Objective:To evaluate the effectiveness and safety profile of combined phacoemulsification with 23G pars plana vitrectomy when compared to pars plana vitrectomy alone in phakic patients.Methods:This study was performed at Al-Ehsan Eye Hospital (tertiary care eye hospital in Lahore, Pakistan) from January 2016 to August 2016. A total of 40 eyes in two equal groups of 20 eyes each, were enrolled in this prospective study. Group-A underwent combined phaco-vitrectomy, whereas Group-B underwent vitrectomy only for various vitreoretinal pathologies. We evaluated the safety of combined surgery, intra-operative and postoperative complications and short term surgical outcome.Results:The most common reason for vitreoretinal intervention was rhegmatogenous retinal detachment followed by vitreous haemorrhage in combined study population. There was statistically significant difference in best corrected visual acuity pre-operatively and post operatively within the groups and between the groups. The most significant immediate post operative observation in Group-A was enhanced anterior chamber inflammation as compared to Group-B, whereas most signification observation in Group-B was development of visually significant cataract (35%) at 6 months follow-up. There was no other significant sequel or complication difference between both groups.Conclusions:Combined phaco-vitrectomy is a safe and effective procedure with minimum complication profile and it avoids the need of subsequent cataract surgery.

Objectives: To compare the effectiveness of fluid-air exchange with silicone oil-fluid exchange in reducing the residual silicone oil (SO) droplets after the removal of SO. Methods: This was a prospective, quasi-experimental study conducted from October 2021 to February 2022 at Eye Unit-III, COAVS, Mayo Hospital, Lahore. Sixty-one patients with siliconized eyes underwent removal of SO with two different techniques and were divided into fluid-air exchange and oil-fluid exchange groups. To quantify the residual silicone droplets objectively, B-scan echographic images were analyzed within seven days of surgery. Silicone oil index (SOI) which is the amount of residual SO droplets/vitreal area in the images was calculated with the help of imagej software. Results: The residual SOI of the fluid-air exchange group (0.99 ± 1.76%) was significantly lower than the oil-fluid exchange group (3.25 ± 3.85%). The SOI is positively correlated with the duration of tamponade, preoperative intraocular- pressure and axial length. Persistent IOP elevation post-operatively was seen in 16.67% individuals in the fluid-air exchange group and 54.8% individuals in the oil-fluid exchange group. Conclusion: Fluid-air exchange group was found to be superior in reducing residual SO droplets than the oil-fluid exchange group. doi: https://doi.org/10.12669/pjms.39.2.6243 How to cite this: Rizwan A, Javaid RMM, Latif S, Sarwar MS, Khan AA. Comparison of residual silicone oil index after removal of silicone oil with fluid-air versus oil-fluid exchange. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6243 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose:  To determine the mean change in refractive status after Levator muscle resection in patients of simple congenital ptosis. Study Design:  Quasi Experimental study. Place and Duration of Study:  This study was carried out at Institute of Ophthalmology, King Edward Medical University, Mayo Hospital Lahore, from 2014 to 2015. Material & Methods:  Fifty patients were selected under the age of 12 years with no sex predilection presenting with simple congenital ptosis of pupil sparing type. Patients with neurogenic, aponeurotic ptosis, mechanical ptosis, Blepharophimosis syndrome, patients with previous failed ptosis surgery and patients with corneal anomalies were excluded. After history and examination, Cycloplegic retinoscopy was done, which was repeated after surgical intervention. All interventions were done by a single ophthalmic surgeon. The patients were examined and discharged on the second post operative day. All data including preoperative and postoperative recordings of spherical and cylindrical values were collected on a self-designed proforma. Follow up period was extended to 3 months. At 3rd month cycloplegic retinoscopy was done and change in character of refractive status was analyzed. Mean change in refractive status was calculated by difference of preoperative and postoperative sphere and cylinder values. Results:  Mean age of patients was 4.26 ± 3.78 years. Mean change in spherical value after treatment was 0.447 ± 0.339. This difference was statistically significant with p-value = 0.000. While mean change in cylindrical value after treatment was 0.640 ± 0.580. This difference in cylinder value after treatment was also statistically significant with p-value = 0.000. Conclusion:  Levator muscle resection has a significant effect on refractive status of the patients with congenital ptosis.

Objectives: The objective of the study is to assess the retinal redetachment after early and late removal of silicone oil. Place and Duration of Study: Department of ophthalmology eye unit 3, KEMU /Mayo hospital, Lahore from February 2021 to July 2021 . Study: Quasi experimental trial. Patients and Methods: Time of silicone oil removal of first group (29 patients) at 6 weeks and second group (29 patients) at 12 weeks post-operatively. Presence of 360 barrage laser. The two groups were compared as to the condition of the eye at the time of SOR at 1st day 1st week, 1st months.3rd month following SOR. Inclusion Criteria PPV for rhegemantogenous RD with all types of breaks with silicon oil tamponade, both gender 360 barrage laser. Exclusion criteria bands keratopathy grade c PVR, presence of cataract, GRT, only eye Results: The risk of retinal re-detachment was similar in both groups. Conclusion: The danger of re-detachment was not increased by early removal of silicone oil after six weeks, and higher compliance with the removal period was ensured. In patients who are less likely to follow a procedure for delayed removal, it is especially advised..

Purpose:  To compare the frequency of hypotony after 23-gauge (G) pars plana vitrectomy (PPV) with suture-less sclerotomy versus intrascleral hydration for sclerotomy closure in eyes with air/gas tamponade. Study Design:  Quasi-experimental study. Place and Duration of Study:  College of Ophthalmology and Allied Vision Sciences, Mayo Hospital, Lahore from November 2021 to May 2022. Methods:  A total of 90 eyes were included who underwent PPV with air/gas tamponade. One group underwent PPV with suture-less sclerotomy while the other got intrascleral hydration for sclerotomy closure. Intraocular pressure (IOP) was measured pre and post-operatively at day one and day seven by applanation tonometry in all eyes. IOP of 6 mmHg or less was defined as hypotony. Primary endpoint measure was rate of early post-operative hypotony. Results: A total of 90eyes of 90 patients, 40 (44.4%) males, and 50 (55.6%) females were included in the study. Five (5.6%) patients reported hypotony, out of which, only one (2.2%) case was seen in the intrascleral hydration group while rest (8.9%) were of the sutureless group. Sclerotomies requiring sutures were 4.44% (6 of 135) in sutureless group while 0.74% (1 of 135) in intrascleral hydration group. Paired sample T-test for the means of pre-operative and post-operative IOP was significantly different in both groups. For suture-less PPV, mean difference was 3.089 ± 7.960 mmHg (P = 0.013), while for the intra scleral hydration group, it was 3.778 ± 7.048 mmHg (p = 0.001). Conclusion:  Intrascleral hydration is a suitable option for PPV sclerotomy closure without having any side effects.

Purpose: To determine frequency of post-operative macular edema in diabetic retinopathy patients having received preoperative intravitreal bevacizumab, after phacoemulsification cataract surgery while compared with the controls. Study Design: Quasi experimental trial Place and Duration of Study: Department of ophthalmology eye unit 3, KEMU /Mayo hospital, Lahore from March 2020 to August 2020. Methods: A total of 60 patients were included in the study and randomly divided into two groups. Patients of study group were given 1.25mg bevacizumab injection by IV route two weeks priority to surgery while nothing was administered in the control group. Before one week of surgery ocular examination and OCT were perfumed and it was repeated after every month of performance of surgery. Allocation of patients was even not known to the researcher to avoid biasness. Components of monthly examination were best correct visual acuity, slit lamp examination and central macular thickness quantification with OCT. Standard cataract surgery was performed in all the patients (phacoemulsification and implantation of monofocal intraocular lens (IOL)). Post-operatively, all patients were given standard treatment i.e moxifloxacin-dexamethasone). Follow up of all the patients was made for consecutive three months on monthly basis to assess outcome variables i.e macular edema was observed keeping in view central macular thickness. Results: In patients of study group, 16.66% had developed macular edema while in control group it was observed in 46% patients. While comparing macular edema between side of eye, study group had 02 (13.33%) patients belonging to right eye while 03(20.0%) had left eye. However, in control group it was 08 (53.33%) and 06 (40.0%) for right and left eyes respectively. Group A had 230.23 ± 32.16 µm central macular thickness while it was 274.21 ± 25.34 µm in group B. Conclusion: In macular edema prophylaxis using preoperative intravitreal bevacizumab is efficacious in comparison with the controls in patients with mild-moderate edema. Keywords: NPDR, Macular edema, Intravitreal Bevacizumab, Phacoemulsification Surgery, Diabetic Retinopathy.