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Purpose:  To report the preferences and trends in managing Rhegmatogenous retinal detachment (RRD) in Pakistan. Study Design:  Cross sectional survey. Place and Duration of Study:  Shifa International Hospital, Islamabad, from December 2018 to January 2019. Method:  A survey was conducted in which the vitreo-retinal (VR) surgeons were asked to respond to 10 questions. The questions were meant to assess their practice and management strategies in treating RRD. Duration of survey was 1 month. Results:  Sixty-two VR surgeons of Pakistan responded to this survey. Most of the VR surgeons belonged to Punjab (56%) followed by Sindh (25%). Regarding their primary practice setting 50% of VR surgeons worked both in government and private practice, 30% practiced in academic/university hospital and 20% of them had only private practice. Seventy percent of VR surgeons in Pakistan preferred local anaesthesia. In non-posterior vitreous detachment (PVD) RRD, majority (69%) performed segmental buckling (SB) with or without encirclement. In pseudophakic superior macula on RRD with a single retinal tear 50% preferred pars plana vitrectomy (PPV) followed by SB in 25% and pneumatic retinopexy in 18%. In inferior macula off RRD with a retinal tear at 7 0’clock position, 56% of the VR surgeon performed PPV alone or combined with SB. Conclusion:  There is an increased trend towards PPV as a primary procedure for RRD in Pakistani VR surgeons. Local anaesthesia is the preferred anesthesia. Key Words:  Rhegmatogenous retinal detachment, Retinal break, Pars Plana Vitrectomy, Pneumatic Retinopexy.

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Purpose:  To find the success rate of idiopathic and traumatic Macular hole (MH) with minimal/ no posturing after Macular Hole (MH) surgery. Study Design:  Interventional case series. Place and Duration of Study:  Ophthalmology clinic, Shifa International Hospital Islamabad from July 2017 to December 2018. Material and Methods:  Nineteen eyes of 19 patients with either idiopathic or traumatic MH were included in the study. All the patients with decreased vision due to any other cause or previous failed MH surgery were excluded. Their preoperative swept source OCT scans were done and MH was categorized according to size of MH. 27 gauge 3 ports pars plana vitrectomy, inner limiting membrane peel and gas (Hexafluoroethane) tamponade was performed in all the patients. No posturing was advised for small MH while minimal prone positioning was advised for medium and large sized MH. Results:  All the patients had closed MH at post-operative day 1 except one patient who showed decrease in size of hole after surgery. There was significant improvement in vision in all patients from mean preoperative visual acuity of 0.8 logarithm of minimum angle of resolution (Range 0.3 to 2.0) to mean post-operative visual acuity of 0.3 logarithm of minimum angle of resolution (Range 0.1 to 0.5). On an average 4 lines improvement in visual acuity occurred. Conclusion:  This study confirms MH closure within 24 hours on the basis of swept source OCT. Prone positioning does not appear to affect closure of small MH. For medium and large sized MH, minimal posturing is needed.

Purpose:  To highlight the role of anterior segment OCT, in complementing gonioscopic findings in the management of angle closure glaucoma. Study Design:  Descriptive observational case series. Study Place and Duration:  Study was conducted at Eye department of Shifa International Hospital, from January 2019 to March 2019. Methods:  After taking informed consent from the patients, the study was conducted at Shifa International Hospital Islamabad. Patients were selected by convenient sampling technique. Patients were diagnosed on the basis of history and clinical examination. Patients with angle closure on Gonioscopy were included in this series. Detailed ocular examination including visual acuity for distance and near, tonometry, Gonioscopy and anterior segment OCT were performed. Data was collected and presented as case series. Results:  The median age 57 years with 50% more than 60 years and 50% less than 60 years of age. Presenting IOP was less than 21 mmHg in 50% and higher in remaining 50%. On examination 37.5% were categorized as PACS, 12.5% having PAC and 50% as PACG. After definitive treatment 12.5% still needed medical treatment to prevent progression in PACG and none in PACS and PAC. Conclusion:  In narrow angle disease, treatment is designed not only to control intraocular pressure (IOP) but also to keep angle open as much as possible. Appositional closure or peripheral anterior synechiae (PAS) can damage the trabecluar meshwork. Iridoplasty, peripheral Iridotomy (PI) and early lens extraction can defer the need for filtration procedure if done well in time. Key Words:  OCT anterior segment, Narrow angle, Optic nerve head.