Objective The objective of this pilot study was to evaluate the efficacy and safety of per-operative intravitreal methotrexate (MTX) infusion during vitrectomy in patients of retinal detachment (RD) with advanced grade proliferative vitreoretinopathy (PVR). Methods In this prospective interventional case series, we included patients with Grade C PVR, recurrent RD, and open globe trauma. All patients underwent standard single surgeon operated 23-gauge pars plana vitrectomy (PPV) with 80mg of MTX in 1000mL of irrigation fluid. All patients were followed up after four months to assess the final status of retinal attachment and visual acuity. Ethical review board permission was sought for this off-label use of MTX and all patients signed an informed consent form before this intervention. Results Thirty eyes of 30 patients with recurrent retinal detachment, open globe trauma, or grade C PVR at initial presentation were included in this study. After PPV, these patients were followed up after four months. A total of 24 (80%) patients maintained retinal attachment at four months. Mean preoperative best-corrected visual acuity (BCVA) was 1.35 logarithm of the minimum angle of resolution (logMAR) (range 0.5-3) and mean four months postoperative BCVA was 1.01 logMAR (range 0.3-3) (Student’s t -test; P -value <0.05). Seventeen (56.6%) eyes had pre-operative BCVA of 1.0 whereas 25 (83.3%) had BCVA of 1.0 at the end of the follow-up period. Six (20%) patients had preoperative BCVA of 0.7 whereas 12 (40%) patients had BCVA of 0.7 at four months postoperatively. Out of six (20%) eyes developing RD after this intervention, four eyes achieved retinal reattachment after a second surgery. We did not observe any MTX-related complications during the follow-up period of this study. Conclusion Intravitreal MTX infusion during PPV for complicated RD as an adjunctive therapy showed encouraging results and was found to be safe in its use. We need more rigorous and controlled studies to confirm the possible advantages of MTX and its role in the prevention of PVR.

Purpose:To evaluate the outcome of scleral buckling surgery using a wide angle non-contact viewing system and chandelier endoillumination for per-operative fundus visualization in patients with non-complex rhegmatogenous retinal detachments.Materials and Methods:This was a prospective, interventional study carried out at the Department of Ophthalmology, Mayo Hospital Lahore over a period of six months. Non-probability convenience sampling technique was employed. Fifteen eyes of fifteen pati-ents underwent modified scleral buckling procedure for rhegmatogenous retinal detachment using a 25G Awh Chandelier (inserted into the sclera through the pars plana) and wide angle viewing system to view the fundus intraoperatively instead of the conventional Indirect Ophthalmoscope.Results:The mean age of the patients in this study group was 41.9 12.4 years. Out of fifteen patients, 13 had flat retinas postoperatively. Two patients had to undergo pars plana vitrectomy with silicone oil tamponade due to development of retinal detachment secon-dary to PVR.Conclusion:Modified scleral buckling with the con-current use of a chandelier light and wide angle viewing system provides an easier and more convenient means of visualizing the fundus under panoramic viewing conditions intraoperatively.Key Words:Wide angle viewing system. Retinal detachment. Scleral buckling. Endoillumination.

Purpose:  To assess the safety and efficacy of supra choroidal triamcinolone injection (SCT) in cases of refractory diabetic macular oedema. Study Design:  Interventional case series. Place and Duration of Study:  Lahore General Hospital, Lahore, from July to December 2019. Methods:  A total of 22 eyes of patients above 18 years of age, with either Type-1 or Type-2 diabetes mellitus and treatment resistant central Diabetic Macular Edema (DME) of 320 um or more (measured on Zeiss Cirrus HD-OCT) and Best Corrected Visual Acuity (BCVA) of less than or equal to 20/40 were included in the study. BCVA, Intra Ocular Pressure (IOP) and Central Subfield Thickness (CST) was recorded. After Supra-Choroidal triamcinolone (SCTA), patients were followed up at one and three months and same clinical parameters were recorded and the results were analysed. Results:  out of 22 patients, 10 (45.45%) were males and 12 (54.54%) were females. Mean pre injection CST was 615.5 ± 200.28 um and Log MAR BCVA was 0.9 ± 0.20. Mean post injection CST at one and three months was 302.45 ± 52.45 and 301.66 ± 55.82 um. Mean post injection Log MAR BCVA at one and three months was 0.52 ± 0.3 and 0.40 ± 0.22. The results were statistically significant for pre and post injection CST at both one and three months (p-value < 0.00001). Pre and post injection BCVA was also statistically significant (p-value < 0.05). Conclusion:  CST is a safe and effective means to reduce refractory diabetic macular edema and improve OCT macular thickness. Key Words:  Diabetic macular edema, Suprachoroidal Triamcinolone, Central sub-field thickness.

Purpose:  To compare the completeness of ILM peel in cases of Idiopathic Epiretinal Membranes following double staining and double peeling  versus en bloc dissection of both using negative staining method. Study Design:  Quasi experimental study. Place and Duration of Study:  Jinnah Hospital Lahore, from October 2017 to March 2018. Material and Methods:  Forty eyes of forty patients with Idiopathic Epiretinal membranes (ERM) were selected by non-probability convenient method and divided into two groups. In group A, the ERM was initially stained with Trypan blue and then peeled. Subsequently the macula was re-stained with Brilliant blue G (BBG). In group B, ERM and ILM were successfully peeled together as a single membrane utilizing the single block technique, after a desired negative staining effect was obtained by injecting BBG. The thoroughness of the ILM peel was established using another injection of BBG although a few remains were often identified outside the central macular area, no other dyes were used. Results:  In group A, 8 of the 20 eyes (40%) had full undisturbed ILM present whereas in 10 eyes (50%) the ILM was there but damaged, only 2 eyes (10%) had near total ILM removed. In group B, the dual peeling was successful in 17 of the 20 cases (85%). There has been no recurrence of ERM until now. Conclusion:  Instead of peeling twice, the single en bloc negative staining technique with Brilliant blue G is a safer and more effective method for removal of ERM together with ILM.

Purpose:  To find out the frequency of diabetic retinopathy and factors responsible for poor diabetic control in patients with type 2 diabetes in a trust hospital. Place and duration of Study:  Akhtar Saeed Medical College, from January 2018 to December 2019. Study Design:  Descriptive cross-sectional study. Methods:  Total 395 diabetic patients belonging to lower socioeconomic class were included in the study. Type 1diabetes, age below 20 years, high myopia, papilledema, dense cataract, corneal scar and patients on dialysis were excluded. Age, gender, duration of disease, family history of diabetes, drugs used for diabetic control, compliance with drug, random serum sugar level at presentation, HBA1c level, best corrected visual acuity, slit lamp and fundus findings were noted. Results:  There were 270 (68.4%) females and 125 (31.6%) males (total 395). Random serum sugar was below 200mg/dl in 188 (47.6%). Family history of diabetes was positive in 145 (36.7%). Duration of diabetes was below ten years in 288 (73%). Visual acuity was less than 6/60 in 36 (6.3%) patients. HbA1c was within normal range in only 124 (31.4%). CSMO was present in 199 (50.37%) patients. Diabetic retinopathy was observed in 57 (14.43%) patients. Patients using oral hypoglycemic agents were 225 (57%), on insulin 151 (38.23%) and19 (4.8%) were using both oral drugs and insulin. Compliance was poor in 294 (74.4%). Conclusion:  Poor monetary resources compounded with lack of knowledge about disease, misconceptions regarding insulin and imbalanced diet are big hurdles in achieving optimal glycemic control in lower socio-economic class. Key Words:  Diabetic Retinopathy, glycated hemoglobin (HbA1c), blood serum sugar, clinically significant macular edema.