Suprachoroidal Versus Intravitreal Injection of Triamcinolone Acetonide As Primary Treatment For Diabetic Macular Edema

Abstract Objective: This study aims to evaluate and compare the effects of suprachoroidal and intravitreal triamcinolone administration, as a primary treatment, on best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) in patients with diabetic macular edema (DME). Methods: A quasi-experimental study was conducted from November 2022 to April 2023. 64 eyes were enrolled with Inclusion criteria comprising patients with diabetic macular edema (DME) (central involving) with BCVA < 6/9, CMT > 300 µm on optical coherence tomography (OCT), and no prior DME treatment. Patients were divided into suprachoroidal triamcinolone (SCTA) (Group I) and intravitreal triamcinolone (IVTA) (Group II) groups. Follow-up occurred at 1 week, 1 month, and 3 months post-injection. BCVA, CMT, and IOP were recorded. Data were analyzed using SPSS with a significance threshold of p < 0.05. Results: Both treatment groups exhibited improved BCVA and reduced CMT. Suprachoroidal delivery demonstrated more substantial visual acuity improvements compared to the intravitreal group. Reduction in IOP was observed in the suprachoroidal group at 1stweek post-treatment (p<0.001), while the intravitreal group experienced increased IOP at later follow-ups (p<0.001). Conclusion: This study illuminates the efficacy of both suprachoroidal and intravitreal triamcinolone administration as the primary treatment for DME. While both modalities displayed promising outcomes, suprachoroidal delivery exhibited more substantial visual acuity improvements with fewer side effects and promising alternatives for DME treatment.

A high frequency divide-by-odd number CMOS LC injection-locked frequency divider

Numerous circuit topologies have been proposed for divide-by-ρ injection-locked frequency dividers (ILFDs), most of which have been optimized for division by even numbers, especially divide-by-2. It has been more difficult to realize division by odd numbers, such as divide-by-3. In this paper we present simulations of an RF CMOS ILFD that can operate equally well in both divide-by-2 and divide-by-3 modes. The ILFD is based on a cross-coupled CMOS LC oscillator with direct injection and an auxiliary injection path. The paper presents two variants of the circuit architecture and Cadence simulations in the multi-GHz frequency range using a standard TSMC 65 nm CMOS process design kit. © 2013 Springer Science+Business Media New York

A \u27divide-by-odd number\u27 direct injection CMOS LC injection-locked frequency divider

The use of resonant CMOS frequency dividers with direct injection in frequency synthesizers has increased in recent years due to their lower power consumption compared to conventional digital prescalers. Numerous circuit topologies have been proposed, most of which have been optimized for division by even numbers, especially divide-by-2. It has been more difficult to realize division by odd numbers, such as divide-by-3. This paper proposes a simple modification to a CMOS injection locked frequency divider (ILFD) with direct injection, which gives it a wide locking range both in the \u27divide-by-odd number\u27 mode and in the conventional \u27divide-by-even number\u27 regime, thereby opening up applications which require frequency division by an odd number. The paper presents the circuit architecture, SPICE simulations and experimental validation. © 2012 IEEE

Factors affecting the visual outcomes and central macular thickness in diabetic maculopathy after intravitreal bevacizumab

Objective: To assess the outcomes of intravitreal bevacizumab in patients of diabetic maculopathy by anatomical outcomes and best-corrected visual acuity, and to assess the prognostic factors that influence the efficacy of intravitreal bevacizumab. Method: The quasi-experimental study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, from January 2019 to January 2020, and comprised patients with diabetic maculopathy who were administered intravitreal bevacizumab on a monthly basis for three months with further injections administered on an as-needed basis in cases of persistent macular oedema or deterioration of best-corrected visual acuity. The assessment was done pre-injection, and three and six months after the injection. Outcome variables were best-corrected visual acuity and central macular thickness. Data was analysed using SPSS 22. Results: Of the 34 patients, 2(5.9%) were males and 32(94.1%) were females. The overall mean age was 58±10 years. Of the 55 eyes, 27(49.1%) were right and 28(50.9%) were left eyes. After 3 months, the best-corrected visual acuity improved by one line in 20(36.4%) eyes. At 6 months, it improved by one line in 25(45.4%) eyes. After 3 months, the central macular thickness of 48(87.2%) eyes improved anatomically. At 6 months, a further decrease in central macular thickness resulted in 50(90.9%) eyes. The best-corrected visual acuity at 6 months was inversely correlated with central macular thickness and disruption of inner segment/outer segment integrity. Conclusion: Intravitreal bevacizumab injection led to appreciable improvement in best-corrected visual acuity and central macular thickness at 6 months. Disruption of inner segment/outer segment integrity, presence of exudates and cystic changes were noted that lead to poor visual prognosis. Key Words: Intravitreal injection, Bevacizumab, Prognostic factors, Diabetic retinopathy, Optical coherence tomography

Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi

Objective: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. Methods: The is a prospective cohort study carried out from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital (FFH) Rawalpindi. A total of 65 eyes of 65 patients of corneal ulcer meeting the inclusion criteria were evaluated and corneal scrapes were sent for microbiological assessment.  Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity (BCVA), treatment and complications. Results: Out of 65 eyes of 65 patients, 40 (61.5%) were females and 25 (38.4%) were males. Most common local risk factor was ocular surgery (29.2%) followed by ocular trauma (23.1%). Diabetes was present in 44.6% of the cases. Culture results after corneal scrapings were positive for 39 (60%) of the total samples, while 26 (40%) had no growth. Bacterial growth was present in 51.3% of eyes, fungal in 28.2% while 20.5% of the eyes were infected with polymicrobial organisms. Most common pathogens were Pseudomonas (25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up period 40 cases (61.5%) showed improvement. Conclusion: This study concluded that isolated Pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are very much needed in developing countries to avoid blindness due to keratitis. Keywords: Infective keratitis, risk factors, corneal ulcer, culture sensitivity

Intra Ocular Pressure Change After Low Energy And High Energy Nd:Yag Laer Posterior Capsulotomy

  OBJECTIVE To determine the frequency of change in Intraocular Pressure (IOP) among patients undergoing YAG Laser Posterior Capsulotomy and to compare IOP change based on the level of YAG laser energy and number of shots applied. METHODOLOGY A descriptive cross-sectional study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital Rawalpindi, from December 2021 to November 2022. A total of 200 pseudophakic eyes with posterior capsular opacification were included in the study. Preliminary baseline intra-ocular pressure (IOP) was measured by Goldman Applanation Tonometry (GAT). Patients were divided into groups according to the laser energy utilized and the number of shots. IOP was measured after 1 and 4 hours post-procedure and results compared. RESULTS In the low energy group (mean energy 2.73 mJ), average IOP calculated was 14.86 and 12.97 mmHg after 1 and 4 hours of procedure respectively. While in the high energy group (mean energy 4.11mJ), it was 19.42 and 17.51 mmHg respectively. In group 1 (less than 20 shots), mean IOP 1 and 4 hours procedure was 13.88 and 12.97 mmHg respectively. In group 2 (greater than 20 shots) the mean IOP was 21.63 and 18.31 mmHg respectively. The rise in IOP was significantly higher for the higher laser energy and in the group with greater number of shots at both 1 and 4 hours (p=0.000). CONCLUSION In conclusion, we found that significant rise of IOP is noted when more energy and greater number of shots are utilized in YAG laser capsulotomy. &nbsp

ROLE OF INTRACAMERAL ANTIBIOTICS AS PROPHYLAXIS AGAINST INFECTION IN CATARACT SURGERY

ABSTRACT OBJECTIVE: This study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery. MATERIAL AND METHOD: This was a prospective interventional randomized study conducted in Ophthalmology department, Fauji Foundation Hospital, Rawalpindi, from June 2022 to November 2022.  A total of 90 eyes of 90 patients were selected after approval from ethics committee from the Institutional Review Board. Patients were divided into two groups – Group A, received one drop of 5% povidone-iodine 15 minutes before surgery and postoperative antibiotics eye drops 4 times per day for 10 days; group B received the same prophylaxis for endophthalmitis as group A, plus an IC injection of 0.05 mL of commercially available moxifloxacin hydrochloride at 5.45 mg/mL immediately after IOL implant. After intervention, both groups were followed up at one, seven, and thirty days post surgery. Patients were also observed for endophthalmitis. SPSS-26 was used for data analysis. RESULTS: The overall mean age in this study was 60.4 + 8.6. Most of the patients were female in both groups i.e. around 87%. None of the case of endophthalmitis found in either group. CONCLUSION: On the basis of our study findings, we conclude that the use of intracameral antibiotics should not be considered as “standard of care†in order to prevent the occurrence of endophthalmitis in cataract surgeries. KEY WORDS: Cataract surgery, endophthalmitis, intracameral antibiotic, moxifloxaci

Comparison of Effects of Preserved and Preservative Free Anti-Glaucoma Drugs in Causing Dry Eyes

Objective: The aim of this study was to assess the potential impact of antiglaucoma medication preservatives on ocular surface health and the subsequent development of dry eye symptoms. Methods: A non-randomized controlled trial study was conducted from March 2023 to June 2023.The study enrolled 32 patients, with 16 participants in each group. Patients meeting the inclusion criteria, including confirmed diagnosis of glaucoma and stable ocular health, were allocated to Group A(preserved medication) or Group B(preservative-free medication).Tear Film Break-Up Time(TBUT) and Schirmer's test were employed as objective indicators of tear film stability and tear production respectively. Measurements were recorded at baseline and after a 3-month duration of medication use. Results: At 1st visit, mean TBUT was 10.87 sec and mean Schirmer's test was 13.75 mm in group A while in group B it was 11.25 sec and 14.56 mm respectively. After 3 months of medication use, mean TBUT and mean Schirmer’s was 9.62 sec and 11.81 mm respectively in group A while in group B it was 10.18 sec and 13.18 mm respectively. The results showed that initial ocular status was similar in both groups however the decrease in values showed ocular surface deterioration. Notably group A demonstrated a more substantial decline in tear production compared to group B. Conclusion: This study underscores the importance of both preserved and preservative-free anti-glaucoma medications. Although both may potentially exacerbate dry eye symptoms to a greater extent, preservative-free anti-glaucoma may offer benefits in maintaining ocular surface health with long-term use

An LC CMOS injection-locked frequency divider for divide-by-two and divide-by-three operation

Numerous circuit topologies have been proposed for divide-by-m injection-locked frequency dividers (ILFDs), most of which have been optimized for division by even numbers, especially divide-by-2. It has been more difficult to realize division by odd numbers, such as divide-by-3. This paper describes a CMOS injection locked frequency divider (ILFD) that can operate equally well in both divide-by-two and divide-by-three modes. The ILFD is based on a cross-coupled CMOS LC-tank oscillator having capacitive and direct injection via both NMOS and PMOS transistors connected across the LC tank. The circuit is similar to a conventional CMOS ILFD for divide-by-two operation with direct injection, but it combines the effects of two independent injection techniques to maximize the width of its divide-by-three locking range. The paper presents the circuit architecture, SPICE simulations, and experimental measurements. © 2013 TU Dresden