Asian Journal of Research and Reports in Ophthalmology

A Randomized Prospective Study on the Timing of Ranibizumab Administration before Vitrectomy in Patients with Severe Diabetic Retinopathy: Assessing Complications, Visual Outcomes, and Retinal Traction Development

Ponomarev V.O., Spandau U., Kazaikin V.N., Yurchenko O.M. — Wed, 01 Jan 2025 00:00:00 +0000

Currently, proliferative diabetic retinopathy (PDR) and diabetic macular oedema (DMO) are recognised complications of diabetes mellitus (DM) and rank among the top five leading causes of blindness and visual impairment worldwide, including among working-age individuals. The only pathogenetically justified treatment for PDR complicated by cataract and DMO with vitreomacular traction is surgery. This approach aims to restore optical media transparency, remove fibroglial tissue (FGT), relieve traction, and eliminate retinal ischaemia zones by performing panretinal photocoagulation (PRP).

Aim: The use of anti-VEGF therapy prior to vitrectomy for diabetic retinopathy remains a topic of debate. This study aims to evaluate whether pre-treatment with anti-VEGF offers clinical benefits.

Study Design: Prospective, randomised study

Place und Duration of Study: MSTC “Microsurgery of the eye”, Yekaterinburg city, Academician Bardina street 4a. Russian Federation, between 09/2022 and 05/2024.

Methodology: All patients were randomly assigned to one of three groups: Group 1: Underwent phacoemulsification and an injection of Ranibizumab, followed by vitrectomy, PRP, and silicone oil endotamponade one month later. Group 2: Received an intravitreal injection of 0.05 ml of Ranibizumab, followed 5–7 days later by phacoemulsification combined with vitrectomy, PRP, and silicone oil endotamponade. Group 3: Underwent phacoemulsification combined with vitrectomy, PRP, and silicone oil endotamponade, without prior intravitreal injection. Silicone oil was removed three months postoperatively. Clinical follow-up was conducted at 1 day, 3 months, and 6 months after surgery. The primary outcome measures were visual acuity and central retinal thickness, while secondary outcomes included the incidence of complications.

Results: The study included 113 patients with proliferative PDR in the advanced stages as classified by the ETDRS. The preoperative visual acuity was 0.04±0.02 in Group 1, 0.03±0.71 in Group 2, and 0.06±0.27 in Group 3. Central retinal thickness (CRT) was 512±9.4 µm in Group 1, 477±11.4 µm in Group 2, and 602±17.4 µm in Group 3. At the final follow-up, best-corrected visual acuity (BCVA) improved to 0.35±0.03 in Group 1, 0.41±0.03 in Group 2, and 0.22±0.07 in Group 3 (P ≤0,05). The minimum CRT at this stage was 294±19.4 µm in Group 1, 254±14.3 µm in Group 2, and 301±12.8 µm in Group 3 (P ≥0,05!). The incidence of complications at the final follow-up was as follows: retinal haemorrhage occurred in 2% of patients in both Groups 1 and 2, and 7% in Group 3 (P ≤0,05); haemophthalmos was observed in 0% of patients in Groups 1 and 2, but 9% in Group 3 (P ≤0,05); iris rubeosis occurred in 4% of patients in Group 1, 0% in Group 2, and 6% in Group 3; and tractional retinal detachment was reported in 11% of patients in Group 1, 4% in Group 2, and 19% in Group 3(P ≤0,05). Over the entire follow-up period, the overall complication rates were 30% in Group 1, 18% in Group 2, and 70% in Group 3 (P ≤0,05). The high incidence of haemorrhagic complications in Group 3 (22%) was statistically significant (P ≤0,05).

Conclusion: Preoperative administration of Ranibizumab at different intervals prior to surgical intervention statistically significantly improved both functional and anatomical outcomes in the treatment of PDR compared to sham treatment. The best functional and anatomical outcomes were observed in the group that received anti-VEGF injection five days before vitrectomy.

Recommendations: We recommend preoperative Ranibizumab before surgery. Both timings, 5 days and 30 days, give good results. In addition, we advise against vitrectomy without preoperative Ranibizumab.

Unexpected Corneal Perforation after Use of Topical Non-Steroidal Anti-inflammatory Drugs

Houda Bezza, Oumayma El Mansouri, Asma El Adrari, Mohamed Kriet, Fouad Elasri — Fri, 23 May 2025 00:00:00 +0000

We report a case of 67-year-old with a type 2 diabetes on insulin therapy followed for moderete proliferative diabetic retinopathy undergoing pan-retinal photocoagulation (PRP) who suffered from ocular redness and pain after the application of Non-steroidal anti-inflammatory drugs (indomethacine) post-PRP. Slit lamp examination, a corneal perforation was noted on the inferotemporal side of the right eye, with iris that seals the perforation. We performed an anterior segment optical coherence tomography (OCT) of the right eye revealing corneal perforation with iris plugging the perforation and re-epithelialization of the defect.

Challenges and Management Strategies for Endophthalmitis in Silicone Oil-filled Eyes: A Comprehensive Narrative Review

Hassan Moutei, Ahmed Bennis, Fouad Chraibi, Meriem Abdellaoui, Idriss Benatiya — Wed, 23 Apr 2025 00:00:00 +0000

Aims: This narrative review aims to examine current knowledge on the management of endophthalmitis in silicone oil-filled eyes by analyzing therapeutic strategies, clinical outcomes, and the unique challenges associated with this context.

Study Design: Narrative review based on critical synthesis of published clinical and experimental literature.

Place and Duration of Study: Conducted at the Department of Ophthalmology, University Hospital Hassan II of Fez. The literature analyzed spans from January 2000 to March 2025.

Methodology: A Systematic search of the PubMed, Scopus and Google Scholar databases was carried to identify publications written in English or French that specifically addressed endophthalmitis in the context of silicone oil tamponade. Studies included randomized and non-randomized trials, clinical case series, systematic reviews, and cohort studies. only articles that provided detailed information on diagnostic approaches, therapeutic protocols, and clinical outcomes were integrated. A total of 221 publications were initially identified. Data were synthesized narratively.

Results: Although rare, endophthalmitis in silicone oil filled eyes constitutes a major diagnostic and therapeutic challenge. The antimicrobial properties of silicone oil, while suggested by experimental and clinical findings, remain debated and vary depending on the pathogen. Key risk factors include unsutured sclerotomies, combined procedures, and anatomical variables. The clinical presentation is often atypical, complicating early detection. Culture positivity remains low. The mainstay of treatment consists of silicone oil removal, intravitreal antibiotic injection and, in selected cases, reinjection of silicone oil. Pharmacokinetic studies suggest altered antibiotic behavior in oil filled eyes, requiring dosage adjustments. Despite adequate treatment, visual outcomes are often limited.

Conclusion: The rapid adaptation of therapeutic based on cultures results, antibiotic sensitivity profiles, and the clinical response remains crucial in the management of infectious endophthalmitis occurring in eyes underwent tamponade by silicone oil. Although available data are mainly derived from retrospective analyzes and isolated cases reports, they highlight the importance of early intervention and tailored management. Larger prospective studies are necessary to optimize diagnostic and therapeutic protocols and improve visual prognosis. Additionally, further research into the antimicrobial properties of silicone oil and the impact of current management strategies on long-term outcomes is needed.

Anterior Ischemic Optic Neuropathy Revealing Thyroid and Lymph Node Tuberculosis: A Case Report

Lakrafi Yassir, Mina Moudatir, Khadija Echchilali, Hassan El Kabli — Sat, 01 Mar 2025 00:00:00 +0000

Tuberculosis is a bacterial infection caused by the Mycobacterium tuberculosis complex, which includes five Mycobacteriums : Tuberculosis (commonly known as Koch's Bacillus), Bovis, Africanum, Microti, and Pinnipedii. This condition affects both humans and certain animal species (such as cattle). Human contamination occurs either via respiratory or digestive routes, with four possible outcomes: early-onset of the tuberculosis disease, late-onset of it, latent tuberculosis infection, or the total elimination of the bacillus. It can affect both immunocompetent and immunodeficient individuals, and when the disease manifests, it may be unifocal or multifocal, leading to clinical polymorphism that complicates the diagnostic process. We report the case of a patient, who had contact with livestock (the wife of a farmer who owns cattle), with no known immunodeficiency, vaccinated against tuberculosis, and in whom bifocal tuberculosis was diagnosed following an etiological assessment of anterior ischemic optic neuropathy. This represents a presentation undescribed previously, with the following atypical features: bifocal localization in an immunocompetent patient vaccinated against tuberculosis, the unusual thyroid involvement, the identification of Mycobacterium Bovis, and the fact that this inaugural presentation has not been previously documented in the medical literature.

Bilateral Central Retinal Vein Occlusion Revealing Malignant Hypertension and Terminal Renal Failure: A Case Report

Thu, 22 May 2025 00:00:00 +0000

AIMS: This case highlights the critical need for routine blood pressure monitoring, as unrecognized hypertension can lead to devastating complications. Early diagnosis and timely intervention are essential to prevent irreversible target organ damage and improve long-term cardiovascular and renal outcomes.

Case Report: We present the case of a 35-year-old male who developed acute bilateral vision loss due to grade IV hypertensive retinopathy with bilateral central retinal vein occlusion. Further investigations revealed previously undiagnosed malignant arterial hypertension, complicated by end-stage renal disease and severe left ventricular hypertrophy. Despite prompt initiation of intensive antihypertensive therapy, renal function remained irreversibly impaired, necessitating kidney transplantation six months later. Over a one-year follow-up period, hypertensive retinopathy gradually resolved.

Conclusion: Malignant hypertension is a severe and life-threatening condition that can lead to multiorgan damage if left undiagnosed and untreated.

Trabeculectomy: Outcomes, Complications and Factors of Failure in an Adult Population

Tue, 18 Mar 2025 00:00:00 +0000

Glaucoma is the most common irreversible blindness-causing pathology worldwide, and its prevalence continues to increase. It is often asymptomatic for a long time, which frequently delays diagnosis. Trabeculectomy remains the reference technique for surgical management of glaucoma.
The goal of this study is to describe the characteristics, outcomes, and postoperative complications of trabeculectomy, and to identify the risk factors related to its failure, in order to increase the success rate and its effectiveness in our context.

This is a retrospective study of eyes that underwent trabeculectomy between 2020 and 2024 at the ophthalmology department. Data were collected using a chart containing preoperative, perioperative, and postoperative parameters. An empirical analysis was conducted, leading to various statistical results. The SPSS software was used to study the prognostic factors for therapeutic failure of trabeculectomy.

A total of 62 eyes from 59 patients were identified. The most common etiology was primary open-angle glaucoma (50%). The average number of hypotensive medications used was 3.9, and 64% of patients were on quadruple therapy. The average visual acuity (VA) in logMAR before trabeculectomy was 1.55 (corresponding to 1.6/10), and the preoperative intraocular pressure (IOP) was an average of 30 mmHg ± 1.5. Regarding anti-metabolites, 40% had received 5-FU, while only 24% had received MMC.

Postoperatively, VA improved by two lines, from 0.4 log MAR immediately post-surgery to 0.2 log MAR at 10 months. At 10 months postoperative, the filtration bleb (BDF) was formed in 96% of cases, with two blebs remaining encapsulated, and one eye maintaining a flat bleb. The IOP reached an average of 14.8 ± 0.3 mmHg.

Early complications included immediate postoperative hypotony in 10 eyes, managed by reinforcement of the sutures, with recovery in 7 cases; 3 cases complicated with choroidal detachment and hyphema. Immediate postoperative elevated IOP was seen in 9 patients, managed by BDF massage in 5 eyes, and needling in 4, with recovery in follow-up visits.
Late complications were mostly cataract development in 16% of cases (10 eyes), choroidal detachment in 3 eyes (1 recovered, 2 progressed to phthisis), blebitis-related endophthalmitis in 2 eyes (recovered with antibiotic injections), and endophthalmitis from a corneal abscess on a severely altered surface, with no recovery.

Therapeutic success, defined as an IOP ≤18 mmHg, was achieved in 84% of cases (complete success in 44% of eyes, partial success with adjunctive medical treatment in 40% of eyes). Therapeutic failure occurred in 16% of cases. The risk factors associated with therapeutic failure identified in our study were: younger age (p=0.02), type of glaucoma (secondary glaucoma, p=0.04), preoperative IOP (p=0.001), and non-use of anti-metabolites (p=0.01).
Our results align with several studies in the literature, particularly the large AGIS study and the study by Edmunds et al., which represent national experience with trabeculectomy in England, focusing on complications and risk factors for failure.

This study is significant because it assesses how trabeculectomy treats glaucoma, determines risk factors for adult surgical failure, and demonstrates possible outcomes. By improving surgical methods, postoperative care, and patient selection, an understanding of these results raises long-term success rates and preserves vision. Knowledge of these risk factors will also help improve the success rate of trabeculectomy and minimize postoperative complications, leading to better overall management of glaucoma.

Gonioscopy and Ultrasound Biomicroscopy in the Detection of Narrow Anterior Chamber Angle

Mon, 09 Jun 2025 00:00:00 +0000

Background: Glaucoma, a leading cause of irreversible blindness worldwide, demands early detection to prevent vision loss. Primary angle-closure glaucoma (PACG) is more common and severe in asian populations. Gonioscopy is the clinical gold standard for evaluating anterior chamber angles (ACA), but its subjective nature limits accuracy. Ultrasound biomicroscopy (UBM) offers an objective, high-resolution alternative.

Objective: This study aimed to compare the efficacy of gonioscopy and UBM in evaluating anterior chamber angles in patients with occludable angles identified by van Herick criteria.

Methods: A cross-sectional study was conducted at the National Institute of Ophthalmology & Hospital (NIO&H), Dhaka, from March 2018 to February 2020, involving 30 eyes of 30 patients. Each underwent gonioscopy with a Posner 4-mirror goniolens and UBM using a 50-MHz probe. Parameters measured included Anterior Chamber Angle (ACA), angle opening distance at 500 µm (AOD 500), and anterior chamber depth (ACD). Diagnostic values of UBM were analyzed using SPSS v25.

Results: Participants had a mean age of 57.93 ± 6.65 years; 63.3% were female. Gonioscopy mostly revealed Grade 2 angles. UBM commonly showed angles between 110–200 µm. UBM exhibited high sensitivity (91.7%–100%) and specificity (50%–100%), with an overall diagnostic accuracy of 93.3%.

Conclusion: UBM is a reliable, sensitive, and specific tool for evaluating occludable angles. It complements gonioscopy and enhances diagnostic precision in glaucoma management, especially in tertiary care settings.

A Retrospective Study on AIDS Related Ocular Complications Particularly Cytomegalovirus Retinitis in 100 AIDS Patients

Sat, 28 Jun 2025 00:00:00 +0000

The aim of this work is to investigate the ocular complications of AIDS and especially cytomegalovirus retinites. This is a retrospective descriptive study of 100 patients (diagnosed with HIV according to WHO diagnostic criteria for all stages) for a duration of 02 years (January 2019 to January 2021) and follow-up at the adult ophthalmology department at the University Hospital 20 August in Casablanca. Out of 100 patients examined: 60 patients have an ophthalmological involvement of the posterior segment, Sex ratio: 0.73(41.66% Men, 58.33% women), Average age: 40 years with extremes of 25 and 60 years, the average rate of CD4 was 233 cells/mm.

Expert Perspectives on the Management of Moderate to Severe Dry Eye Disease in Indian Settings

Manjula S, Krishna Kumar M — Mon, 07 Jul 2025 00:00:00 +0000

Objective: To assess ophthalmologists’ clinical perspectives on the burden, diagnosis, and management of moderate to severe dry eye disease (DED), with a particular focus on the use of trehalose-based formulations in Indian settings.

Methods: The cross-sectional study was conducted among 192 ophthalmology experts across India using a 23-item questionnaire to evaluate their perspectives on DED, including its prevalence, demographics, diagnostic approaches, treatment preferences, management challenges, and use of therapies such as trehalose. Data were analyzed using descriptive statistics, with categorical variables presented as percentages.

Results: Nearly half of the clinicians (46.88%) preferred trehalose as a lubricant for managing moderate to severe DED, particularly after cataract surgery. The majority (42.71%) had been using trehalose eye drops for 3–5 years, and approximately 68% reported switching to trehalose when patients showed an inadequate response to carboxymethylcellulose 0.5%. About 45% of the experts noted that the most common dosing regimen was four times daily. Improvement in Schirmer’s values and tear breakup time (TBUT) by week eight was observed by around 46% of clinicians. A large majority of respondents (80.73%) stated that trehalose acts through multiple mechanisms, including induction of autophagy, protection against oxidative stress, and preservation of labile proteins.

Conclusion: The study highlights the growing preference for trehalose-based eye drops in managing moderate to severe DED, especially post-cataract surgery, among Indian clinicians. Consistent clinical improvements and recognition of trehalose’s multifaceted mechanisms support its use, particularly when conventional lubricants are ineffective.