A study of evaluation of various risk factors of retinal vein occlusion

Background:A study of various ocular & systemic risk factors in Retinal Vein Occulation (RVO) at tertiary eye care centre.Methods:A prospective study included 50 eyes of 50 patients, in period of September 2010 to August 2012. Inclusion criteria: 1. Age >25 years, 2. All newly diagnosed cases of vein occlusion. Exclusion criteria: 1. Age <25 years 2. All other ocular diseases causing significant visual impairment. A detailed history, ophthalmic & systemic examinations with all necessary investigations-as and when required were done.Results: In our study, RVOs were more common in males – 26 (52%) & in 56-65 years of age group - 16 (32%). BRVO (Branch Retinal Vein Occlusion)s were more common than CRVO (Central Retinal Vein Occlusion) - Nonischemic (26%) >Ischemic (24%). In risk factors - most common was hypertension - in 38 (76%) patients. Followed by descending order, hyperlipidemia 27 (54%) >diabetes mellitus 16 (32%) >tobacco 14 (28%) >hyper homocystinemia 4 (8%) >severe alcohol 2 (4%). The complications were more in ischemic than Nonischemic-CRVO >BRVO - they were macular edema 43 (86%) >neovascularization at iris - 14 (28%) >neovascularization at angle - 10 (20%) >neovascular glaucoma – 4 (8%). Conclusion:RVOs are more common with increasing age, in males & most common risk factor is hypertensive. Most common cause for vision loss is macular edema - ischemic >non-ischemic.

Managing the posterior polar cataract: An update

Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications have been suggested to enhance safety and reduce posterior capsule rupture rates in these polar cataracts. This review article tries to present the various techniques and strategies to published in literature to manage PPCs. It also discusses pearls for making surgery more reproducible and consistent, as well as the role of newer diagnostic and surgical technology based on the published literature on the subject

Comparison between Ringer′s lactate and balanced salt solution on postoperative outcomes after phacoemulsfication: A randomized clinical trial

Aim: To compare the effects of balanced salt solution (BSS) and Ringer′s lactate (RL) on corneal thickness, endothelial morphology, and postoperative anterior chamber inflammation in eyes undergoing phacoemulsification. Setting: Iladevi cataract and IOL research center, Ahmedabad, India. Materials and Methods: This prospective randomized study comprised 90 consecutive patients with age-related cataract who were randomly assigned to either Group 1 (n = 45) with BSS or Group 2 (n = 45) with RL. Observations made included measurement of central corneal thickness (CCT), presence of anterior chamber flare and cells, endothelial cell loss, and change in coefficient of variation (CV). Data was analyzed using Mann Whitney test and test of proportion. Results: Mean increase in CCT on postoperative Day 1 was 58µm and 97µm in Groups 1 and 2 respectively ( P = 0.01). Increase in CCT at one month was 10µm and 11µm in Groups 1 and 2 respectively ( P = 0.99); increase in CCT at three months was 3µm and 6µm in Groups 1 and 2 respectively ( P = 0.86). Number of eyes with flare grades in a range of 0 to 3 was statistically higher in Group 2 on postoperative Day 1 ( P = 0.004, 0.016, < 0.001, 0.047 for Grade 0, 1, 2 and 3 respectively). Number of eyes with cells of Grade 3 on first postoperative day was significantly higher in Group 2 as compared to Group 1 ( P = 0.004). Three months postoperatively, endothelial cell loss was 5.5% and 7.8% in Groups 1 and 2 ( P = 0.21) and change in CV was 3 and 5.4 in Groups 1 and 2 ( P = 0.20) respectively. Conclusion: BSS offers a significant advantage over RL in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification

Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab

Purpose. To determine the risk factors associated with sustained intraocular pressure (IOP) rise in patients enrolled in the treat and extend (T&E) protocol receiving aflibercept/ranibizumab therapy for 3 years. Design. Retrospective, observational chart review. Setting. Multicentric. Patients. 789 patients (1021 eyes; 602 males) enrolled in T&E using aflibercept/ranibizumab for diabetic macular edema (DME), wet age-related macular degeneration (AMD), or macular edema in retinal vein occlusion (RVO). Intervention. The history, examination (clinical and special investigations), and treatment records were thoroughly scrutinized. Sustained IOP rise was defined as a rise in IOP above baseline by ≥6 mmHg and/or >24 mmHg on 2 or more consecutive visits. The Wilk–Shapiro test was used for confirming normality of data. The Mantel–Haenszel test and generalized estimating equations were used to analyse multicentric data as well as to analyse data from both eyes of the same patients in the event that both eyes were under therapy. The relative risk, chi-square test (with and without Yates’ correction), and univariate and multivariate analysis were used wherever appropriate. Statistical significance was set at P<0.05. The primary outcome measure was the determination of risk factors for sustained IOP rise with ranibizumab/aflibercept therapy. Secondary outcome measures included determining the incidence of IOP rise (short term and sustained), visual field, and retinal nerve fibre layer (RNFL) changes. Results. The mean follow-up was 42.4 months. Male gender, South Asian ethnicity, older age, presence of AMD and vein occlusion, use of ranibizumab, higher number of injections, narrow angles, switch to bevacizumab/ranibizumab, and preexisting glaucoma were associated with sustained IOP rise. No significant visual field and RNFL changes were seen. The overall incidence was 8.91%. No patient required filtering surgery. No patient with IOP rise returned to baseline. Conclusion. IOP rise is an important consideration as the chronicity of the condition can eventually lead to glaucomatous changes in eyes with already compromised vision. Follow-ups and use of appropriate therapy can be determined correspondingly