning of lids, abnormalities of lashes and pre-existing tear film abnormality. Patients with previous eye surgery were excluded. We collected data regarding surgical outcomes and satisfaction of patients.

Results: Forty-three patients were included in this study. There were 30 men and 13 women in the age range of 59 to 82 years (mean 72.2±4.9 years). There were 28 right and 15 left lower eyelids. Surgical success with anatomical correction of Involutional ectropion was achieved in all patients. Distribution of type of lid abnormality is shown in Table 1. There were no perioperative or postoperative complications. After initial 100% results, only two out of forty-three eyelids (4.6%) had recurrence of involutional ectropion after 4 and 6 months.

Conclusion: LateralTarsalStrip is a simple and effective approach in achieving correction for entropion/ectropion.

Enhancing Vision: Evaluating the Effectiveness of Telescopic Devices in Individuals with Retinitis Pigmentosa

2024-10-12T05:49:23+00:00

Introduction: Retinitis pigmentosa (RP) comprises inherited retinal disorders leading to vision loss. LVDs aid individuals with RP by enhancing visual acuity (VA). Low Vision Devices (LVDs) offer the potential to enhance the independence and function of visually impaired individuals.

Objective: The objective of this study was to evaluate the effectiveness of telescopic LVDs in individuals with retinitis pigmentosa (RP).

Methods: A retrospective, interventional study was conducted at the Khyber Teaching Hospital, Pakistan, Records of 56 non-syndromic RP patients, examined between January 1, 2020 and December 31, 2022, having best corrected VA between 0.30 and 1.30 logMAR were reviewed. Descriptive statistics and paired sample t-tests were employed to analyse changes in VA.

Results: Most RP patients were male (39; 69.7%), with a high consanguinity rate (43; 76.8%). Of the 56 subjects, 45(80.35%) showed an improvement in distance VA with the telescope, while 11(19.64%) had constricted visual fields and showed no improvement in VA. The mean distance best corrected VA improved from 0.90logMAR (without LVDs) to 0.58 logMAR with a LVD (p<0.001). Binocular telescopes were preferred by 51.8% of adults and children.

Conclusion: LVDs significantly enhanced VA for individuals with RP, emphasising the importance of early device availability. It is important to note that not all patients may show the same pattern of improvement. A personalised rehabilitation plan may be necessary for each individual.

Newly Developed Head-Mounted Ultraviolet-Activated Riboflavin Device for Corneal Cross-Linking Therapy

2024-10-12T05:31:52+00:00

Purpose: To compare the effectiveness of a newly developed head-mounted device (UV-GAMA) with traditional UV-CXL in terms of bacterial and fungal eradication.

Study Design: Pre-clinical experimental study.

Place of Study: Department of Microbiology, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada.

Methods: Bacterial and fungal isolates were cultured and suspensions were created to make a solution of 10⁸/ml. Each test series had a non-illuminated control vessel without bacterial or fungal inoculation as a negative control. Every bacterial and fungal isolate was treated with 30 minutes of UV radiation. The bacterial and fungal suspension was cultured for 24 hours and 96 hours, respectively. The number of CFU was counted for each solution, as well as the corresponding control solution, and the concentration of bacteria was calculated.Two-way ANOVA and the student t-test were used for statistical analysis. The results of each bacterial/fungal count were examined separately. The level of significance was fixed at 5%.

Results: Treatment with riboflavin + UV-GAMA and riboflavin + UV-CXL showed significantly reduced bacterial and fungal colonies compared to the positive control. Thus, riboflavin + UV-GAMA and riboflavin + CXL showed a similar outcome in terms of reducing bacterial colonies.

Conclusion: The newly developed UV-GAMA head-mounted device shows a comparable result to the established CXL device. This finding emphasizes that the newly developed UV-GAMA can be used as an alternative to the existing CXL device.

Suprachoroidal Injection of Triamcinolone Acetonide: Advancing Treatment for Resistant Diabetic Macular Edema

2024-11-14T08:09:34+00:00

Purpose: To evaluate the effectiveness and safety of suprachoroidal triamcinolone acetonide (SCTA) in managing treatment-resistant diabetic macular edema (DME) over a 6-month period.

Study Design: Interventional case series.

Place and Duration of Study: Benazir Bhutto Hospital, Rawalpindi Medical University from June 2023 to May 2024.

Methods: A total of 64 phakic eyes with refractory DME were included. All eyes received a single SCTA injection (4 mg in 0.1 ml).Re-injection if needed was given after 3 months.Central subfield thickness (CST), best-corrected visual acuity (BCVA), and intraocular pressure were measured at baseline, 1^st, 3^rd, and 6^th month post-injection. Analysis was performed using paired t-test and repeated measures ANOVA in SPSS version 27, with p value< 0.05 considered significant.

Results: The mean baseline BCVA was 0.800±0.16LogMAR, improving to 0.709, 0.386, and 0.480 at 1^st, 3^rd and 6^th month respectively after injection (p=0.000). The mean baseline CST was 685.20±133.21, which significantly reduced to 308µm at 1^st month, 298.78 µm, and 346.91 µm at 3^rd and 6^th month respectively (p=0.000). There was no statistically significant difference in IOP and cataract grading 6^th month after SCTA. A re-injection was required in 28.1% of patients after 3 months, with no major complications observed.

Conclusion: Suprachoroidal triamcinolone acetonide is an effective and safe therapy, resulting in both anatomical and functional improvement in patients with resistant diabetic macular edema for up to 6 months.It is advisable that SCTA be utilized with caution by skilled surgeons when treating resistant DME.

Treatment of Blepharoptosis in paediatric patients using modified frontalis sling technique with lid crease creation

2024-08-15T11:15:35+00:00

Purpose: To observe the aesthetic and visual outcomes of a modified frontalis sling technique with lid crease creation in pediatric patients of upper lid drooping associated with weak Levator muscle.

Study Design: Quasi experimental study.

Place and Duration of Study: Al-Ibrahim Eye Hospital from January 2024 to June 2024.

Methods: This study included pediatric patients (either gender) with congenital ptosis associated with weak Levator muscle. Preoperative eye examination and Ptosis examination including lid crease and fissure height, Levator muscle function, MRD-1, MRD-2, and Bell’s reflex were performed. All the registered patients underwent modified frontalis sling procedure with lid crease creation using silicon tube. Lid fissure and lid crease height and MRD-1 measurements were performed at I^st, 8^thand 24^th weeks after surgery. Pictures were captured both pre and postoperatively for comparison. Any side effect occurring during or after the procedure were also noted.

Results: Six months after the procedure, 86% of patients showed desired results, with symmetrical eyelid appearance and negligible undercorrection (<1mm). Mean lid fissure height, lid crease height and MRD-1 were significantly increased (3.77±1.76 mm,3.20±0.51mm and3.23±1.65mmrespectively) after 6 months. Visual acuity was also improved. Minor side effects were observed only in few cases. Undercorrection of around 1mm occurred in 6 (13.95%) patients.

Conclusion: Modified frontalis sling technique with lid crease creation using silicon tube has shown superior aesthetic and visual results along with less side effects in paediatric patients of upper lid Ptosis from birth.

The Impact of Induced Anisometropia on Binocular Vision

2024-10-12T05:54:26+00:00

Purpose: To assessthe impact ofinduced anisometropia on binocular visual function.

Study Design: Quasi experimental study.

Place and Duration of Study: Optometry clinicsof Qassim University, from January 2024 to June 2024.

Methods: The study included 60 subjects of 16-26 years. Anisometropic myopia was induced by plus lenses (+1DS, +2DS, +3DS) and anisometropic hypermetropia was induced by minus lenses (-1DS, -2DS, -3DS) keeping them emmetrope with normal binocularity. Subjects with squint, suppression and amblyopia were excluded. Clinical assessment included;assessment of vision,refraction and near phoriawith Maddox wing. Assessment of bifovealfusion, suppression and diplopiawas done using Worthfour dot test and stereoscopic vision with Titmus fly test. Data was analyzed by using SPSS- v.25.

Results: There were 66.7% males and 33.3% females. Mean agewas 22.37±2.81 years. A significant difference in stereoacuity was found in 1D (41.75±130.26 sec arc), 2D (233.77±172.09 sec arc) and 3D (399.267±181.31 sec arc) anisometropic myopia (p˂0.001) as well asanisometropic hypermetropia(p˂0.001).There was no significant difference in stereoacuity between males and females (p ˃ 0.05). However, diplopia was higher in 3D of anisometropic hyperopia (73.3%) than anisometropic myopia (66.7%). Monocular suppression was present in 6.7% and 3.3% of 3D anisometropic hyperopia and anisometropic myopia respectively. Alternate suppression was present in 1.7% of eyes with 2D anisometropic hyperopia only.

Conclusion: Small degree of anisometropia significantlyimpact binocular vision. It affects bi-foveal fusion, leads to diplopia, suppression and reduction in stereopsis.

Visual Acuity and Refractive Errors in Toddlers

2024-12-23T11:00:01+00:00

Purpose: Uncorrected refractive error is the leading cause of visual impairment in children worldwide, especially in this digital era. The purpose of this study was toexamine toddlers' visual acuity (VA) and refractive errors in several playgroups and kindergartens in Makassar and Gowa, Indonesia.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Four Playgroups and Kindergartens in Makassar and Gowa, Indonesia from July 2023 to August 2023.

Methods: The subjects of this study were 245 playgroup and kindergarten students. An ophthalmologist and an experienced optometrist examined visual acuity and refractive errors of the subjects using Kay Picture test linear crowded book and a Retinoscope, respectively. The data were analyzed using the One-Way ANOVA test and the Chi-square test.

Results: Thirty-four children out of 245 (13.87%) had decreased visual acuity. One subject had myopia (2.9%), 21 had simple myopic astigmatism (61.8%), seven had compound myopic astigmatism (20.6%), three had compound hyperopic astigmatism (8.8%), and two subjects had mixed astigmatism (5.9%).Males had higher prevalence of decreased visual acuity as compared to females. There was no significant difference in visual acuity of different age and gender (p=0.437; p=0.312).

Conclusion: The prevalence of reduced visual acuity in children aged two to six years was 13.87%. The most frequently encountered refractive error was simple myopic astigmatism, accounting for 61.8% of cases.

Trends in Diabetic Retinopathy Severity among Patients at A Tertiary Care Eye Hospital: A Call to Strengthen Preventive Care

2024-12-16T09:48:55+00:00

Purpose: To analyze trends in diabetic retinopathy (DR) and its management at a tertiary healthcare center from January 2016 to December 2019.

Study Design: Descriptive study.

Place and Duration of Study: National Eye Center, Cicendo Eye Hospital, from August to September 2020.

Methods: Data were obtained from the diabetic retinopathy database in the vitreo-retina unit. Information on patients’ sex, age, diagnosis, and treatment from each year was retrospectively reviewed. Inclusion criteria encompassed all first-time DR patients scheduled for pan-retinal photocoagulation (PRP) laser, anti-VEGF injection, or pars plana vitrectomy (PPV). Patients with incomplete data or repeated visits were excluded. Among 63,824 records analyzed, 22,169 met the inclusion criteria. Patients were categorized into vision-threatening diabetic retinopathy (VTDR), requiring treatment at the first visit, and non-VTDR.

Results: Of the 22,169 patients included, 53.88% were female, and the majority were aged between 50 and 59 years. VTDR accounted for 19.12% of cases, while 80.88% were non-VTDR. Annual trends revealed changes in DR management approaches, with an increasing prevalence of VTDR and PPV emerging as the most frequently performed treatment.

Conclusion: The predominance of non-VTDR cases highlights the urgent need for improved DR management at primary and secondary healthcare levels. Strengthening early detection and intervention protocols is essential to prevent disease progression and alleviate the burden on tertiary care facilities.

Effect of Refractive Error Correction on Dry Eye Disease among Computer Operators of Hayatabad Medical Complex Peshawar

2024-10-12T05:22:00+00:00

Purpose: To determine the frequency of dry eye disease and association of refractive error correction on dry eye disease among computer operators.

Study Design: Cross-sectional.

Place and Duration of Study: Hayatabad Medical complex, Peshawar from June 2022 till December 2022.

Methods: This study recruited 93 computer operators in Hayatabad Medical Complex. Data collection began after approval from hospital ethical and research committee. Symptoms of dry eye were recorded in a pre-designed proforma after obtaining written informed consent. The Schirmer test was used to measure tears volume.Data was analyzed using SPSS version 23. Quantitative variables were described as mean + standard deviation and categorical values in frequency and percentages. Post stratification chi square test was utilized. A p value of less than 0.05 was considered statistically significant

Results: The mean age of the subjects was 38.7 + 8.5 years. There were 75.3% males. The mean duration of the job was 8.1 + 3.5 years and mean daily computer use was 8 + 2.2 hours. Use of spectacles was reported by 30.1% participants and contact lenses by 17.2%. Dry eye disease (on Shirmer’s test) was recorded in 24.7%. Refractive errors correction had no statistically significant effecton dry eye disease (for glasses p=0.313 and contact lens p=0.193).

Conclusion: Dry eye disease is significantly high in our population among avid screen users, but the refractive error correction has no effect on dry eye disease.

A Pilot Study on Knowledge, Attitude, and Practice Regarding the Use of Dietary Supplements as Adjuvant Therapy for Glaucoma

2024-08-27T07:17:19+00:00

Purpose: To find out knowledge, attitude, and practice among ophthalmologists regarding nutritional supplements in the management of glaucoma.

Study Design: Cross sectional study.

Place and Duration of Study: Lotus Eye Hospital and the College of Optometry.

Methods: A questionnaire-based cross-sectional pilot study was conducted. All questions in the 4-section questionnaire were mandatory. A Google form was created to share the questionnaire with potential participants. The final questionnaire link was emailed, distributed, and posted on social media to ophthalmologists. Final analysis was done after the data was manually entered into an excel sheet. Chi-square test was used to find out any association of knowledge, attitude, and practice based on years of experience, gender, and place of practice. P value < 0.05 was considered statistically significant.

Results: Out of 156 ophthalmologists, there were 99 males and 57 females. The average age was 41.88±6.15 years. Only 57.5% had good to fair knowledge, 25% had a positive attitude towards the role of nutritional supplements in glaucoma management, and practice patterns showed that only 30% prescribed supplements. The commonly prescribed supplements were Lutein, Zeaxanthin, flavonoids, and Omega3. A statistically significant 73% of respondents worked in private hospitals and 27% in public hospitals (p=0.005). With standard glaucoma therapies, 58% of respondents with 6-10 years of experience did not prescribe nutritional supplements. Limitations of the study include included a relatively small sample of 156 ophthalmologists, limiting the generalizability of the findings to a broader population. The distribution of the questionnaire via email and social media may have introduced selection bias, as only those with internet access and willingness to participate were included.Reliance on self-reported responses may lead to response bias, as participants might overstate or understate their knowledge, attitudes, and practices. The study did not assess whether the use of nutritional supplements by the ophthalmologists led to improved patient outcomes, which limits the practical implications of the findings. Addressing these limitations in future studies, such as through larger sample sizes, randomized designs, and longitudinal approaches, could provide more robust and generalizable insights into the role of nutritional supplements in glaucoma management.

Conclusion: The study results indicate that only 1 in 3 ophthalmologists administer supplements as adjuvant therapy for glaucoma. Randomized controlled trials of nutritional supplements as glaucoma adjuvant therapy can improve ophthalmologists' knowledge, attitude, and practice.

Effects of Prostaglandin Analogue on the Central Retinal Thickness in Patients with Type 2 Diabetes Mellitus

2024-06-29T08:12:58+00:00

Purpose: To determine the central macular thickness in patients with type 2 Diabetes using Latanoprost eye drops and to compare with type 2 diabetic patients using Timolol eye drops.

Study Design: Quasi experimental study.

Place and Duration of Study: Al-Noaman Teaching Hospital from February 2023 to April 2023.

Methods: One hundred diabetic patients were divided into two equal groups (Timolol group and Latanoprost group). Visual acuity was tested using Snellen chart, IOP was measured with Goldmann Applanation Tonometer, central corneal thickness (CCT) measurement was done to correct IOP for CCT. Optical coherence tomography (OCT) was used to measure central retinal thickness (CRT).

Results: The mean age of Timolol group was 57.91±1.6 years, which was very close to the mean age of Latanoprost group (57.57±1.63 years). There were 30 females and 20 males in each group. HbA1Cwas 8.99±0.47% in Timolol and 6.28±0.08% in Latanoprost group (p <0.001). The IOP showed statistically lower levels in Timolol group in comparison to Latanoprost group, 28.81±0.93 mmHg in comparison to 29.56±1.04 mmHg, respectively. In Timolol group, visual acuity significantly improved, the IOP was reduced, and the CRT was significantly lowered. However, in Latanoprost group, the pre and post treatment values showed that only the IOP significantly improved. Visual acuity and CRT were statistically and clinically the same.

Conclusion: Latanoprost may increase the central retinal thickness in diabetic patients without diabetic macular edema, however the rationale for stopping the medication in low-risk patients is still lacking.

Outcomes and Complications of Ahmed Glaucoma Valve Implantation in Neovascular versus Other Secondary Glaucoma: A One-Year Follow-up Study

2024-12-16T09:53:26+00:00

Purpose: To compare the visual outcomes and intraocular pressure between patients with neovascular glaucoma (NVG) and other secondary glaucoma (OSG) one year after Ahmed glaucoma valve (AGV) implantation.

Study design: Retrospective study.

Place and Duration of Study: Islamic International Medical College/Railway Hospital Westridge Rawalpindi, from January 2015 to January 2022.

Methods: Ahmed glaucoma valve (model FP7) was implanted in 54 patients with NVG and OSG. The preoperative and post-operative vision and IOP was compared between the two groups with one year follow up. Success was defined as IOP of 5-21 mmHg without topical therapy (complete success) or with topical therapy (qualified success), no loss of light perception and not requiring subsequent glaucoma surgery or tube removal.

Results: After one year, the mean postoperative vision improved to 0.9385 from 1.25 LogMAR in NVG group and to 0.8143 from 0.8500 LogMAR in OSG group. The mean IOP reduced from 41.69 to 16.27mmHg in NVG group. While in OSG group it reduced from 33.39 to 12.857 mmHg one year postoperatively (p-value 0.0001). Hyphema was the commonest complication in NVG and hypertensive phase in the OSG. NVG group showed complete success in 2, qualified success in 18 and failure in 6 cases. In the second group, complete success was seen in 8, qualified success in 18 and failure in 2 cases.

Conclusion: Ahmed glaucoma valve implantation is effective in saving useful vision andcontrolling IOP in majority of refractory glaucomas and the results are comparable between neovascular and other secondary glaucomas.

The Influence of Surgeon’s Hand Dominance on Surgically Induced Astigmatism (SIA) in Phacoemulsification

2024-12-16T10:36:23+00:00

Purpose: To compare the influence of surgeon hand dominance on surgically induced astigmatism in Phacoemulsification.

Study Design: Quasi experimental study.

Place and Duration: Acuity Eye Center, Lahore, from 2023 to 2024.

Methods: Surgically induced astigmatism (SIA) of 200 patients who underwent phacoemulsification by a single experienced surgeon with temporal clear corneal incision was analyzed. The surgeon performed phacoemulsification holding the phaco hand-piece in the right dominant hand when operating the right eye and the left non-dominant hand when operating the left eye. The patients keratometric (K) values were taken with Nidek auto-refracto keratometer (ARK-510A) 1 day before surgery (Baseline) and 6 weeks post-operatively. The pre-operative and 6 weeks post-operative K values were entered into the spreadsheet. SIA was calculated, analysed and plotted by ASCRS (American Society of Cataract and Refractive surgery) SIA Calculator (V100 Tool). Comparison of SIA between dominant and non-dominant hand phacoemulsification was calculated through SPSS (Version 26).

Results: All the participants were between 30 to 80 years of age. Double angle plot for SIA using ASCRS V100 tool revealed significant insights into the astigmatic changes post-surgery in both the right and left eyes.The centroid values, indicative of the mean astigmatic change, were 0.49±0.26D and 0.55±0.31D, respectively. The comparison between both left and right phacoemulsification showed that the difference was non-significant between dominant and non-dominant hand (P=0.251).

Conclusion: Despite the challenges of adapting surgical technique to accommodate hand dominance, our findings indicate a non-significant difference in postoperative SIA outcomes.

Effectivity of Posterior Optic Capture in Preventing Visual Axis Opacification Following Pediatric Cataract Surgery: A systematic review and meta-analysis

2024-12-28T07:47:57+00:00

Common complication after pediatric cataract surgery is visual axis opacification (VAO). Current surgical approach commonly used today is posterior capsulotomy with anterior vitrectomy (AV), but posterior optic capturewithout AV, has been introduced as an alternative. This study reviews posterior optic capture in preventing VAO following pediatric cataract surgery.Literature searches through various databases and comprehensive analysis results in 5 selected articles. Selected studies state that optic capture is as effective as conventional methods in preventing VAO. Optic capture is a safer alternative for IOL implantation, as it results in fewer inflammatory complications and eliminates the need for AV. Hence, optic capture reduces the additional risks associated with AV.Posterior optic capture is comparable to the standard surgical approach in preventing VAO. Furthermore, it is safer in terms of inflammatory sequelae and lens epithelial cell proliferation. Optic capture presents an alluring alternative surgical approach to overcome the need for vitrectomy.

Effect of Coenzyme Q10 in Inhibiting Retinal Ganglion Cell Apoptosis on Glaucomatous neuro degeneration Model

2024-12-23T13:37:00+00:00

This study aimed to explore CoQ10 properties in inhibiting retinal ganglion cell (RGC) apoptosis in the glaucomatous animal model.A comprehensive literature search was performed in Medline/Pubmed, Science Direct, ProQuest, and Web of Science till August 8th, 2023. The authors conducted study selection, data extraction, and risk of bias assessment independently. This study was registered at PROSPERO (registration number CRD42023454777).A total of 5 studies which vary in glaucomatous animal models were selected. All the studies showed a decreased mean of apoptotic RGCs in the glaucomatous CoQ10-supplemented model compared to control. Studies suggest CoQ10 may modify Bax/Bad/BcL-xL-mediated apoptotic pathway.Oxidative stress was also shown to be decreased in several studies which was marked by reducing protective oxidative stress markers (SOD2; HO1).Further research on human subjects was needed to explore CoQ10 potentials.

A New Frontier of Hope: Highlighting the Promising Potential of Spliceosome Inhibitor E7107 in Treating SF3B1 Mutant Uveal Melanoma

2024-12-09T22:57:15+00:00

Dear editor

This letter highlights the promising nature of spliceosome inhibitor E7107 in SF3B1 mutant uveal melanoma and warrants future research to establish its clinical application, safety, and efficacy for these patients.

Uveal melanoma originates from the melanocyte of the uvea and has a metastasis rate of about 25-34% within a span of ten years leading to poor prognosis and a death rate of 80% at 1 year following metastasis.¹ This shows the horrible nature of these melanomas and demand for an inevitable urge of definitive treatment options for these patients. However, unfortunately, the treatment options are very limited and poor. Various prognostic factors have been identified for uveal melanoma including mutations in genes encoding BRCA-1 associated protein (BAP1) being worst, splicing factor 3b subunit 1 (SF3B1) being intermediate, and eukaryotic translation initiating factor 1A X-linked (EIF1AX) being best prognostic factor.^2,3A large percentage of about 15%-35% of uveal melanomas have SF3B1 mutations which make it an important prognostic feature however there is no well-established pharmacological agent targeting or utilizing this major prognostic mutation as a therapeutic fortune. A recently introduced protein Tebetafusp though showed prolonged survival in metastatic carcinoma but available only for metastatic uveal melanoma

Postoperative Management of Congenital Cataracts: Challenges and Strategies

2024-10-31T08:15:31+00:00

Congenital cataracts are a leading cause of childhood blindness worldwide, particularly affecting populations in developing countries where access to timely surgical interventions may be limited.1 Approximately 200,000 children globally suffer from visual impairment due to cataract each year, underscoring the urgent need for effective surgical and postoperative management strategies.2The prevalence of childhood cataract in low-income countries was reported to be between 0.42 and 2.05 per 10,000, compared to 0.63 to 13.6 per 10,000 in high-income countries.2The management of postoperative complications, such as myopic shift, inflammation, glaucoma, amblyopia, and infection, is critical for preserving vision in these young patients. However, long-term follow-up and family involvement also play a central role in ensuring the best possible visual outcomes.

Macular hole after successful pneumatic retinopexy

2024-11-18T10:03:56+00:00

Pneumatic retinopexy has become widely recognized as an effective approach for treating certain types of retinal detachments. However, the occurrence of a macular hole following pneumatic retinopexy is rare, affecting 0.3% of cases. This case highlights the early development of a macular hole following an initially successful Pneumatic retinopexy. A 55-year-old male presented with a decrease in visual acuity in his right eye for one week. Examination revealed retinal detachment, with a single horseshoe tear located at 10 o’clock position in the right eye. The patient underwent pneumatic retinopexy, which involved cryoretinopexy and an intravitreal injection of sulfur hexafluoride. Initially, complete reattachment of the retina was achieved. Two weeks later, the patient reported a central scotoma with a reduction in visual acuity. Optical coherence tomography identified a new macular hole. This case emphasizes the potential for rare complications associated with pneumatic retinopexy, which are typically attributed to persistent vitreous traction.

Management of Malignant Glaucoma in a Pseudophakic Silicon Oil-Filled Eye: A case report

2024-10-17T05:42:15+00:00

This case report describes malignant glaucoma following Ahmed glaucoma valve implantation in a pseudophakic silicone oil-filled eye. A 44-year-old woman with Behcet's disease and congenital cataract underwent pars plana vitrectomy and silicone oil injection for pseudophakic rhegmatogenous retinal detachment. Despite maximum tolerated anti-glaucoma medications, uncontrolled intraocular pressure (IOP) prompted Ahmed glaucoma drainage device implantation. Early postoperative findings revealed diffuse shall owing of the anterior chamber, peripheral iridocorneal touch, and an elevated, diffusely spread bleb with corneal contact. Diagnosis of over-filtration was established after excluding posterior segment pathologies. Initial interventions included anterior chamber reformation with cohesive viscoelastic and subsequent interventions due to recurrent shallowing. Silicone oil removal and localized zonulectomy during a follow-up visit successfully restored and maintained the anterior chamber for five months. This case underscores the efficacy of tailored surgical approaches in managing recurrent malignant glaucoma in complex scenarios.

Dry age-related macular degeneration with unilateral geographic atrophy

2024-10-17T05:37:50+00:00

An advanced form of age-related macular degeneration (AMD) known as geographic atrophy (GA) is typified by atrophic lesions that begin in the outer retina and gradually enlarge, ultimately resulting in irreversible visual loss. We present the case of a 55-year-old male healthy patient who had dry AMD in one eye and unilateral geographic atrophy in the other eye. Clinical examination, optical coherence tomography (OCT), and OCT angiography were used to confirm the diagnosis. Growing older and family history are the two main risk factors for GA. Geographic atrophy can be prevented by managing modifiable risk factors such as smoking, controlling systemic disorders, and maintaining a balanced diet.