Visually significant VAO is a common complication after pediatric cataractsurgery and can be amblyogenic, occurring in up to 71% of pediatric patients who receive primary PPC-AntVx and virtually 100% of pediatric patients who have the capsule left intact . This is consistent with our data in which 80% of the patients who had the capsule left intact required treatment for VAO within 2.5 years of the original cataractsurgery. In young children or patients who are developmentally delayed, PPC-AntVx is routinely performed due to a high risk of development of VAO soon after cataractsurgery ; in our study, this pro- cedure reduced the development of VAO from 80% to 40%. If possible, we pre- fer to manage VAO with Nd:YAG laser capsulotomy, but many of our patients required a surgical posterior capsulotomy with anterior vitrectomy due to deve- lopmental delay causing inability to cooperate or, even when cooperation was good, nystagmus causing eye movement during the procedure. Due to the risk of retinal re-detachment, collaboration with a retinal surgeon may be required to perform the surgical posterior capsulotomy.
Every effort was made to ensure that different providers did not unduly influence the outcome data. There is no difference in the number of laser spots placed between groups or with respect to the treated eye (Table 1). Fur- ther, there was no statistically significant difference found between providers in scheduled days versus actual elapsed days between examinations (Table 5), nor in the differ- ence in the median follow-up time between the two groups (Table 6). These criteria are important when com- paring patientstreated by three different surgeons at our institution in the prethreshold versus threshold treatment arms.
Aiello et al found that, following ICCE, patients with or without background retinopathy were at particularly high risk of developing vitreous haemorrhage, presumably reflecting progression of the disease to PDR. Alparl and Pollock et al observed deterioration of diabetic retinopathy in some diabetic patients following either ICCE or ECCE, with the least progression occurring in patients who underwent ECCE with IOL implantation in the capsular bag. Although clinical evidence suggests that ICCE may have a more deleterious effect than ECCE on the postoperative course of diabetic retinopathy, the precise role of the posterior lens capsule in reducing vascular complications after cataractsurgery in diabetic patients requires further investigation.
penetrating injury by thorn and two had bilateral congenital cataract. Preoperative vision varied from PL+ PR+ to 6/24. Seven patients showed good post-operative visual recovery in the range 6/18 to 6/9. One patient of long standing congenital cataract did not improve after surgery due to severe amblyopia. Out of seven patients, one patient had developed choroidal detachment on day one, however he recovered gradually by wait and watch method, while another patient had develop posterior capsule opacification after three month, so he was treated by Nd YAG capsulotomy and subsequently regained 6/9 vision.
It has been estimated that up to 20% of all cataractsurgery is .  Many such patients have pre- existing diabetic retinopathy (DR) at the time of cataractsurgery. Cataract in diabetes patients reduces their visual acuity (VA), renders adequate examination of the retina more difficult or sometimes impossible, and makes photocoagulation of DR more difficult. Therefore, it is important to perform cataractsurgery for visual rehabilitation. Studies have reported the progression of retinopathy after extra capsular cataract extraction (ECCE)  and suggested to delay ract surgery especially in patients with more advanced However, besides visual rehabilitation, a substantial percentage of diabetics require lens extraction to permit proper diagnosis and treatment of retinopathy. Earlier t extraction in diabetic patients, before macular oedema develops, may help stabilize retinopathy-associated macular
The present study concluded that diabetic patients regardless of the stage of diabetic retinopathy can expect improved visual outcome following cataractsurgery. This holds good for patients with advanced stages of diabetic retinopathy also. The present study population included 300 eyes that underwent cataractsurgery. None of the diabetics had proliferative diabetic retinopathy pre-operatively or clinically significant macular oedema at baseline. In our study, post-operative visual improvement was seen in 142 eyes (94.6%), remained stationary in 7 (4.5%) and worsened in 1(0.6%) patient among diabetics whereas visual acuity improved in 138 (92%), remained stationary in 12 (8%) among non-diabetics. Pre-operative visual acuity was directly proportional and diabetic retinopathy stage was inversely proportional to post-operative visual outcomes. The present study indicated that good visual acuity could be expected after cataractsurgery in patients with good pre-operative visual acuity and early stages of diabetic retinopathy.
use of nepafenac in diabetic patients, the potential for cor- neal problems was considered a safety concern. Therefore, eligible patients could not have had significant corneal stain- ing scores at baseline and must not have had histories of dry eye syndrome. Patients were also excluded for other condi- tions that may have caused macular edema, including pre- existing histories of retinal vein occlusions, ocular surgeries, inflammatory eye diseases, ocular infections, congenital ocular anomalies, and ocular traumas. Further, to ensure that patients entering the study did not have pre-existing macular edema, a reading center (Duke Reading Center, Durham, NC) performed an expedited review of optical coherence tomography (OCT) images collected at screening from each patient to confirm, prior to randomization, that the patient had a central subfield macular thickness less than 250 microns. The purpose of this review was also to identify and exclude patients who had baseline cysts, and the presence of macular traction and epiretinal membranes, which would confound retinal thickness measurements. Finally, patients were pro- hibited from using concomitant medications such as topical or systemic NSAIDs and steroids, which might have interfered with the assessment of the study outcome measures.
At present, in Vietnam, advances in neonatology allow survival of children with extremely low gestational age and weight at birth, leading to an increase in the number of patients with ROP. Refractive error is a known complication of ROP and its treatment, and is a common cause of vision impairment in children. It is also treatable. Therefore, we initiated this study to evaluate the refraction of eyes treated with diode laser photocoagulation for prethreshold ROP at a mean of 5 years after treatment.
In cases of XFG or PACG, the evidence suggests that it is preferable in most cases to perform cataractsurgery first as, as has been shown in the section above. In many cases this will reduce IOP sufficiently so that glaucoma surgery is not necessary. In cases of PACG, the main cause for the high IOP is postulated to be obstruction of aqueous outflow due to a crowded anterior chamber. Taking out the cataract (or even the clear lens) will reduce this crowding and hence addresses the (probable) cause for the high IOP (32). When cataractsurgery is performed, the surgeon should avoid making conjunctival incisions (e.g. sub-tenon’s anaesthesia) as this has been shown to increase subsequent trabeculectomy failure due to ‘priming’ of fibroblasts (39). This priming is thought to occur even if the conjunctival incisions are made away from the site of the subsequent trabeculectomy surgery. There are good clinical data also to support this idea. In a study from 1991, 66 subjects that had trabeculectomy were examined and risk factors for failure were entered into a multiple regression model. Formerconjunctival incisional surgery was associated with failure at 3 years (40). A later study by Broadway and Hitchings found success at 6 years after trabeculectomy was 93% in a control group versus 38% in a group that had had previous conjunctival incisional surgery (p<0.001) (41). Histological examination of the conjunctiva from the latter group found a significantly higher proportion of fibroblasts. Fontana et al. published two separate papers in 2006, which, if compared, have interesting findings. The first paper was a retrospective analysis of 89 eyes with open angle glaucoma which had had previous cataractsurgery and then had trabeculectomy with MMC (42). The second paper was similar in design, but these subjects (292 eyes) had not had previous cataractsurgery (43). Success based on IOP at 3 years was higher in the group that had trabeculectomy in phakic eyes. It should be
Diabetic ophthalmoplegia is a complication of diabetic mellitus. The purpose of this study was to examine the clinical characteristics and severity of retinopathy in diabetic patients with cranial nerve (CN) 3,4 and or 6 palsies involvement. This descriptive study included 96 patients with diabetic ophthalmoplegia who were treated in Matini hospital of Kashan, Iran during the years 2004-2012. Demographic and clinical data including type of DM, stage of diabetic retinopathy, involved cranial nerve, and duration of resolution were examined. Statistical analysis was performed by SPSS 16.0 Software. The result showed that 96 patients 54(56%) were male and 42 (44%) were female. The frequency of 6th nerve involvement was 50(52%), 3 rd nerve 41(43%) , and 4 th nerve 5(5.2%).
A 90-year-old woman was diagnosed with bilateral cata- ract and keratoconus that was previously unknown. The astigmatism was regular (Figure 1) and the patient used to wearing progressive eye glasses. Nine months before surgery, the patient had a retinal arterial occlusion in the right eye. Preoperatively, pseudoexfoliations were noticed in the right eye. Both eyes were planned for cataractsurgery with toric IOLs, but after surgery was performed in the right eye the patient declined further surgery of the left eye. The BCVA increased from 20/50 to 20/40 and the astigmatism (cylinder measure from autorefractor) decreased from –6.12 to –3.75 D. The patient developed posterior capsular opacification after 2 months and was treated with Nd:YAG laser capsulotomy.
including total or subtotal retinal detachment, or macular trac- tion fold capable of reducing best visual acuity to less than 20/200). The current and future examination (and treatment) guidelines are, I think, properly based on the likelihood of cicatrization of the retina and poor visual outcomes, not di- rectly on examination findings of proliferative ROP, which are more likely than not to subsequently regress, as in the cases cited; ie, we are looking to screen enough infants to capture all the likely progressors, recognizing that there may always be outliers in any statistically based guideline. We feel that the bad outcome outliers to these guidelines will be very rare. 4. Although the current and future guidelines do include provi-
I also declare that this bonafide work / a part of this work was not submitted by me / anyone else, for any award, for Degree / Diploma to any other University / Board either in India / abroad. This is submitted to The Tamilnadu Dr. M. G. R. Medical University, Chennai in partial fulfilment of the rules and regulations for the award of Master of Surgery degree Branch -III (Ophthalmology) to be held in May 2019.
abstract Retinopathy of prematurity (ROP) remains a signi ﬁ cant threat to vision for extremely premature infants despite the availability of therapeutic modalities capable, in most cases, of managing this disorder. It has been shown in many controlled trials that application of therapies at the appropriate time is essential to successful outcomes in premature infants affected by ROP. Bedside binocular indirect ophthalmoscopy has been the standard technique for diagnosis and monitoring of ROP in these patients. However, implementation of routine use of this screening method for at-risk premature infants has presented challenges within our existing care systems, including relative local scarcity of quali ﬁ ed ophthalmologist examiners in some locations and the remote location of some NICUs. Modern technology, including the development of wide-angle ocular digital fundus photography, coupled with the ability to send digital images electronically to remote locations, has led to the development of telemedicine-based remote digital fundus imaging (RDFI-TM) evaluation techniques. These techniques have the potential to allow the diagnosis and monitoring of ROP to occur in lieu of the necessity for some repeated on-site examinations in NICUs. This report reviews the currently available literature on RDFI-TM evaluations for ROP and outlines pertinent practical and risk management considerations that should be used when including RDFI-TM in any new or existing ROP care structure.
Methods: The quality of life (QoL) evaluation was undertaken using the Italian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Results: The overall QoL, assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, was better in patientstreated with MSCL than in those treated with SCL. The better QoL correlates with the highest response scores to the questions on the relative global functioning scales in patientstreated with MSCL.
Abstract: Vascular endothelial growth factor (VEGF) contributes to the development of retinopathy of prematurity (ROP). We investigated the association of ROP with VEGF genetic polymorphisms and its clinical parameters in Japanese people. Sixty-seven infants with a gestational age of 30 weeks or less were enrolled and classified into the threshold ROP group (infants with Stage 3 ROP in zone I or II, five continuous or eight total clock hours of the retina and the presence of plus disease, n = 30) and the nonthreshold ROP group (n = 37). The VEGF genotypes of −1498T.C, −1154G.A, −634C.G, −7C.T, 936C.T, and 1612G.A were determined. VEGF 936C.T polymorphism and 11 clinical parameters were significantly dif- ferent between the two ROP groups by univariate analysis. A logistic regression analysis with adjustments for gestational age and birth weight showed that the heterozygous or homozygous carrier state of the T alleles of VEGF 936C.T polymorphism (odds ratio 5.12; 95% confidence interval: 1.25–20.92; P = 0.023) and duration of oxygen administration (odds ratio 1.05; 95% confidence interval: 1.00–1.10; P = 0.042) were independent risk factors of threshold ROP. VEGF 936C.T polymorphism may predict threshold ROP in Japanese infants with a gestational age of 30 weeks or less.
uted to IVNV. To knock down Müller cell-derived VEGF, a lentivector with Müller cell-specific promoter CD44 (pFmCD44.1GW) was used to deliver a short hairpin RNA (shRNA) targeting rat VEGF (VEGFA) (Lenti-CD44-VEGFA shRNA). The shRNA was embedded in a microRNA30 context, which allowed shRNA to be expressed in specific cells. Lentivirus was delivered by subretinal injections at p8. Compared with control lentivector, which expressed a shRNA to luciferase (Lenti-CD44-luciferase shRNA), Lenti- CD44-VEGFA shRNA reduced retinal VEGF protein to the levels in retinas of room air raised pups at p18 and inhibited VEGFR2 activation in retinal vascular endothelial cells. Compared with control lentivector, IVNV was significantly reduced at p18 in retinas of VEGFA shRNA-treated pups. At p25, VEGFA shRNA-treated pups did not show increased IVNV. Another study evaluated the effect of anti-VEGF antibody and Lenti-CD44-VEGFA shRNA on physiological retinal vascularization. 39 Intravitreal injection of rat VEGF
online (at www.sph.uth.tmc.edu/rmrop/Riskcalc/disclaimer. aspx). If high-risk prethreshold ROP was observed in 1 or both eyes and was confirmed by a second examiner, then the infant was eligible for entry into the randomized trial. Infants with bilateral, high-risk, prethreshold disease had 1 eye randomized to treatment within 48 hours, whereas the fellow eye received conventional management, with examinations occurring at intervals of ⱕ1 week and with treatment if threshold ROP was diagnosed. Infants with high-risk prethreshold ROP in only 1 eye had that eye randomized to treatment within 48 hours or to conventional management. The fellow eye was not included in the study and was treated conven- tionally (eg, treated at the conventional threshold, if ROP pro- gressed to this point). Infants with low-risk prethreshold ROP were examined at least every 4 days for at least 2 weeks (total of 5 examinations). If ROP did not progress to high-risk prethreshold or threshold ROP, then infants were monitored at the physician’s discretion but at least once per week as long as prethreshold ROP persisted.
Posterior capsular opacification was seen in 19(24.05%)eyes. The incidence of PCO is relatively less due to adoption of procedures like primary posterior capsulotomy and anterior vitrectomy. This is supported by the retrospective study by DD Koch and T Kohnen in Trans American Ophthalmol Society 1997, 95:351-365, in which the effect of performing cataractsurgery with and without posterior capsulotomy and with anterior vitrectomy was compared. It was found that performing posterior capsulotomy with anterior vitrectomy was the only effective method of preventing or delaying the development of PCO.
have been an advantage in this study as it is likely to be representative in terms of volume of cataractsurgery performed at the hospital, CEITC. The number of cataract operations was seen to be higher in patients with an age range from 60 to 90. Studies from other developing countries also reported a similar age range to this study (Lundström et al., 2013; Olawoye et al., 2011; Thapa et al., 2011). Cataractsurgery rate was found to be greater in female patients than male patients, which was also evidenced in several studies (Yuan et al., 2015). It has been reported that women have slightly increased the age-adjusted risk for cataract (Olawoye et al., 2011) while another study claim that longer life expectancy of the female is the reason for this higher prevalence of cataractsurgery (Marmamula et al., 2016). This study has shown that a small number of patients had received a formal education, although it is not surprising for this age group when considering the educational context of Bangladesh and other developing countries where elderly is less educated.