Aim: To report the visual and anatomic outcomes of surgery for complex rhegmatogenous retinal detachment in a tertiary eye hospital in Africa over a 5 year period.Methods: Data was obtained from case files of patients who had surgery for complex rhegmatogenous retinal detachment between January 2014 and December 2018 in Eye Foundation Hospital Lagos, Nigeria. Visual and anatomic outcomes were analyzed and logistic regression done to identify factors associated with primary anatomic success, final anatomic success and good visual outcome.Results: A total of 343 eyes of 340 patients that met the inclusion criteria were analyzed. There were 249 (73.2%) males and 91 (26.8%) females with age ranging from 7 to 87 years with a mean age of 49.43 years. Only 41 (12.9%) eyes presented within a week of onset of symptoms, 263 (76.9%) eyes had vitrectomy with silicon oil exchange, 13 (3.8%) eyes had vitrectomy with gas, 15(4.4%) eyes had scleral buckling surgery alone while 51 (14.9%) eyes had combined scleral buckle with vitrectomy. Primary anatomical success was achieved in 281 (88.7%) eyes, Final anatomical success was achieved in 288 (92.9%) eyes and good visual outcomes achieved in 208 (61.4%) eyes. Using a simple logistic regression, eyes with normal or near normal visual acuity at presentation were more likely to have good visual outcomes (p = 0.00034). When compared with macula off rhegmatogenous retinal detachment, eyes with macula on at presentation also had a higher likelihood of final anatomic success (p = 0.001).
Conclusion:Despite complex pathology in eyes with rhegmatogenous retinal detachment, good anatomic and visual outcomes can be achieved after surgery. Primary anatomic success was achieved in 88.7% of eyes and 92.9% of eyes achieved final anatomic success. Good visual outcomes were achieved in 61.4% of eyes. Eyes with normal or near normal visual acuity at presentation were more likely to have good visual outcomes (p = 0.00034). When compared with macula off RRD, eyes with macula on at presentation had a higher likelihood of final anatomic success (p = 0.001).
Purpose: To report the significant worsening of Vitreomacular Traction (VMT), following the intravitreal injection of Bevacizumab (Avastin) in an Age Related Macular Degeneration (AMD) eye; thereby raising the awareness of this possibility. Method: Retrospective observational case report. Results: After 3 monthly doses of intravitreal injection of 1.25 mg/0.05 cc bevacizumab for treatment of AMD, a post injection OCT revealed the presence of VMT and an increased central macular thickness (CMT) by additional 268 microns compared to pre injection levels. Conclusion: Worsening of VMT and increase in CMT following injection of intravitreal drugs can occur. This VMT worsening effect of intravitreal injections is under recognized. It demands greater attention since it is seen with a new common route of ocular drug delivery and may be responsible for cases of pharmacological failure.
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