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AimTo study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsIn a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months).ResultsSixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62).ConclusionsILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment.Trial registration numberCTRI2018/04/012978.

Two eyes of 2 patients with macular hole-associated retinal detachment in clinically diagnosed vitelliruptive stage of Best vitelliform dystrophy were surgically managed by 25-gauge sutureless pars plana vitrectomy, internal limiting membrane (ILM) peeling with inverted ILM flap, and short-acting (SF6) gas tamponade. The patients were assessed with respect to best-corrected visual acuity, color fundus photographs, shortwave fundus autofluorescence, and swept source optical coherence tomography. Surgical intervention led to Type 1 closure of macular hole, resolution of retinal detachment, and improvement in vision in both patients.

Consumpt ion of cola-based soft drinks has been increasing over the last few years. Per capita consumption of cola-based drinks is nearly twice the per capita consumption of milk, and the proportion of persons consuming these beverages has increased in all age groups.1 Excessive consumption of these cola-based drinks has been associated with multiple adverse effects including erosion of dental enamel, bone demineralization, formation of kidney stones, increasing trends in obesity, and diabetes mellitus.2-6 Here, we describe a case of an elderly male presenting with paroxysmal attacks of weakness for the last few years. He had multiple hospitalizations in the past for similar complaints, and during each presentation he was found to have hypokalemia. His symptoms improved promptly after replenishing his serum potassium. Case ReportAn African American male, aged 65 years, presented with the chief complaint of episodic paroxysmal lower limb paralysis, describing it as "both legs giving way." He reported having multiple such episodes in the last 2 to 3 years, which lasted around an hour with no specific precipitating or relieving factors identified by him. He denied any other associated symptoms. He did not have any other significant medical conditions in the past and was not taking any prescribed, over the counter, or herbal medication. He did not recall any of his family members having similar manifestations. On presentation, the patient had mildly decreased tone and strength in his lower extremities bilaterally. His initial laboratory tests were significant for potassium of 1.9 mmol/L and elevated creatine kinase (CK) levels up to 3800 U/L. His electrocardiogram on admission was remarkable for ventricular rate of 61 beats per minute, prolonged corrected QT interval, QRS widening, and U waves merging with T waves in anteroseptal leads (figure 1). He had normal complete blood count, liver function, renal function, and thyroid Keywords: cola; hypokalemia; paralysis; rhabdomyolysis We report a rare case of cola-induced hypokalemia presenting as recurrent attacks of lower extremity weakness and falls. Excessive consumption of cola-based drinks has been associated with dental enamel erosion, obesity, and diabetes. There are very few published cases depicting the correlation between cola drinks and hypokalemic manifestations. In our patient an extensive workup was performed, and common causes were ruled out before making the diagnosis of cola-induced hypokalemia. Improvement in the patient's symptoms and electrolyte levels after reducing the consumption of cola-based drinks further confirmed our diagnosis. This case also emphasizes the importance of obtaining a detailed history and consideration of broad differential diagnoses in identifying uncommon but reversible etiologies.