Vitreo</b>-<b>retinal interface changes on optical coherence tomography in the fellow eyes of patients with macular hole

AIM: To study the vitreo-retinal interface and macular changes on optical coherence tomography (OCT) in the fellow eyes of patients with macular hole.METHODS: Patients with idiopathic macular hole in one or both eyes presented to our institute between January 2003 and December 2009 were evaluated retrospectively. Demographic details, best-corrected visual acuity and vitreo-retinal interface, and macular changes of the fellow eye on OCT were studied.RESULTS: Seventy patients underwent OCT of both eyes during the study period. The average age group was 61.96 years and 35 (50%) were females. Among the fellow eyes, normal foveal contour was noted in 36 (51.4%) eyes and 34 (48.6%) eyes were observed to have vitreo-retinal interface changes. Of them, 13 (18.6%) eyes had some stage of full thickness macular hole and 21 (30.0%) eyes had interface changes. There was no statistical correlation between involved eye lesions (P=0.64) or visual acuity (P=0.55) as predictors of development of either fellow eye lesions or poor visual acuity.CONCLUSION:There is a significant chance of having vitreo-retinal interface findings in the fellow eyes of patients presenting with macular hole. OCT should be considered in both eyes of patients with macular hole to detect early changes in the fellow eyes, which may require an early intervention

The Involvement of Complement Factor B and Complement Component C2 in an Indian Cohort with Age-Related Macular Degeneration

PURPOSE. Genes involved in the complement cascade such as complement factor B (CFB) and complement component C2 have been implicated in age-related macular degeneration (AMD) worldwide. In continuation of the analysis of CFH and LOC387715/HTRA1, this study was conducted to gain understanding of the role of CFB and C2 in an Indian AMD cohort. METHODS. Single nucleotide polymorphisms in CFB and C2 were screened in a cohort of clinically well-characterized patients with AMD (n ϭ 177) and unaffected normal control subjects (n ϭ 175). Screening was accomplished by a combination of customized genotyping followed by validation through resequencing. In addition, genotyping of two CFB variants (rs12614 and rs641153) that were in close proximity had to be resolved by resequencing. Estimates of allele and genotype frequencies, odds ratios, Hardy-Weinberg equilibrium, linkage disequilibrium (LD), and haplotype frequencies were also performed. RESULTS. Three SNPs in C2 (rs547154 [IVS10] ; P ϭ 5.4 ϫ 10 Ϫ11 ) and CFB (rs641153 [R32Q], P ϭ 2.2 ϫ 10 Ϫ7 and rs2072633 [IVS17]; P ϭ 2.0 ϫ 10 Ϫ4 ) were strongly associated with reduced risk of AMD. The rs547154 and rs641153 were in strong LD (DЈ ϭ 0.90, 95% CI ϭ 0.81-0.96) and a protective haplotype T-A was observed (OR ϭ 0.10, 95% CI ϭ 0.05-0.20). LD was moderate (DЈ ϭ 0.77, 95% CI ϭ 0.67-0.85) between the rs547154 and the rs2072633 SNPs, and the haplotype T-T generated with these SNPs was relatively less protective (OR ϭ 0.28, 95% CI ϭ 0.18 -0.44). CONCLUSIONS. The results of the present study provide an independent validation of the association of rs547154 (C2) and rs641153 (CFB) SNPs with reduced risk of AMD in an Indian cohort. (Invest Ophthalmol Vis Sci

Pneumatic retinopexy: principles and practice

Pneumatic retinopexy (PR) is an alternative to scleral buckling for the surgical repair of selected retinal detachments. A gas bubble is injected into the vitreous cavity, and the patient is positioned so that the bubble closes the retinal break (s), allowing absorption of the subretinal fluid. Cryotherapy or laser photocoagulation is applied around the retinal break(s) to form a permanent seal. The procedure can be done in an outpatient setting, and no incisions are required. A multicenter randomized controlled clinical trial has demonstrated that the anatomic success rate is comparable to scleral buckling, but the morbidity is significantly less with PR. If the macula was detached for less than two weeks, the visual results are significantly better with PR than with scleral buckling. Cataract surgery was required significantly more often following scleral buckling than following PR. Two independent reports have shown that an attempt with PR does not disadvantage the eye; such that the results of scleral buckling after failed PR are not significantly different than primary scleral buckling. A comprehensive review of the world literature on PR revealed 27 statistical series totaling 1,274 eyes. These combined series had a single-operation success rate of 80&#x0025;, and 98&#x0025; were cured with reoperations. Pneumatic retinopexy should be considered in cases without inferior or extensive retinal breaks and without significant proliferative vitreoretinopathy. The cost of buckling varies from 4 to 10 times that of PR

Clinical Study Case Control Analyses of Acute Endophthalmitis after Cataract Surgery in South India Associated with Technique, Patient Care, and Socioeconomic Status

properly cited. Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in-and ambulatory care surgeries, respectively, was close to statistical significance (P = 0.054). Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety

Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report.

PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 &#x002B;/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 &#x002B;/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6&#x0025;) of 15 eyes improved vision or retained preoperative vision, one (6.7&#x0025;) eye lost light perception and one (6.7&#x0025;) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7&#x0025;) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 &#x002B;/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG