Cataract surgery is constantly evolving. Purpose of this study was two folds: to estimate visual outcome and evaluate safety and efficacy of sutureless manual extra-capsular cataract extraction.This was a prospective, interventional case series, using sutureless manual extra capsular cataract surgery technique from June 2004 to January 2007 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex Peshawar. Patients included in the study were those having operable cataracts. All those having corneal co-morbidities extensive enough to block visualisation of posterior segment details, chronic adenexal diseases, long standing glaucoma, advanced diabetic eye disease and retinal detachment evident on B-Scan ultrasonography were excluded from the study. After thorough examination and investigation all the patients were operated upon by a single experienced surgeon using the same technique. Their visual outcome was analysed. The patients were followed for a period of six weeks.A total of 1500 cataract surgeries were carried out, of which 1211 (80.74%) patients completed six weeks of follow up. Seven hundred and fifty seven (62.51%) had an uncorrected good visual acuity (6/6-6/18) on 1st post-op day, 1131 patients (93.40%) had an uncorrected visual acuity of 6/6-6/18 on 6th week follow up. Mean surgically induced astigmatism at 6 weeks was 0.3 dioptres.Sutureless manual extra capsular cataract surgery is a safe and effective technique. It offers faster wound healing and quick rehabilitation of cataract patients at any level of community eye care setting.
Objectives: Pterygium is a wedge of conjunctival tissue ploughing across the limbus into the superficial cornea. Various surgical techniques are used to treat this condition. Conjunctival auto-transplant over the bare area is one of the techniques used. This trial was conducted to evaluate the results of conjunctival autotransplant in the treatment of pterygium.
Material & Methods: This study was conducted at Saidu Teaching Hospital, Saidu Sharif Swat and Kuwait Teaching Hospital Peshawar, from 1st July 2008 to 31th December 2009. Complete history and clinical examination was recorded on a pre-designed profroma. The diagnosis of pterygium was a clinical one. All the pterygia were examined with slit lamp to look for vascularity, advancement towards the cornea and congestion. The surgical technique comprised of surgical excision of pterygium, and conjunctival auto-transplant on the bare sclera. Nylon 10/0 was used for suturing the conjunctiva. Follow up period was 6 months.
Results: In this study 70 patients were operated; 51 males and 19 females with a male to female ratio of 2.9:1. Recurrences occurred in 6(9.52%) cases. Other post-operative complications were granuloma formation in 1(1.58%), conjunctival cyst formation 2(3.7%), and persistent irritation due to chronic inflammation in 2(3.17%) case. Minor post-operative temporary complications were graft edema, delayed wound healing and foreign body sensation.
Conclusion: Conjunctival auto-transplant is an effective and safe procedure for excision of pterygium.
Purpose: To evaluate the efficacy and safety of cataract extraction through small pupil with the help of a specially designed instrument called club. Study Design: Interventional case series. Place and Duration of Study: Euro eye clinic from January 2019 to December 2019. Methods: Seventeen consecutive patients with pupil diameter of <4mm after maximal pharmacological dilatation were recruited for study. Inclusion criteria was patients with less than 4mm pupil size after maximum pharmacological dilation. Patient with previous anterior segment surgery and small pupil with posterior synechea were excluded. The instrument (club) was originally designed for breaking posterior synechae. Sutureless Manual Extracapsular Cataract Extraction (SMECE), more commonly known as MSICS, was performed in all cases. After tunnel formation and capsulotomy, club was used to bring lens edge out in pupillary margin. Lens was then maneuvered into anterior chamber and expressed out. Results: All 17 patients had successful SMECE. In one patient pupil was stretched before applying instrument. None of the patients had posterior capsular rupture or hyphaema. Conclusion: This instrument designed in Center of Ophthalmic Instrument and Equipment Designing (COIED) is very useful, safe and cost effective. In Extra Capsular Cataract Extraction (ECCE) or SMECE, surgeons usually do keyhole iridotomy, mechanical stretching or multiple sphincterotomies for managing small pupil. With this new instrument, cataract extraction can be done without surgical trauma to the pupil, thus preserving pupil shape. Key Words: Sutureless Manual Extra capsular Cataract Extraction (SMECE), Manual Small Incision Cataract Surgery (MSICS), Miosis.
Purpose: To study the effect of intrastromal Voriconazole for treatment of resistant fungal keratitis in a tertiary care eye hospital in Lahore, Pakistan.
Study Design: Experimental interventional study.
Place and Duration of Study: Avicenna Medical College Hospital, Lahore, from July 2017 to July 2019.
Methods: Sixty four patients were selected. All patients with fugal keratitis were included. The patients with previous corneal scar, mature cataract, endophthalmitis, Panophthalmitis, scleral involvement, impending or frank corneal perforation and uncontrolled diabetic patientswere excluded.Corneal scrapings of all patients were sent for 10% KOH staining. All patients were given intrastromal Voriconazole at 3 to 4 sites in divided doses in one ml syringe with 27-guage needle. Injection was repeated on 4th and 8th day. It was combined by topical antifungal and antibiotic eye drops six hourly. Patients were followed at day two, five, nine, three weeks and at 3 months.
Results: There were 55 males and 9 females. Average size of ulcer was 6.4mm ranging from 5.5mm ± 1.8mm. Fifty six (88%) patient showed improvement while eight (12%) patients ended up in melting of cornea which was managed with tectonic corneal graft. In three (5%) patients penetrating Keratoplasty was done. Conjunctival congestion and ocular pain improved significantly one week after third dose but final visual acuity was not significantly improved due to scarring.
Conclusion: The intrastromal corneal voriconazole is an effective treatment for fungal keratitis in term of healing corneal ulcer, control of infection and saving of eye from corneal perforation and permanent blindness.
Key Words: Voriconazole, Fungal keratitis, Penetrating Keratoplasty.
Objective: To compare post-operative induced mean astigmatism and visual acuity in patients undergoing 20-gauge vitrectomy versus 23-gauge vitrectomy. Methodology: It was a randomized controlled trial conducted in the Department of Ophthalmology, Lady Reading Hospital Peshawar from December 2015 till December 2016. Total 70 patients were enrolled on the basis of inclusion and exclusion criteria and were divided into group A and group B randomly on lottery method. Baseline astigmatism and visual acuity was calculated along with mean and standard deviation for each patient before surgery. Patients in group A underwent 20-gauge vitrectomy procedure while patients in group B underwent 23-gauge vitrectomy procedure. The patients were followed up at one week after the surgery. Post-operative astigmatism and visual acuity and their mean and standard deviation were calculated. Results: In group A, mean pre operative astigmatism was 0.70 ±0.39, while in group B, it was 0.79 ±0.44. The mean post operative astigmatism in group A was 2.21 ±0.66, and in group B, it was 0.74 ±0.44. Mean induced astigmatism in group A was 1.52 ±0.51, while in group B, it was 0.08 ±0.25. The mean pre operative visual acuity in group A was 1.66 ±0.78, while in group B it was 1.41 ±0.71. The mean post operative visual acuity in group A was 0.84 ±0.42, while in group B it was 0.67 ±0.40. Conclusion: Vitrectomy with 23-gauge instruments showed decreased induced astigmatism than 20-gauge vitrectomy; however there was no significant difference in the visual acuity between the two procedures.
Abstract AIM: To evaluate the aldose reductase ( ALR2 , rs759853), receptor for advanced glycation end products ( RAGE , rs2070600), and vascular endothelial growth factor ( VEGF , rs833061) association with diabetic retinopathy in type 2 diabetic patients in Khyber Pakhtunkhwa population. Methods: A Case control study was conducted on a total of 550 subjects consisting of 186 with diabetic retinopathy (DR) having type 2 diabetes, 180 had type 2 diabetes (T2DM), and 184 healthy controls (HC). All the samples were subjected to DNA isolation using salting-out method followed by SNP genotyping through Tetra-ARMS PCR. Chi square and Exact Fischer tests were used for allele and genotype distribution. Odd ratio and confidence interval values were found out by online software Medcalc Odd ratio Calculator. Results: Multiple parameters such as random blood sugar (RBS) (p<0.001), fasting blood sugar (FBS) (p<0.001), HbA1c (p<0.001), total cholesterol (p<0.001), LDL (p<0.001), HDL (p<0.001), BMI (p<0.001) and hypertension (p=0.018) showed strong association with DR as compared to DM and HC. Our results showed that VEGF rs833061 (p<.001) and RAGE rs2070600 (p<.001) polymorphism was strongly associated with an increased risk of DR. The odd ratio of CC genotype in VEGF (0.262, 95% CI=0.129-0.531) and AA genotype in RAGE (0.59, 95% CI=0.032-0.110) was noted. However, the significance in ALR2 rs759853 gene polymorphism was observed at (p=0.001). Conclusion: There is a statistically significant association of VEGF rs833061 and RAGE rs2070600 with diabetic retinopathy in type 2 diabetic patients. Also, this is the first study to report the association of RAGE with diabetic retinopathy in type 2 diabetes in Khyber Pakhtunkhwa population.
Objective: To evaluate the drug utilization of Angiotensin Receptor Blocker (ARB) along with their ADRs in a tertiary care hospital. And to monitor, report of adverse drug reaction and drug interactions, if any.
Methods: The patients who meet the inclusion and exclusion criteria were enrolled into the study. The pertinent data such as demographic details, drug name, dose, frequency, and laboratory data were gathered from medical records of the patient and results were analyzed.
Results: Total of 100 patients were included in this study, the maximum utilization of antihypertensive drug (ARB) was telmisartan (90%) and widely use of ARBs in the age group of 41-50 y. Total 32 ADRs were observed and most probable ADRs included headache (42.8%), Nausea (14.28%) and dizziness (12.5%).
Conclusion: Telmisartan was the most prescribed and utilized drug than the other drugs of ARBs. Maximum ADRs were noted in females, the most frequent ADRs headache, nausea and dizziness were reported. The majority of reactions were probable on causality assessment done by WHO-UMC and Naranjo’s scale having mild severity. So it can be concluded that considering risk factors, prevention and management of ADRs can drastically improve the therapeutic outcomes of the patients.
To assess patients' history, demographic charactertics, cause for enucleation and orbital implant trends.A cross-sectional descriptive case study of 70 patients who underwent enucleation for various reasons between January 2004 to June 2007 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar were reviewed. The patients' history, demographic characteristics, cause for enucleation after histopathology and the type of orbital implant were analyzed.Seventy eyes of patients who underwent enucleation were reviewed. The male patients were 62.85% and female 37.14%. The most common age group involved was paediatric in 51.42%. Retinoblastoma was the most common indication for enucleation in 42.85% of children followed by choroidal melanoma in 17.14%, painful blind eye in 11.42% and phthisis bulbi in 8.57% in adults. Enucleation with orbital implant was done in 45.71%, with dermofat graft in 34.28% and no implant in 20%. The most common complication being erosion in 21.87% and excessive discharge in 15.62%.Males were the usual victims. Majority of patients were of paediatric age group. The most common indications for enucleation was retinoblastoma in children and choroidal melanoma and painful blind eye in adults.
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