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Purpose:  To find out the outcomes of suprachoroidal Triamcinolone injection in refractory diabetic macular edema. Study Design:  Quasi experimental study. Place and Duration of Study:  Al-Ehsan Eye Hospital, Lahore from Jan 2020 to 31st Dec 2020. Methods:  Sixty-five patients with refractory diabetic macular edema were included. Patients underwent complete ocular history and examination. To document baseline macular edema, SD-OCT was done. The recruited patients received 0.1ml of suprachoroidal Triamcinolone injection (40mg/ml) using a 30 gauge syringe. Follow up was performed at one week, one month and third month after injection. At each follow up, best corrected visual acuity, central macular thickness and retinal nerve fiber thickness were documented. Data was analysed using SPSS version 36.0. Comparison of BCVA, central macular thickness and retinal nerve fibre layer thickness (RNFL) before and after injection was analyzed by paired sample t-test with p value of ≤ 0.05 as significant. Results:  Out of 65 patients, 29 (44.62%) were females. Mean age of patients was 54 ± 8.4 years (range 40 to 80 years). Central macular thickness after suprachoroidal Triamcinolone injection changed from 556.2 ± 10.9 to 313.6 ± 7.2 ųm. Change in visual acuity was 0.9 ± 0.01 to 0.6 ± 0.02. Pre-treatment and post-treatment visual acuities demonstrated a substantial change after undergoing treatment along with decrease in central macular thickness with p value ˂ 0.001. Conclusion:  Suprachoroidal Triamcinolone injection results in anatomical as well as functional improvement in diabetic patients with refractory macular edema.

Background: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges. Methods: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA). Results: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively. Conclusion: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.

Purpose:  To study the outcomes of early removal of segmental buckle on visual acuity, retinal status, and astigmatism. Study Design:   Interventional case series Place and Duration of Study:  Mayo hospital, from February 2018 to July 2018. Methods:  Ten patients fulfilling the inclusion criteria were recruited. All the patients underwent segmental radial sponge with cryoretinopexy, with or without drain and intraocular gas tamponade as per need. Post-operative follow ups were at 1st week, 4th week and 6th week. Sponge was removed at 6th week after making sure that the retina was attached. Follow ups after buckle removal were planned at 1st week, 1st month and 3rd month.  Improvement in VA, retinal status and astigmatism were noted. The commonest reason for the explant removal was infection followed by pain. Normality was checked through Shapiro-Wilk’s W-test and the normality criteria was met so paired sample t-test was used to assess the significance of astigmatism pre and post-surgery. Results:  The average age was 32.30 ± 16.75 years (range, 03 – 61 years). Anatomical success was achieved in 100%. Visual acuity improved in all patients. Moreover, early removal of buckle reduced astigmatism and further improvement in vision was also noted. Pre and post-surgical vision improvement was statistically significant with p-value of 0.000. After removal of buckle, improvement of astigmatism was also statistically significant p-value 0.004. Conclusion:  The early removal of scleral explant not only provides symptomatic relief to the patients, but is also associated with marked improvement in visual acuity was noted. Key Words:  Visual Acuity, Astigmatism, Retinal Detachment, Segmental Scleral Buckle.

Purpose: To find out the effect of Intravitreal  Bevacizumab on optic nerve head perfusion using Ocular Coherence Tomography Angiography (OCTA) in patients with diabetic macular edema (DME). Study Design:  Interventional case series Place and duration of study: Ophthalmology Department, Mayo Hospital, Lahore from June 2018 to January 2020. Methods: In this study 57 eyes of patients fulfilling the inclusion criteria were selected from the outpatient department. After informed consent, detailed history and ocular examination was performed. Baseline OCTAwas donein all cases. The patients received intravitreal Bevacizumab (1.25mg in 0.05ml). OCTA was repeated three weeks after injection. Both the pre and post injection ONH perfusion was compared and analyzed using SPSS. Demographic chracteristics like age and gender were calculated. Paired sample t-test was applied to check the significance of difference between pre and post injection values. P-value of <0.05 was considered significant. Results:There were 16(28.1%) males and 41(71.9%) females. Mean age of the patients was 53.54±7.00 years. Pre injection blood flow was 56.11 and post injection was significamtly reduced to 52.69. The mean difference between was 3.423 and confidence interval of the difference was (2.5755-4.2701).  P-value 0.000 was <0.05  whichshowed significant reduction in perfusion of ONH. Conclusion:Intravitreal Bevacizumab decreases the optic nerve head blood flow and should be used with care in patients having reduced blood flow states and also in patients with advanced glaucomatous optic neuropathy.