ViteroRetinal Surgery

Background and objective: Retinopathy of Prematurity is a retinal vascular and capillary proliferation disease affecting premature infants undergoing oxygen therapy—the current study aimed to introduce adjusted screening criteria for children in the Kurdistan region. Methods: A retrospective review of medical records was conducted to analyze patients who underwent Retinopathy of Prematurity screenings in the Kurdistan region (Duhok Eye Hospital) between 01.01.2019 and 30.03.2023. The screening procedure involved pupil dilation using 1.25% phenylephrine ophthalmic solution and 1% tropicamide. Examinations were conducted using indirect ophthalmoscopy. To optimize screening and ensure timely treatment, three criteria were applied to all 500 babies based on gestational age and birth weight: 33-35 weeks and/or 2500-3000 g, 31-33 weeks and/or 2100-2500 g, and ? 31 weeks and/or ? 2100 g. Results: This study demonstrates a noteworthy association between gestational age and retinopathy of prematurity prevalence. Among neonates born at or before 31 weeks, 81.90% developed retinopathy of prematurity, while only 18.10% did not. For neonates delivered at 32-33 weeks, 27.37% experienced retinopathy of prematurity, with 72.63% avoiding it. At 34-35 weeks, 11.11% experienced retinopathy of prematurity, 88.89% did not. The data also reveals a relationship between birth weight and the requirement for retinopathy of prematurity treatment. Among neonates with a birth weight of less than 2100 grams, a substantial 56.27% required treatment, while 43.73% did not. Conclusions: The study underscores the importance of tailored screening and intervention strategies for retinopathy of prematurity, especially in the vulnerable in the Kurdistan region.

Three-port pars plana vitrectomy (PPV) requires thorough visualization of the peripheral vitreous base, typically achieved using scleral depression. Traditional methods, involving either a trained assistant or chandelier illumination, are limited by cost, assistant dependency, and inconsistent visualization. In this article, we describe a “do it yourself”(DIY) cost-effective, improvised illuminated scleral depressor—“The Lumi-Indent”—created by inserting a 25-gauge endoilluminator into the cap of a disposable hypodermic needle and securing it with sterile tape. The device was used in 50 consecutive vitreoretinal surgeries with 360° vitreous base shaving. No intraoperative complications were noted. We also review existing techniques, including Veckeneer’s Tyndall effect-enhanced transillumination with triamcinolone and PFCL; Bamonte’s simplified method using a venflon cannula sleeve; Mandelcorn’s light pipe and finger-mounted ring depressor; Todorich’s digital heads-up system with a molded adapter tip; and Tan’s cotton swab-modified depressor. While each approach improves surgeon independence and peripheral visualization, many require either costly equipment or present structural limitations. Our Lumi-Indent depressor offered consistent illumination, scleral rigidity, and smooth conjunctival navigation, without the risk of bending or damaging the light pipe. Its negligible cost and simplicity make it an ideal solution for high-volume or resource-limited settings. In conclusion, the Lumi-Indent is a safe, frugal, and efficient tool for assistant-free vitreous base shaving, expanding the accessibility of advanced surgical techniques.

Background and objectives: Following a successful cataract surgery with intraocular lens implantation, cystoid macular oedema can be one of the leading causes to visual impairment. We aimed to evaluate the postoperative thickness and alteration of the central macular thickness in healthy patients with senile cataract and diabetics following uneventful phacoemulsification surgery using Optical Coherence Tomography. Methods: A retrospective analysis was conducted between April and September,2022, at the public Duhok Eye Hospital in Duhok city. Data were collected from patients who were undergoing simple uneventful phacoemulsification and intraocular lens implantation. Every patient was prepared to be enrolled for cataract surgery with the preoperative assessment of central macular thickness and then to be reassessed and compared after a week then one month postoperatively. Results: The post operative comparison between the mean central macular thickness values in group 1, at week one, and after one month, with the group 2's mean revealed statistically significant differences. Group 1's mean age was 55.30 ± 5.66 years while group 2's mean age was 60.20 ± 10.74 years. There were 45 (41%) females and 75 (59%) males in total for the study group1 consisted of 48.5% females and 51.5% males, while group 2 had 33.3% females and 66.7% males. Conclusion: After a safe and uneventful phacoemulsification surgery, there was a trivial variation in the central macular thickness between normal nondiabetic people and diabetic persons without complication, before and after operation.

Purpose: To analyze anatomic and visual outcomes of young adults with uncomplicated primary rhegmatogenous retinal detachment (RRD) treated with scleral buckle, pars plana vitrectomy (PPV), or combined PPV and scleral buckle. Methods: Patients included in the Primary Retinal Detachment Outcomes study with a minimum of 6 months follow-up were evaluated in this multicenter interventional cohort study,. Patients with complex RRDs were excluded. Primary outcomes were single surgery anatomic success and final visual acuity (VA). Results: Scleral buckle was performed in 91 eyes (55%), PPV in 32 (19%), and combined PPV and scleral buckle in 42 (25%). Single surgery anatomic success rates were 79.3% for PPV alone, 83.7% for primary scleral buckle, and 92.7% for combined PPV and scleral buckle (analysis of variance, P = .25). When adjusting for potential risk factors, eyes that had PPV alone were more likely to redetach compared with those that had combined PPV and scleral buckle (hazard ratio [HR], 7.24, 95% CI, 1.25-42.1; P = .03), while rates of redetachment were similar in eyes that had scleral buckle alone and combined PPV and scleral buckle (HR, 3.24, 95% CI, 0.63-16.63; P = .16). However, eyes that had combined PPV and scleral buckle were less likely to result in good vision compared with eyes that had scleral buckle alone (odds ratio [OR], 0.26, 95% CI, 0.07-0.94; P = .04). Similarly, eyes that had PPV alone were less likely to obtain good vision compared with eyes that only had scleral buckle (OR, 0.20, 95% CI, 0.05-0.81; P = .02). Conclusions: For young adults in this study, the best visual outcomes resulted from scleral buckle, and a higher single surgery success rate was found with combined PPV and scleral buckle.

To describe the demographics, clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India. This was a retrospective longitudinal hospital-based study of 1382 children aged ≤12y included in the National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) Study. Data on patient demographics, treatment approach, and best-corrected visual acuity (BCVA) changes were reviewed. The mean age of the study cohort was 4.54±2.46y, with males constituting the majority (55.4%). The cause of amblyopia was refractive error in 73.2%, strabismus in 7.3%, and anisometropia in 6.8% of eyes. The majority of therapies comprised glasses (74.4%), followed by occlusion+glasses (10.3%), occlusion alone (7.3%), and surgery+patching+glasses (5.1%). The mean occlusion time was 2.46±1.14h. After a median follow-up of 10.00 (6-85)mo, the mean BCVA significantly improved from 0.85±0.41 to 0.55±0.42 logMAR. Subgroup analysis revealed BCVA gain for all etiologies, including refractive errors (P<0.001), strabismus (P<0.001), cataract (P<0.001), and ptosis (P<0.001). Additionally, eyes with refractive errors showed significantly better BCVA than eyes with cataracts (P<0.001), strabismus (P<0.001) and marginally better BCVA than eyes with ptosis (P<0.05), both at the baseline and final visit. Refractive errors are the commonest cause of amblyopia, followed by strabismus and anisometropia. Timely detection, optimal therapy, and periodic follow-up are crucial in bettering visual acuity regardless of the cause.

A 24-year male with Eales disease and vitreous hemorrhage underwent 25-gauge vitrectomy with fluid–gas exchange (Sulphur Hexafluoride 20%) in the right eye and presented with feather-like opacification of the posterior subcapsular area of the lens on the first post-operative day [Fig. 1]. The opacification reduced after 1 week and completely cleared at 2 weeks.Figure 1: Slit-lamp photograph taken with a smartphone, showing feathering of the posterior subcapsular areaFeathering of the posterior subcapsular area of the lens is seen in gas-filled eyes and could be due to desiccation of the posterior lens surface or hydration of lens fibers from contact with the gas bubble.[1,2] This condition often resolves spontaneously in 4–6 weeks.[3] Authors' Contributions Biju Raju: Concepts, Literature search, Manuscript preparation, Manuscript editing, Manuscript review. Chandrasekhar Nooyi: Concepts, Manuscript editing, Manuscript review. Jyothi R: Literature search, Manuscript preparation, Manuscript editing. NSD Raju: Manuscript preparation, Manuscript editing, Manuscript review. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.

BackgroundThis case report describes a rare case of Coats disease in adult female patient with preserved vision after intravitreal Aflibercept injection and laser photocoagulation.Case presentationA female patient of Asian Palestinian descent, aged 20, exhibited a progressive and painless deterioration in the vision of her left eye over a period of two weeks. She exhibited no additional ocular symptoms. Prior to her presentation, she had no notable medical history and her vision was normal in both eyes. Inferotemporal telangiectasia, sausage-like blood vessels with perivascular sheathing in the peripheral fundus, extensive exudate involving the macula, severe macular edema, and localized inferotemporal exudative retinal detachment were observed upon examination of the posterior segment of her left eye. Following this, optical coherence tomography (OCT) identified subretinal exudate, intraretinal and subretinal fluid. After establishing the diagnosis of stage 3 Coats’ disease, the patient was treated with intravitreal Aflibercept (Eylea) injections and sectoral laser photocagulation. The third injection resulted in the absence of intraretinal and subretinal fluid by OCT, but the subretinal exudate remained unresolved. One month subsequent to the previous injection, FFA guided sectoral laser photoagulation was applied to the inferiotemporal ischemic area. The patient was subsequently monitored monthly, and her vision improved. Five months after treatment, her vision has improved to 0.7 (6/8.7) and she has remained stable ever since. At present, the patient is undergoing routine outpatient follow-up.ConclusionCoats disease is an idiopathic, progressive disease that mostly affects male infants, yet adult cases have been documented. Our case and the existing body of literature indicate that adult individuals have a favorable visual prognosis in the small proportion of cases where this occurs. It appeared that the implementation of intravitreal therapies and increased use of lasers led to enhanced visual outcomes. It is recommended to perform lifelong follow-up to monitor for recurrences and complications.

Abstract Purpose: To evaluate choroidal thickness and lens thickness among various subtypes of angle closure disease and compare it with healthy controls Methods: This observational comparative study was conducted between June 2022 and February 2023 at our eye hospital, including eyes with subtypes of angle closure disease and healthy controls. Lens thickness was measured using an automated optical biometer, and choroidal thickness was measured using enhanced depth imaging spectral-domain optical coherence tomography in the subtypes of angle closure disease and healthy control subjects. Results: One hundred and twenty-four eyes were enrolled, including 93 angle closure disease eyes and 31 healthy eyes. The mean choroidal thickness was significantly higher in angle closure subtypes than healthy controls (247.19 ± 40.97 µm, 318.81 ± 24.81 µm, 383.81 ± 53.06 µm, 173.65 ± 28.19 µm in primary angle closure suspect, primary angle closure, primary angle closure glaucoma, and healthy controls, respectively (P &lt; 0.001)). The mean lens thickness was higher in angle closure disease compared to the control group (P &lt; 0.01). Conclusion: Increased choroidal thickness might be another anatomic characteristic of primary angle closure eyes along with increased lens thickness. This finding may support the hypothesis that choroidal enlargement plays a part in the development of primary angle closure disease. Trial registration number: CTRI/2022/08/044903