ASSOCIATION OF LATTICE DEGENERATION IN PATIENTS WITH CHRONIC SEROUS CHORIO-RETINOPATHY

Objective: To establish the association of lattice degeneration in patients with chronic serous chorio-retinopathy at tertiary care ophthalmology hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Sep 2019 to Dec 2020. Methodology: The sample population comprised of 80 subjects which included 40 cases of chronic serous chorio-retinopathy and 40 controls. Chronic serous chorio-retinopathy was diagnosed by consultant ophthalmologist on basis of fluorescein angiography and spectral-domain optical coherence tomography. Peripheral retinal examination was done among all the study participants to look for lattice degeneration. Pearson chi-square test was applied to look for the relationship of various factors with lattice degeneration including the presence of chronic serous chorio-retinopathy. Results: Two groups with equal number of subjects were included in the study. Mean age of the study participants was 49.14 ± 2.93 years. 60 (75.0%) participants were male while 20 (25%) were female. Fifty four (67.5%) had no lattice degeneration while 26 (32.5%) showed the presence of lattice degeneration on detailed ophthalmic examination. Chi-square test showed that having chronic serous chorio-retinopathy and use of steroids were statistically significantly associated with presence of lattice degeneration among the study participants. Conclusion: Chronic serous chorio-retinopathy emerged as a condition strongly associated with lattice degeneration of peripheral retina. Use of topical or systemic steroids also increased the chances of developing lattice degeneration in our study population.

Iatrogenic Retinal Penetration from Intravitreal Injections

We present 2 cases of iatrogenic retinal penetration from intravitreal (IVT) injections in a retrospective noncomparative case series of 2 patients. The first patient, an 81-year-old Caucasian male, developed dense vitreous hemorrhage soon after receiving an IVT bevacizumab injection for macular edema from central retinal vein occlusion. A 25-g vitrectomy 1 week later showed a retinal hole surrounded by fresh hemorrhages in the same quadrant as the IVT injection. The second patient, an 87-years-old male, developed a retinal detachment after 28 injections of anti-VEGF medications for neovascular AMD. A peripheral round hole was observed during vitrectomy without any lattice degeneration in the same quadrant as prior IVT injections. Both eyes were pseudophakic, had normal axial lengths, and received injections without measuring the injection site. Retinal penetration from IVT injections can result in serious sight-threatening complications. Measuring the injection site from the limbus should be part of safe IVT injection technique.

Four Cases of Rhegmatogenous Retinal Detachment That Recurred More than 10 Years after Initial Reattachment by Pars Plana Vitrectomy

<b><i>Purpose:</i></b> The purpose of this report was to present our findings in 4 cases of rhegmatogenous retinal detachment (RRD) that recurred 10, 11, 12, and 17 years after a reattachment surgery by pars plana vitrectomy (PPV). <b><i>Methods:</i></b> Four cases of a recurrent RRD had undergone scleral buckling surgery and vitrectomy. <b><i>Patients:</i></b> The recurrence of the RRD was observed 10–17 years after the successful attachment by PPV. The macula was detached in all cases, and none of the eyes had severe proliferative vitreoretinopathy. The cause of the recurrence was a new retinal break in 3 eyes and a reopening of an old retinal break in the other eye. The new breaks had a punched-out shape and had neither a horseshoe tear nor an atrophic hole associated with lattice degeneration. PPV combined with scleral buckling was performed, and a reattachment was achieved in all cases. The best-corrected visual acuity (BCVA) at the last visit ranged from 20/30 to 20/25, but the BCVA in 1 eye was 20/200 because of amblyopia. <b><i>Conclusions:</i></b> We experienced 4 rare cases of a recurrent retinal detachment 10–17 years after the primary RRD. PPV and scleral buckling were effective and the anatomical and the functional outcomes were good.

Factors Predisposing to Rhegmatogenous Retinal Detachment in a Tertiary Care Hospital of Pakistan

Purpose: To find out the factors predisposing to rhegmatogenous retinal detachment. Study Design: Descriptive cross sectional study. Place and Duration of Study: Liaquat National Hospital, Karachi, from October 2017 to April 2018. Methods: After approval from ethical review committee 117 patients presenting with Rhegmatogenous retinal detachment (RRD) were included in the study. A detailed history was taken including previous surgery and trauma. Complete ocular examination was performed including dilated fundus examination. Data was analyzed using SPSS version 21. Mean and standard deviation were computed for quantitative variable i.e. age and frequency. Percentages were calculated for qualitative variables i.e. gender, eye involved, lattice degeneration, trauma and intraocular surgery. Stratification was done with regards to age, gender, eye involved to see the effect of these modifiers on individual factor (lattice degeneration, trauma, intraocular surgery) by using chi square test and considering p value ≤ 0.05 as significant. Results: There were 117 patients including 91 males and 26 females. Sixty four were right eyes and fifty three were left eyes. Mean age was 37.30 ± 8.97 years. Lattice Degeneration was observed in 29.1% patents, Trauma was 37.6% and intraocular surgery was observed in 33.3% patients. There was a significant association of age with trauma (p = 0.045) and intraocular surgery (p = 0.001), which had statistically significant association with RRD. Conclusion: Intraocular surgery, trauma were significantly associated with age and RRD. However, although lattice degeneration is an established risk factors for Rhegmatogenous retinal detachment it was not associated with increased age. Key Words: Rhegmatogenous Retinal Detachment, Lattice Degeneration, Trauma, Intraocular Surgery.

RETINAL CHANGES IN MYOPIC PATIENTS AT A TERTIARY CARE CENTRE IN EASTERN INDIA

Background: Myopia is a major cause of visual impairment in both the developed and the developing world. Its prevalence ranges between 83% to 97% and the prevalence of high myopia ranges between 7% and 22%. Individuals with high myopia have increased risk of retinal complications which can be potentially sight threatening. Aims And Objectives: To determine the prevalence and types of retinal changes in patients with myopia and the relationship of the retinal changes with the severity of myopia. Materials And Methods: Patients attending the outpatient department having myopia and age more than 8 years were selected for the study. They underwent dilated fundoscopy (direct and indirect ophthalmoscopy) to record the various retinal changes. Results: Tessellated fundus (58.5%) and peripapillary atrophy (40.5%) were the most common ndings. Temporal crescent (21.5%), lattice degeneration (16.5%), white with or without pressure (11%), retinal tears (4%) and retinal detachment (2%) were also seen. No changes were observed in 22% of the eyes. Conclusion: Myopic individuals should be educated on the symptoms of various complications and seek care immediately if symptoms arise

Vitrectomy with air tamponade and cryotherapy for retinal detachment repair without perfluorocarbon use: A UK 12-month prospective case series

Introduction: Rhegmatogenous retinal detachment (RRD) is commonly managed by pars plana vitrectomy (PPV). Gas tamponade has significant clinical and quality of life factors that affect the patient. Using shorter acting air tamponade, intuitively leads to surgical concern for higher rate of primary detachment. To circumvent this, surgeons advocate the use of perfluorocarbon to maximise sub-retinal-fluid drainage when using air tamponade and/or avoid using cryotherapy due to longer duration for scar formation relative to laser. These steps are a deviation from traditional technique for otherwise routine primary RRD repair and discourages popularisation of using air tamponade despite the benefits to patients. Method: Prospective 12-month, single centre, single surgeon, consecutive study from January to December 2019. Inclusion criteria was as per based on the pneumatic retinopexy versus vitrectomy for retinal detachment: (i) single retinal break or group of breaks, no larger than 1-clock-hour (30°), in detached retina; (ii) all breaks in detached retina lie above the 8 to 4 o’clock meridian; and (iii) breaks or lattice degeneration in attached retina at any location. We excluded PVR formation and RRD in the inferior 4 o’clock hours. Results: We report primary and final success rate of 96% and 100%, respectively in 23 eyes (22 macular-on and one macular-off) with RRD eyes in a 12-month period. Cryopexy was utilised in 65% patients and in isolation in 23% with no perfluorocarbon use in all eyes. Conclusion: We show cryotherapy can be used safely in AT-RRD without PFCL in RRD fulfilling PIVOT trial criteria with minimal cataract formation and IOP spikes and faster post-operative visual rehabilitation.

Involvement of the Retinal Pigment Epithelium in the Development of Retinal Lattice Degeneration

Lattice degeneration involves thinning of the retina that occurs over time. Here we performed an immunohistological study of tissue sections of human peripheral retinal lattice degeneration to investigate if retinal pigment epithelium (RPE) cells are involved in the pathogenesis of this condition. In two cases of retinal detachment with a large tear that underwent vitreous surgery, retinal lattice degeneration tissue specimens were collected during surgery. In the obtained specimens, both whole mounts and horizontal section slices were prepared, and immunostaining was then performed with hematoxylin and antibodies against glial fibrillary acidic protein (GFAP), RPE-specific protein 65 kDa (RPE65), pan-cytokeratin (pan-CK), and CK18. Hematoxylin staining showed no nuclei in the center of the degenerative lesion, thus suggesting the possibility of the occurrence of apoptosis. In the degenerative lesion specimens, GFAP staining was observed in the center, RPE65 staining was observed in the slightly peripheral region, and pan-CK staining was observed in all areas. However, no obvious CK18 staining was observed. In a monkey retina used as the control specimen of a normal healthy retina, no RPE65 or pan-CK staining was observed in the neural retina. Our findings suggest that migration, proliferation, and differentiation of RPE cells might be involved in the repair of retinal lattice degeneration.