Ganekal, Sunil

Abstract Purpose: The purpose of the study was to evaluate the efficacy of Sustained-release Intravitreal Dexamethasone implant (Ozurdex; Allergan Inc., Irvine, CA) during vitrectomy in preventing proliferative vitreoretinopathy (PVR). Methods: Double-blind, prospective, randomized, placebo-controlled trial. Eighty consecutive patients diagnosed with rhegmatogenous retinal detachment with high-risk PVR were randomized to study and control groups ( n = 40 each). Study group/Adjunct group (group 1) patients underwent vitrectomy with Sustained-release Intravitreal Dexamethasone implant (0.7 mg). In the control group (group 2), a similar surgery was performed without the use of a dexamethasone implant. Patients were evaluated at 1 month, 3 months, and 6 months after surgery. Postoperative retinal reattachment, recurrence of PVR, best-corrected visual acuity, and complications at the end of 6 months were compared between the two groups. Results: At 6 months postsurgery, 68.7% of patients had reattached retina. There was no significant difference ( P > 0.05) in retinal reattachment in both of the groups. The rate of postoperative PVR in the control group was 56%; in the study group, the rate was 46% ( P > 0.05), which proves statistically insignificant. In addition, there was no statistically significant difference in visual outcomes between the two groups ( P > 0.05), and no significant difference in the complication rate and drug toxicity was noted between the two groups. At 6 months, fewer adjunct patients had Cystoid macular edema or a foveal thickness of >300 μm compared with controls ( P = 0.003, P = 0.031). Conclusions: This study fails to prove the efficacy of the intraoperative use of Sustained-release Intravitreal Dexamethasone implant for the prevention of postoperative PVR or improvement in final visual acuity but it does reduce inflammation and CME. At the same time, no significant complications could be attributed to the treatment.

To correlate UBM and clinical findings in patients with closed globe injury. Prospective observational study of 75 patients, ≥ 12 years of age presenting to ophthalmic outpatient department within one week of sustaining closed globe injury. Patients with seriously ill polytrauma and open globe injuries were excluded from the study. Comprehensive ophthalmic examination including Visual acuity assessment, slit lamp examination, fundus examination and IOP measurement. Gonioscopy and UBM examination was done in all patients on presentation except for patients with hyphema (UBM and gonioscopy done at 4 weeks to prevent rebleed).Mean age of the patients was 31.4 ±8 years, most common external findings included lid ecchymosis (47%), subconjunctival hemorrhage (93%). The common anterior segment finding included traumatic iritis (87%), traumatic hyphema (61%) and traumatic cataract in 27% of patients. Clinical evidence of zonular dialysis was seen in 13% of patients. UBM was able to detect zonular defects in 62% patients (P=0.008). Most of the patients (57%) had zonular dialysis less than 3 clock hours on UBM examination. UBM confirmed the presence of other clinical findings like iridodialysis, cyclodialysis. UBM is a safe and effective adjunctive tool for clinical assessment and management of ocular trauma. It can diagnose subtle zonular dialysis and other anterior segment changes following blunt trauma. UBM should be an integral part of ophthalmic examination especially in patients requiring surgical intervention after closed globe injury.