We present a case of a 65-year-old Pakistani woman who underwent an uneventful standard left phacoemulsification with posterior chamber intra-ocular lens placement for a mature senile cataract. She was observed to develop post-operative astigmatism secondary to a tilted intra-ocular lens and required repeat surgical intervention to correct the malposition. Per-operatively, the lens was found to be defective with a fixed bend at the haptic-optic junction which necessitated the need for an intra-ocular lens exchange procedure that restored adequate vision. The study highlighted defects in the structural integrity of intra-ocular lenses as an important differential to consider in such cases, and established lens replacement as a successful intervention to improve visual outcome.
Background: Macular oedema is a final common pathway of a multitude of both ocular and systemic insults. This study was conducted to evaluate the short-term efficacy and safety of intraocular Ranibizumab in patients with macular oedema in a ‘real-world’ setting in Pakistan. Methods: A prospective multicenter study conducted at Amanat Eye Hospitals in Islamabad and Rawalpindi from 1st August 2018 to 1st November 2019. Forty-four eyes of 34 patients with macular oedema were treated with monthly intravitreal Ranibizumab (Patizra®) injections for three consecutive months. Best-corrected visual acuity (BCVA), and optical coherence tomography (OCT) parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared. Results: BCVA improved from logMAR 0.61±0.40 at baseline to 0.27±0.35 four weeks after the third intravitreal injection. CRT decreased from 428.54±187.06μm at baseline to 364.50±170.49 μm. Macular volume showed a non-significant decrease from 9.97±3.19 mm3 at baseline to 9.22±2.68 mm3 four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study. Conclusion: Treatment with intravitreal Patizra® injections was found safe and resulted in clinically and statistically significant improvement in visual acuity and the SD-OCT parameter of central retinal thickness in patients with macular edema secondary to various retinal pathologies. There was no significant decrease in the macular volume.
Purpose: To compare the short-term efficacy and safety of intraocular Ranibizumab and Bevacizumab in patients with treatment Naïve macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Amanat Eye Hospital, from August 2018 to November 2019. Methods: Patients with macular edema confirmed with optical coherence tomography (OCT) or leakage on fluorescein angiography were included. Patients with NVE, PDR without macular edema and patients who switched to alternative anti-VEGF compounds prior to the completion of three consecutive monthly injections of their respective anti-VEGF or switched to other treatment options were excluded from the study. A thorough clinical examination was conducted including best corrected visual acuity (BCVA, intraocular pressure (IOP), anterior and posterior segment examination and OCT macula. The patients were then allocated to one of the two study arms (either Bevacizumab or Ranibizumab) based on the doctor’s input and patient affordability. All patients underwent three consecutive injections of the selected molecule at one month intervals. BCVA, CRT and macular volume were then recorded 04 weeks after the third injection. Results: A statistically significant mean vision gain was observed from baseline in both groups (p < 0.05). However, the change in BCVA was not significantly different between intravitreal Bevacizumab group and intravitreal Ranibizumab group (p > 0.05). Similarly, although there was improvement in CRT and macular volume in both groups but there was no statistically significant difference between the two. Conclusions: Treatment with intravitreal Bevacizumab and Ranibizumab injections cause statistically similar anatomical and functional results in cases of treatment naïve macular edema. Key Words: Bevacizumab, Ranibizumab, Macular Edema, Diabetic Retinopathy, Macular Degeneration, Retinal Vein Occlusion.
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