Objectives: To determine the frequency and severity of surgical Vitreo-Retinal diseases during COVID-19 lockdown period (LP) and compare it with same period last year. Methods: Single hospital based retrospective Cohort Study. Data of the patients that underwent retinal surgeries during the COVID-19 LP i.e., 23-03-2020 till 23-06-2020 and same period last year i.e., 23-03-2019 till 23-06-2019 was analyzed. Results: One hundred thirty-six eyes of 105 patients were included. Among these eyes, 48 (35.3%) were operated during the COVID-19 LP while 88 (64.7%) were operated during the same time last year. A decline of 45.5% (p=0.023) was observed in the frequency of surgeries during the LP. Mean age of patients during the LP was 43.2 ± 20.3 years compared to 48.4 ± 17.9 years last year. There was reduction in the surgeries for Diabetic Tractional Retinal Detachment (11.4% vs 4.2% during LP, p=0.166), Vitreous hemorrhage (10.2% vs 8.3% during LP, p=0.04), Full thickness macular hole (3.4% vs 0% during LP) and Epiretinal membrane (12.5% vs 0% during LP). While Rhegmatogenous retinal detachment (27.3% vs 58.3% during LP, p<0.001) among other disorders had a higher proportion during the LP. Conclusion: The decline in the frequency of retinal surgeries during the LP is indicative of complex pathologies presenting later with more advanced disease. However, earlier presentation and an increase trend in surgeries for RRD during the LP shows the positive impact of free time on the health concerns of our population. doi: https://doi.org/10.12669/pjms.37.7.4291 How to cite this:Awan MA, Shaheen F, Mohsin F. Impact of COVID-19 lockdown on Retinal Surgeries. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4291 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.

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare spectrum of retinal vasculitis, aneurysms, and neuroretinitis affecting young individuals in their third decade. Most of our current knowledge is based on case reports, case series, and a handful of collaborative studies. There is much diversity in treatment approaches and outcomes in the reported literature. We have aggregated published case reports and case series into quantitative and narrative synthesis to draw evidence-based conclusions toward clinical features, atypical and rare findings, systemic associations, disease course, and treatment outcomes. The analysis suggested the disease mostly affects young individuals with a female predilection. Anterior chamber and vitreous inflammation are common than previously believed. The most prevalent pattern of retinal vasculitis in IRVAN eyes is mixed vasculitis, followed by arteritis and phlebitis. Most eyes at the time of presentation have capillary nonperfusion and require treatment. Most eyes retain good visual acuity; however, treatment is required to maintain visual function. Intravitreal antivascular endothelial growth factors administered as an adjunct to retinal laser photocoagulation are more likely to improve visual outcomes. Besides, we have discussed the different hypotheses on the etiopathogenesis of the disease and stronger evidence suggests an inflammatory origin of the disease.

Objective: It is to report the rate of infectious endophthalmitis (IE) with Anti VEGF injection in our set up and compare our procedure protocols with those being practiced on international and local level. Methods: A single hospital based retrospective, consecutive case series conducted at Shifa International Hospital, Islamabad after taking International Review Board (IRB) approval from the hospital’s ethics review committee. Total 7542 Anti-VEGF injections; 5976 (79.2%) Bevacizumab (Avastin), 1081 (14.3%) Ranibizumab (Patizra/ Lucentis) and 485 (6.4%) Aflibercept (Eylea) were administered to 2734 patients in a clean room in an office based setup during the 5 years i.e. August 2014 to July 2019.   Results: Only a single case of IE occurred during the study period that led to IE rate of 0.01% (1 out of 7542 injections) compared to the 0.028% previously reported in international literature and 0.027% in a local study. IE was successfully treated with 25 gauge pars plana vitrectomy. Conclusion: Our results depict that Anti VEGF injections can be administered in a clean room as a routine procedure in an office based setup by following standard sterilization protocols. Also, we strongly discourage the practice of giving same day bilateral IVT injections as this put the patients at the risk of bilateral IE leading to grave consequences. Timely diagnosis and intervention are pivotal in the management of this devastating complication. Keywords: Bevacizumab, Endophthalmitis, Intravitreal injections, Continuous...

Introduction This study aims to evaluate the primary anatomical success and visual outcomes of 25-gauge pars plana vitrectomy (25g PPV) in patients with rhegmatogenous retinal detachment (RRD) in Pakistan. Design This is a five-year retrospective, interventional cohort study conducted at tertiary care hospitals in Pakistan from October 2013 to October 2018. Methods This is a retrospective, interventional cohort study of 418 consecutive patients with RRD who underwent 25g PPV. All surgeries were performed by two experienced surgeons at tertiary care hospitals in Pakistan. Consecutive patients who underwent 25g PPV surgery as the treatment for RRD from October 2013 to October 2018 were included. We excluded patients who had a history of previous retinal surgery or did not complete the 4-8 weeks of primary outcome visit. We used the Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corporation, Armonk, NY, USA) for statistical analysis. A p-value of <0.05 was considered significant. Results We identified 452 patients through the coding system of our hospitals who underwent 25g PPV surgery for RRD during the study period. A total of 441 patient files were reviewed for the study, of which 418 patients met the criteria for final analysis. The mean age was 49 ± 15.8 years. There was a higher number of males (n = 284, 67.9%). In our study, 186 (44.4%) patients were phakic at the time of presentation. The macula was detached in 361 (86.4%) patients. At the primary outcome visit (4-8 weeks of follow-up), the primary anatomical success rate was 89.47%. The most common cause of failure was proliferative vitreoretinopathy (PVR) (n = 20), followed by missed breaks (n = 5). Conclusions The surgical outcomes of RRD with 25g PPV surgery in our study were similar to the outcomes reported in the developed world. We propose a prospective multicenter national study to prospectively evaluate the risk factors for RRD surgical failure in the Pakistani population.

Objective:  To report our experience with 27 gauge (27G) pars plana vitrectomy (PPV) system for a variety of simple to complex posterior segment disorders Methods: Single center, Retrospective, Cohort study. Data of 665 eyes of 574 patients that underwent 27G PPV for a variety of indications from July 2015 to June 2019 at a tertiary care hospital was analyzed. Results: Common surgical indications included; Diabetic tractional retinal detachment (196, 29.5%), vitreous haemorrhage (191, 28.7%), full thickness macular hole (80, 12%), epiretinal membrane (66, 9.9%), endophthalmitis (26, 3.9%), tractional diabetic macular edema (14, 2.1%), ectopia lentis (11, 1.7%), dropped lens matter (13, 2%) and others (68, 10.2%). Mean operating time was 62 ± 37 minutes. With the exception of 2 cases where 20G fragmatome was utilized, no case required conversion to 20 gauge system while a 25G trocar was used for the silicon oil injection. Per-operative complications included; iatrogenic retinal tear (2 eyes, 0.3%) and supra choroidal silicon oil migration (1 eye, 0.15%). Post-operative complications were raised IOP (7 eyes, 1%), endophthalmitis (1 eye, 0.15%), hemorrhagic occlusive retinal vasculitis (1 eye, 0.15%) and retinal detachment (2 eyes, 0.3%). Mean Visual Acuity improved from 1.62 ± 0.68 logarithm of minimum angle of resolution (logMAR) to 0.4 ± 0.38 logMAR (P <0.001). Conclusion: With 3 months follow up time, 27 G PPV has proved to be a safe and effective system for both simpler and complex retinal pathologies requiring significant surgical manipulation. Continuous...