Features of retinopathy of prematurity in a tertiary care hospital in Lahore

To study the demographic and clinical features of Retinopathy of Prematurity in urban Punjab. The cross-sectional study was performed at Hameed Latif Hospital, Lahore, from April 2010 to October 2013 and comprised neonates born with birth weight less than 2000g, gestational age less than 37 weeks, or those who were considered high risk for Retinopathy of Prematurity. Variables recorded included history, birth weight, gestational age, oxygen supplementation, development of Retinopathy of Prematurity, and laser treatment. Data was analysed using SPSS 17. There were 285 neonates in the study with a mean birth weight of 1280.34 +/- 350.43g and mean gestational age being 29.38 +/- 3.14 weeks. Overall, 167[58.6%] received supplemental oxygen, 86[30.2%] were anaemic and 44[15.4%] received blood transfusion. Besides, 47[16.5%] premature babies were product of multiple gestation, 34[11.9%] were having respiratory distress, 25[8.8%] had sepsis and received intravenous antibiotics, 70[24.6%] developed Retinopathy of Prematurity, and 22[7.7%] developed threshold disease and received laser treatment at mean gestational age of 32.11 +/- 2.53 weeks. Screening is key to preventing childhood blindness caused by Retinopathy of Prematurity. Prematurity, low birth weight and supplemental oxygen therapy are significant risk factors for the condition

Efficacy of external dacryocystorhinostomy [DCR] with and without mitomycin-C in chronic dacryocystitis

To compare the efficacy of external dacryocystorhinostomy [DCR] with and without intraoperative application of mitomycin-C in patients with chronic dacryocystitis. An experimental study. Department of Ophthalmology, Bahawal Victoria Hospital [BVH], Bahawalpur, from September 2009 to December 2010. One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group A included patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups. Surgical success rate [efficacy] in group 'A' was found to be 97.5% and 86.25% in group 'B'. The difference in success rate was statistically significant [p=0.017]. External dacryocystorhinostomy with intraoperative mitomycin-C is more efficacious in achieving lacrimal system patency than external dacryocystorhinostomy without mitomycin-C

Effect of intracameral use of dexamethasone on corneal endothelial cells

To evaluate the effect of intracameral dexamethasone on corneal endothelium. Quasi experimental study. Layton Rehmatulla Benevolent Trust Eye Hospital, Lahore, from May 2011 to January 2012. Study subjects were adults of either gender with senile cataract who underwent phacoemulsification. They were divided in two groups, each had 110 patients. Group-A received subconjunctival injection of dexamethasone [2 mg/0.5 ml] at the end of surgery while group-B received intracameral injection of dexamethasone [0.4 mg/0.1 ml] at the end of surgery. Endothelial cell count was performed by specular microscopy pre-operatively and postoperatively at first week, first month and three months. Outcome measures included changes in endothelial cell count. Results were compared using t-test for means. There were 55 [50%] males and 55 [50%] females in group-A and 44 [40%] males and 66 [60%] females in group-B. In group-A, there were 66 [60%] right and 44 [40%] left eyes while group-B had 62 [56.36%] right and 48 [43.63%] left eyes. Mean age in group-A was 55.17 +/- 5.93 years and 54.87 +/- 5.55 years in group-B. Mean phacoemulsification time in group-A was 1.92 +/- 0.63 minutes and 1.82 +/- 0.54 minutes in group-B. After 3 months, in group-A, there was 7.55 +/- 1.19% endothelial cell loss while in group-B, there was 7.63 +/- 1.10% endothelial cell loss. The difference between the two groups was not statistically significant [p=0.614]. Use of intracameral dexamethasone at the end of cataract surgery is safe for corneal endothelium.

Intravitreal bevacizumab in central serous chorioretinopathy

To evaluate the effect of intravitreal bevacizumab injection in patients with central serous chorioretinopathy [CSCR]. Quasi-experimental study. Layton Rehmatullah Benevolent Trust Eye and Cancer Hospital, Lahore, from July 2010 to April 2011. There were 43 eyes of 32 adult patients with CSCR. Patients with choroidal neovascularization, prior treatment for CSCR, history of thromboembolism, intraocular pressure more than 21 mmHg, history of retinal detachment, intraocular inflammation, and allergy to fluorescence were excluded from study. All patients had intravitreal injection of off label bevacizumab. At baseline and follow-up visits, patients had best corrected visual acuity [BCVA] and central macular thickness [CMT] measurement with optical coherence tomography. They were followed-up for 6 months. Outcome measures included BCVA and CMT. Wilcoxon Signed Ranks test was used for evaluation of BCVA and CMT. There were 26 [81.3%] males and 6 [18.7%] females with 21 [65.5%] cases of unilateral and 11 [34.5%] cases of bilateral involvement. Mean age was 39.09 +/- 8.49 years. Nineteen [59.4%] eyes showed less than 6 months involvement and 13 [40.6%] eyes showed more than 6 months involvement. Mean number of injections required was 2.37 +/- 1.24 in acute cases and 3.05 +/- 1.39 in chronic cases. Overall mean of required injections was 2.67 +/- 1.34. Median visual acuity at baseline was 0.25 and at 6 months was 0.7 [p < 0.001]. Median CMT at baseline was 557 micro and at 6 months was 286 micro [p < 0.001]. Intravitreal bevacizumab injection was associated with visual improvement and reduced neurosensory detachment

Bilateral loss of light reflex and accommodation following 360 peripheral retinal laser therapy

We report a case of bilateral loss of pupillary light reflex and accommodation following 360° peripheral retinal laser therapy. A 24 years old male underwent prophylactic laser barrage for peripheral retinal lattice degenerations. Soon after the procedure, he developed bilateral loss of pupillary light reflex and accommodation. The patient faced difficulty while doing near work. On instillation of 0.125% pilocarpine, both pupils demonstrated the phenomenon of denervation supersensitivity. Damage to the short ciliary nerves was the most likely mechanism responsible for this adverse outcome

Effect of phacoemulsification on intraocular pressure

To evaluate the effect of phacoemulsification on intraocular pressure in normal eyes and glaucomatous eyes. Quasi-experimental study. Layton Rehmatulla Benevolent Trust, Eye and Cancer Hospital, Lahore, from September 2009 to August 2010. The study subjects were adult patients with cataract and open or occludable angle, with or without raised intraocular pressure, who underwent phacoemulsification. Patients having any corneal pathology, synecheal angle closure more than 180 degrees, inflammatory eye disease, previous ocular surgery including YAG iridotomy and endothelial cell density less than 1500/mm[2] were excluded from the study. They were followed-up for one year. Outcome measures included intraocular pressure, angle width, visual acuity and number of antiglaucoma medicines. Results were compared using chi-square test for proportions and t-test for mean values. There were 50 [41%] males and 72 [59%] females with 80 [65.6%] right and 42 [34.4%] left eyes. Mean age was 56.4 +/- 8.57 years. Pre-operatively 52 patients had open angles while 70 patients had occludable angles. Postoperatively 96 patients had open angles and 26 patients had occludable angles. Mean pre-operative IOP was 25.70 +/- 7.79 mmHg, which was decreased to 17.44 +/- 2.8 mmHg [p <0.001] at final follow-up visit. Number of mean antiglaucoma agents decreased from 1.12 +/- 1.30 pre-operatively to 0.62 +/- 0.92 at final follow-up visit. Mean pre-operative visual acuity was 0.4 +/- 0.19 that increased to 0.86 +/- 0.15. Phacoemulsification resulted in reduction in intraocular pressure in normal as well as glaucomatous eyes and it significantly reduced the need for anti-glaucoma medicines

Visual results following intravitreal bevacizumab in neovascular age-related macular degeneration

To determine the visual and anatomic outcome of intravitreal Bevacizumab injection in the treatment of neovascular age-related macular degeneration [AMD]. Quasi-experimental study. Layton Rahmatulla Benevolent Trust Eye Hospital [LRBT], Lahore, from January to July 2010. Patients who received, one or more intravitreal Bevacizumab injections [1.25 mg per 0.05 ml] for exudative AMD were included in the study. Outcome measures included standardized visual acuity, optical coherence tomography [OCT], macular thickness, intraocular pressure, and blood pressure at 24 or more weeks follow-up. Descriptive statistics were obtained. Fifty eyes with exudative AMD were observed for six months. The mean VA improved from 0.21 +/- 0.11 before injections to 0.43 +/- 0.11 after injections at six months. Overall, mean OCT macular thickness decreased by 99 micron at last follow-up. At last follow-up, all eyes received an average of 3.28 +/- 0.85 injections. There was no incidence of severe vision loss or adverse effects like endophthalmitis or retinal detachment. Intravitreal Bevacizumab has the potential for improvement of vision in exudative AMD for at least 6 months

Accuracy of the retinal nerve fiber layer measurements by stratus optical coherence tomography for perimetric glaucoma

To calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of measurements of the retinal nerve fiber layer using the Stratus optical coherence tomography in glaucoma subjects with visual field defects on achromatic perimetry as the gold standard. Comparative cross-sectional. Outdoor clinic of Layton Rehmatulla Benevolent Trust Hospital [LRBT], Lahore, from August 2007 to January 2008. Fifty normal subjects and 50 glaucoma patients were selected from outdoor clinic of LRBT. Retinal nerve fiber layer thickness [RNFL] of all the subjects were measured by Stratus optical coherence tomography [OCT]. Visual field defects on achromatic perimetry was used as the gold standard. The sensitivity and specificity of retinal nerve fiber layer measurement for perimetric glaucoma using the OCT were 82% and 96% respectively. The positive predictive value, negative predictive value and diagnostic accuracy were 95%, 84% and 89% respectively. There is a high sensitivity and specificity of RNFL measurements using the new Stratus OCT for the diagnosis of perimetric glaucoma