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, χ^2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ^2: 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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Purpose: The purpose of this study is to describe the incidence and features of macular abnormalities in high myopic eyes detected by optical coherence tomography (OCT). Patients and Methods: This was a prospective observational study that involved 100 eyes of 100 patients with high myopia complaining of recent diminution of vision. OCT examination was done through dilated pupils, OCT examination was done through a dilated pupil using commercially available Cirrus HD-OCT Model 4000 - Carl Zeiss Meditec, Inc., Dublin, California, USA or Spectralis OCT Heidelberg Engineering, Heidelberg, Germany. Results: A total of 100 eyes of 100 patients were studied. There were 45 males and 55 females. The mean age of the patients was 52.9 ± 12.9 (range: 33-70) years. Mean spherical equivalent in these eyes was 14.5 ± 5.8 (range: 8.75-22.75) diopters. Epiretinal membrane was present in 65 eyes. Vitreomacular traction (anteroposterior traction) was detected in 10 eyes. Macular retinoschisis was present in 33 eyes. Conclusion: Macular changes detected by OCT are common pathological findings in high myopia.

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Aims: To review the literature on Screening for Diabetic Retinopathy. Materials and Methods: A comprehensive review of the English language literature, published from March 1980 to June 2014 using key words in Zetoc. Results: Several methods were found to achieve adequate sensitivities and specificities for diabetic retinopathy screening. Studies were compared with respect to (a) Classifications used to grade diabetic retinopathy (b) The evidence for population-based screening for diabetic retinopathy (c) Alternatives to digital photography for screening (d) Reference standards used to study the effectiveness of screening methods (e) The evidence for mydriatic versus non-mydriatic digital photography, or a combination of the two (f) The number of photographic fields captured (g) Measurement of distance visual acuity (h)  Cost-effectiveness of screening for diabetic retinopathy (i) Future developments in screening for diabetic retinopathy Conclusion: Based on an assessment of available studies, the most effective DR screening strategy is the use of mydriatic or staged mydriasis with digital retinal photography. Variables between different screening strategies include whether Visual Acuity is measured and the number of fields captured.

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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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Aim: Cirrus spectral-domain optical coherence tomography (SD-OCT) being noninvasive is gaining more popularity in identifying, monitoring, and classifying children with vitreo-retinal disorder. Normal values of cirrus SD-OCT from children are currently available from developed countries, but not from India. Objective: The primary objective of this study is to provide a normative pediatric database for macular thickness in healthy Indian children using the cirrus SD-OCT. Materials and Methods: The prospective observational study on 157 consecutive healthy children seen between January 2013 and January 2014. Included in the study were 157 subjects with no ocular abnormality, normal (20/20) visual acuity and normal fundoscopy. Cirrus HD-OCT (Carl Zeiss, Dublin, California, USA) device was used. Outcome: Study patients have a mean age of 12.59 ± 3.5 years, with 112 male (12.88 ± 3.5 years) and 45 female (11.8612.88 ± 3.5 years) children. In the linear regression analysis, changes in central subfield thickness and field of the outer macula were independently affected by increase in the age (β = −1.17-1.7, P = 0.004-0.022) and male are found to have significantly higher value when compared with the female (the t-test; t = 1.9-4.8, P = 0.00-0.24). Conclusion: This study established normal reference values for macular parameters measured by Cirrus SD-OCT in healthy Indian children 6-17 years of age, which is statistically different from the databases from other countries. It establishes the importance of the fact that age and gender warrants special consideration during cirrus SD-OCT interpretations in children.

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Vogt–Koyanagi–Harada syndrome is an inflammatory multisystem disorder with ocular, cutaneous and neurological manifestations occurring more commonly in certain dark-skinned ethnic groups such as Asians, patients of Middle-Eastern heritage, and hispanics. Only a few reports have described a masquerade presentation of acute angle closure as an initial manifestation for this uveitic entity, which is typically characterized by panuveitis with serous retinal detachments. This has almost always led to misdiagnosis, unwarranted surgical interventions, and a delay of appropriate timely therapy. In this report, we describe an unusual case of acute unilateral Harada disease presenting as acute angle-closure glaucoma that has remitted following institution of appropriate therapy.

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A 19-year-old primigravida admitted in eclampsia ward noticed sudden loss vision in both the eyes. On the same day, she underwent emergency cesarean section due to her deteriorating systemic condition. After her general condition improved, loss of vision in both the eyes continued. On ocular examination, she had bilateral central retinal artery occlusion (CRAO). This is the second case of bilateral CRAO in eclampsia reported in the English literature till date. In our case, the hematological changes occurring in pregnancy and pregnancy-induced hypertension could have caused CRAO in both the eyes.

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Background: Trauma to eye can cause severe and permanent visual impairment. In some instances there may be vitreous hemorrhage, choroidal hemorrhage, globe rupture and traumatic optic neuropathy. Spectral domain optical coherence tomography (SD-OCT) is a quick, sensitive, non-invasive device that provides high-resolution images of the circumpapillary retinal nerve fiber layer (cp RNFL), yielding reproducible and reliable measurements. Aims and Objectives: TO study visual functions (BCVA, CV, CS) and retinal nerve fiber layer thickness by SD-OCT. Materials and Methods: This was a prospective observational study on 108 patients, performed from Sept 2016 to July 2017. RTA patients with visual loss/visual complaints between ages of 18 – 60 years included. Log Mar BCVA, Colour vision and contrast were noted. RNFL analysis was done by SD-OCT. Results: The mean age was 28.33± 8.70 yrs, There were 19 (17.6%) female, 89(82.4%) male in case group. At first visit, there were significant difference between BCVA, CV and CS between right and left eyes of cases and controls. Significant difference were seen in mean RNFL in right and left eye of cases and control. After follow up,insignificant change in BCVA and CV in both right and left eye. Significant change in CS in both right and left eye. Mean change in RNFL thickness was insignificant. Conclusion: Decrease in visual function occurs following RTA. Also, RNFL thinning occurs which remains persistently thin thereafter.

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Context: Diabetic macular ischemia affects visual function to a variable degree. Aims: This study aims to find whether parameters of ischemia measured on optical coherence tomography angiography (OCTA) correlate with best spectacle-corrected visual acuity (BCVA). Settings and Design: A cross-sectional study was done on 33 eyes with diabetic retinopathy (DR) and 11 nondiabetic control eyes. Subjects and Methods: A 3 mm × 3 mm OCTA images of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and full-thickness retinal slabs were obtained and used to measure foveal avascular zone (FAZ) area and circularity index (CI) manually. Statistical Analysis Used: Statistical comparison between the diabetic and control groups and correlation with BCVA was calculated. Results: CI was significantly higher in controls in each of the SCP (P > 0.001), ICP (P > 0.05), DCP (P = 0.005), and full retinal thickness (P < 0.05) slabs. Compared to the moderate nonproliferative DR group, the control group had a smaller FAZ (P = 0.04) and higher CI (P = 0.01) in the DCP slab. Neither the FAZ area nor the CI was significantly correlated with BCVA in any of the slabs. Conclusions: OCTA can detect a measurable degree of ischemia in diabetic eyes compared to controls. CI is the most sensitive parameter for this purpose. The DCP shows the earliest affection with increasing grades of DR. FAZ area and CI are not good indicators of VA.

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Aim of Study: The aim of the study was to compare the level of tumor necrosis factor (TNF)-α in vitreous samples of naïve wet age-related macular degeneration (AMD) patients and normal individuals, in an attempt to evaluate its role in the disease development. Materials and Methods: A prospective case–controlled study was conducted on 50 eyes –25 naïve wet AMD eyes as “Cases” and 25 eyes without AMD as “Controls.” Vitreous samples were collected by manual aspiration using a 25G needle attached to a 3 ml syringe directed toward the mid-vitreous cavity. The samples were collected, frozen, and stored at − 20°C. The level of TNF-α was assessed using enzyme-linked immunosorbent assay kits. Results: Vitreous TNF-α level was higher in naive wet AMD patients (4.07 ± 0.93 [2.80–6.60] pg/ml; mean ± standard deviation [minimum–maximum]) than patients without AMD (3.54 ± 0.60 [2.60–5.00] pg/ml; P = 0.019). There was no significant difference in vitreous TNF-α level between different choroidal neovascularization subtypes among studied patients (P = 0.460). Conclusion: The levels of TNF-α were shown to be significantly higher in vitreous samples of patients with naïve wet AMD as compared to normal individuals. These results may shed light on the role of TNF-α in the pathogenesis of wet AMD.

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Background: Myopia is one of the common refractive error. Optical Coherence Tomography Angiography (OCTA) is a non-invasive investigation of microvasculature of the retina. Aim: To evaluate the OCTA study of the FAZ area and vascular density (VD) at superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in myopic patients versus healthy controls and their correlations to axial length (AL), best corrected visual acuity (BCVA) and spherical equivalent (SE). Setting and Design: Prospective cross-sectional comparative study. Methods and material 75 eyes of 54 patients, group A are 50 eyes with high myopia and group B are 25 eyes of age matched healthy controls. OCTA images were obtained, analyzed and compared using SPSS v.12 in both groups. Results: Foveal thickness was significantly increased in the myopic group (259.7±23.9) P=0.025, while the paravfoveal thickness was decreased (305.9±18.5) P < 0.001. Both superficial and deep FAZ area were increased in group A. The foveal VD at SCP was significantly higher in Group A (30.3±5.2) P=0.006. The whole image DCP VD was significantly lower (44.5±5.4) P < 0.001. Regarding CC, there was a significant difference in both foveal and parafoveal VD (66.1±4.9) (66.5±4.6) P=0.006 and 0.017, respectively, with both being higher in group A. The study also showed the importance of the CD at DCP and CC being negatively correlated with LogMAR BCVA and positively with the SE, while foveal thickness was positively correlated with the AL. Conclusion: OCTA is a valid and fast technique that could give insights about microvascular changes in myopia.

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Aim: The aim of this study is to estimate the prevalence of albuminuria in type II diabetes mellitus and report its influence, as a risk factor, for the presence and severity of diabetic retinopathy (DR). Subjects and Methods: During the period of January 2012 to May 2013, 420 type II diabetic patients were examined. Albuminuria adjusted for creatinine concentration was measured. Body mass index and hemoglobin A1c were also measured. Patients were evaluated by direct and indirect ophthalmoscopy and were classified as non-retinopathy, non-proliferative, proliferative or diabetic maculopathy. Results: The prevalence of albuminuria among type II diabetic patients in this study was 40.2%. The prevalence of microalbuminuria and macroalbuminuria were 30.7% and 9.5% respectively. The study also showed an association between the degree of albuminuria and severity of retinopathy. Nearly 97.5% of the macroalbuminuric patients had sight threatening forms of retinopathy (proliferative diabetic retinopathy + diabetic maculopathy DM) compared with 87%of the microalbuminuric and only 15% of the normoalbuninuric patients. Conclusion: Micro- or macroalbuminuria are highly prevalent in subjects with type II diabetes. Subjects with micro- and macroalbuminuria are more likely to have DR compared with those without albuminuria.

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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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Objective: To compare the results of silicone oil removal (SOR) 2 months after vitrectomy for retinal detachment with delayed removal for 6 months or more. Study: Prospective and retrospective study. Patients and Methods: A total of 32 patients (32 eyes) in the prospective series of early SOR and 19 patients (22 eyes) in the retrospective series of late removal. The two groups were compared as to the condition of the eye at the time of SOR and 6 months following SOR. Results: Patient compliance with the scheduled time for SOR was more in the early removal series. The outcome was comparable in the two groups as to the risk of retinal re-detachment, while cataract, increased intraocular pressure, oil emulsification, keratopathy, and anterior segment inflammation were more frequently encountered at the time of removal in the late removal series, particularly when it was delayed beyond 6 months. Conclusion: A protocol of early removal of silicone oil after 2 months did not increase the risk of re-detachment, and ensured a better compliance of the time of removal. It can be particularly recommended when patients are less likely to comply with a protocol for delayed removal.

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Aims: Our aim is to evaluate the use of BIOM-3 (Oculus, Germany) and 27-gauge Eckardt twin-light chandelier endoillumination (DORC, Netherland) as an alternative to indirect ophthalmoscope. Settings and Design: A prospective, interventional case series study was conducted in T.E.H. (Private Practice), Assiut, Egypt. Subjects and Methods: Twenty patients (Twenty eyes) complaining of primary rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy ≤ Grade B from January 2013 to April 2014. All patients underwent 27-gauge twin-light chandelier endoillumination for retinal break localization. Break localization was followed by cryopexy (Cryomatic Cryo Console, Keeler Ltd., UK) and standard scleral buckling under surgical microscope. Anatomical and functional outcomes were evaluated at the end of 6 months. Results: Anatomical success (attachment of retina) was achieved in 18 (90%) of twenty eyes. All these eyes remained attached at the end of 6 months. Significant improvement in mean best-corrected visual acuity was achieved at the end of 6 months follow-up 0.05 ± 0.46 preoperatively compared with 0.5 ± 0.14 postoperatively (P = 0.023). Conclusion: Twin-light-assisted scleral buckling for primary RRD is a better alternative to classic surgery with indirect ophthalmoscope.

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Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Materials and Methods: Retrospective analysis of fifty eyes of fifty patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2014 to August 2015. Results: Primary retinal reattachment rate of 41 patients was achieved with single surgery, but final anatomical success was 94% with additional pars plana vitrectomy with silicone oil injection and with vitrectomy with epiretinal membrane removal. The mean follow-up was 6 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

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Context: An objective and quantitative analysis of the normal choroid and retina relation is required for a better understanding of changes that occur in retinal and choroidal diseases. Aims: This study aimed to evaluate choroidal thickness (CT) and corresponding retinal thickness (RT) using enhanced depth imaging mode of spectral-domain optical coherence tomography (SD-OCT) in normal emmetropic eyes. Methods: One hundred and six eyes of healthy, nearly emmetropic eyes of volunteers were examined by Spectralis OCT. Manual measurements of CT were done under the fovea and on the vertical and horizontal line scans at the ETDRS 1 and 3 mm circles. RT was measured in the center foveal subfield and at the same locations of CT measurements. Statistical Analysis Used: Data were analyzed using IBM SPSS software package version 20.0 (SPSS, Inc., Chicago, IL, USA). Results: With a mean age of 50.3 ± 16.5 years, the mean subfoveal choroidal thickness (SCT) was 297.5 ± 86.2 μ while the mean central RT was 264.3 ± 15.9 μ. The mean CT was thinnest at the nasal location but without statistical significance and SCT was higher in males than females. Significant and correlated age-related thinning was observed in both retina and choroid at all locations, except the fovea, where these changes were significant but not correlated. Conclusions: CT has an age-related thinning pattern that correlates with age-related retinal thinning in extrafoveal macular locations. In addition, age can be used as a guide in predicting the normal SCT in emmetropes.

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Purpose: To measure erythropoietin (EPO) level in vitreous and serum of patients with proliferative diabetic retinopathy (PDR) and to detect EPO single nucleotide polymorphism (SNP) genotyping expression in them. Materials and Methods: Concentrations of EPO in vitreous and serum of twenty diabetic patients with PDR undergoing vitrectomy (PDR group) were measured by chemiluminescent immunoassay and compared with those in nondiabetic (ND) patients undergoing vitrectomy for recent retinal detachment (ND group). Genotyping of EPO gene SNP (rs551238) was performed using real-time polymerase chain reaction technique. Results: There were a significant increase in serum EPO level in PDR group than in ND group and a highly significant increase in vitreous EPO level in PDR group than in ND group. Within the PDR group, vitreous EPO level was significantly higher than its serum level; there was up to 6-fold increase in the EPO vitreous level than its serum level. EPO gene SNP rs551238 was significantly associated with PDR in Egyptian patients. Conclusion: The results of the current study suggest the involvement of EPO in the pathogenesis of PDR. Hence, augmenting vascular endothelial growth factor inhibition with the use of EPO inhibitors may provide a better outcome in PDR treatment. The detection of EPO gene SNP rs551238 in Egyptian patients with PDR may help in the identification of the genetic predisposition to diabetic retinopathy in Egyptians and so may help in prevention and early detection of susceptible candidates to PDR.

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Aim of the Study: This study aims to evaluate the thickness of the macula in patients with diabetes but without diabetic macular edema (DME) using optical coherence tomography (OCT) and compare these findings with measurements from normal controls which may be useful for early detection of macular thickening. Patients and Methods: Two hundred subjects were included and divided into 4 equal groups: normal controls, diabetics without diabetic retinopathy (DR), diabetics with NPDR and without DME, and diabetics with PDR and without DME. Full ophthalmological evaluation was done and the fast macular OCT scan was done that divides the macula into 9 sectors. The mean ± standard deviation of macular thicknesses by area were analyzed and compared. Results: A central subfield (CS) was statistically significantly thicker in normal controls compared to diabetics with no DR with no significant difference in other sectors. Furthermore, all of the inner sectors (IS, IN, IT, II) and the ON sector were significantly thicker in normal compared to diabetics with nonproliferative DR (NPDR) group with no significant difference in other sectors. Furthermore, between all sectors except IS and IT on comparing normal versus diabetics with PDR, between nasal sectors (IN and ON) but not in other sectors on comparing diabetics with no DR versus diabetics with NPDR, between all sectors except IS on comparing diabetics with no DR versus diabetics with PDR, and between all sectors on comparing diabetics with NPDR versus diabetics with PDR. Conclusion: This study found that the fovea and perifoveal subfields of the ETDRS grid tended to be thinner in diabetics without DR than in healthy controls and still thinner in eyes with DR, but thicker in eyes with PDR than in healthy controls thus confirming that the loss of neural tissue begins in the early stages of diabetes. As diabetes develops, neurodegeneration may be masked by changes in vascular permeability that cause thickening of the retinal layers.

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Current gold standard treatment for proliferative diabetic retinopathy (PDR) is panretinal photocoagulation (PRP) aimed at reducing the drive for new vessel proliferation. The focus is now changing to include the use of anti-vascular endothelial growth factor (VEGF) agents in conjunction with the gold standard in order to improve efficacy and reduce known side-effects associated with PRP, thus providing better outcomes for this group of advanced retinopathy. This paper aims to summarize our current knowledge behind the development of PDR, with review of treatment with anti-VEGF agents. Systematic search of both PubMed and the Cochrane Central Register of Controlled Trials was performed to identify relevant articles. Only articles in the English-language were selected for review. The use of anti-VEGF agents in conjunction with PRP has been shown to be beneficial in the regression of new vessels, reduction of macular edema as well as reduced duration of vitreous hemorrhage. In addition, its use during surgical intervention for PDR can reduce the duration of surgery and early postoperative complications. Despite the lack of large randomized controlled trials in this area there is significant evidence from case series showing the beneficial as well as the adverse effects of this treatment modality. The need for a large randomized controlled trial is an important development for diabetic retinopathy management.

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Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. Cataract surgery in diabetic patients may result in poor visual outcomes due to the progression of diabetic retinopathy and accelerated development of diabetic macular edema. Researchers and surgeons are interested in learning whether patients with diabetes have increased risks for complications from cataract surgery. In this review, I will evaluate the current management of the adverse events that may occur due to cataract surgery in diabetic patients.

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