ABSTRACT
To describe correlation between central corneal thickness [CCT] and endothelial cell density [ECD] in non-glaucomatous pseudoexfoliative eyes and compare them with age-matched normal eyes. Cross sectional comparative study. Forty eyes of forty subjects with Pseudoexfoliation syndrome [Group A] and forty eyes of forty age-matched subjects without PXS [Group B] were included. Subjects suffering from diabetes, myopia, glaucoma, any pathology of anterior segment, ocular trauma, inflammation or surgery, and contact lens wearers were excluded. Included eyes underwent non-contact specular microscopic examination [Topcon SP2000.P, Topcon Corp. Japan.] to get data about CCT and ECD. CCT in group A was significantly lower than group B [484.68 + 19.727 Vs 500.25 + 24.777 [micro]m, p= 0.003]. ECD in group A was significantly lower than in group B [2124.60 + 251.818 Vs 2431.43 + 224.820 cells/mm2, p<0.000]. There was non-significant correlation between ECD and CCT in both groups. Non-glaucomatous pseudoexfoliative eyes have thinner corneas with decreased ECD. Knowledge of these parameters may be helpful in interpreting intra-ocular pressure and planning surgical procedures
ABSTRACT
To report the frequency, demographic pattern and clinical profile of primary open angle glaucoma [POAG] at Al-Shifa Trust Eye Hospital, Rawalpindi. A hospital based cross sectional observational study. All the patients aged 40 years and above reporting for the first time at glaucoma clinic of Al-Shifa Trust Eye Hospital, Rawalpindi from 1[st] July 2006 to 31[st] December 2007. Initial screening of all the patients was done at general outpatient department of hospital. All confirmed or suspected cases of glaucoma were referred to glaucoma clinic. After taking history, a detailed ocular examination of all patients including Snellen visual acuity, slit lamp biomicroscopy, applanation tonometry, gonioscopy and a stereoscopic assessment of cup disc ratio [CDR] was performed. In selected subjects, Heidelberg retinal tomography and automated visual field assessment was advised. Individual treatment plan for each eye was made keeping in view the stage of disease, compliance and affordability of the patient. Statistical analysis of the data was done with statistical software SPSS version 13.0. Out of the total 1068 patients aged 40 years and above, primary open angle glaucoma was diagnosed in 403 [37.73% of total] patients. Among these 403 patients, 250 [62.0%] were male and 153 [38.0%] were female. Male to female ratio was 1.63:1. Age of the patients ranged from 40-103 years with a mean age of 60.64years [ +/- 12.824 Std. Devj. Bilateral POAG was found in 334 patients [82.87%]. 33 [8%] patients were blind at the time of presentation while 134 [33.25%] patients had a cup disc ratio of 0.8 or more in both eyes. 603 [82.82%] eyes were treated medically, while trabeculectomy was the most common surgical procedure performed in 102 [14.01%] eyes. Majority of the patients belonged to Rawalpindi/Islamabad [43%] and Azad Kashmir [9.3%]. POAG is the most frequent type of glaucoma in our population with male predominance. Unfortunately the disease is more advanced at the time of presentation due to lack of public awareness. Despite availability of modern investigations, finding a patient of glaucoma while there is still some useful visual potential to save is still a big challenge for ophthalmologists in Pakistan
ABSTRACT
Stem cell therapy is emerging as a potentially revolutionary new way to treat ocular surface disorders. Stem cells are a kind of template cells for the body, producing various tissues and cell types. Embryonic stem cells are undifferentiated cells that can develop into any type of adult cells in an appropriate environment or culture. These are derived from embryo 4-5 days after fertilization. An adult stem cell is an undifferentiated cell found among differentiated cells in a tissue or organ; can renew itself and can differentiate to yield the major specialized cell types of the tissue or organ. Stem cells for the cornea reside in the limbal basal epithelium. The limbal palisades of Vogt and the interpalisade rete ridges are believed to be repositories of stem cells. Limbal stem cells are crucial in maintaining the cell mass of corneal epithelium under normal conditions and play an important role in corneal epithelial wound healing. Damage to stem cells results in conjunctivalization of cornea. Corneal Stem Cell Deficiency can be best confirmed histologically by the use of impression cytology. Ocular surface reconstruction techniques have advanced considerably during the last few years with the advent of amniotic membrane transplantation. The latest approach to limbal stem cell transplantation is based on the principle that under suitable laboratory conditions, a small population of limbal stem cells may be expanded from a small biopsy using 3T3 feeder layer or amniotic membrane for subsequent reconstruction of the ocular surface
ABSTRACT
To calculate the frequency of various ocular diseases and provide information regarding causes of visual impairment in the patients aged 70 years and above presenting at Senior Citizens Clinic [SCC] of Al-Shifa Trust Eye Hospital, Rawalpindi. A retrospective analysis of patient record. Randomly selected 1,000 newly registered patients aged 70 years and above who presented at the SCC of Al-Shifa Trust Eye Hospital, Rawalpindi from January 2005 to April 2006. After a brief history, a detailed ocular examination of all the patients was performed, including visual acuity assessment, external inspection, biomicroscopy, applanation tonometry and fundus examination. Further investigations in some cases were advised to establish the diagnosis. Various management options were medical, surgical, prescription of glasses or referral to other clinics. All this record was maintained on specially designed Performa and analyzed using SPSS 10.0. The most common complaint was decreased vision in 89% of patients. The most frequent disease was cataract in 44.3% patients. Visual impairment [Visual acuity equal to or <6/60 in the better eye] was recorded in 21.1% patients and the major causes of visual impairment were cataract in 45%, glaucoma in 15.38% and retinal diseases in 14.61%. Intra ocular pressure >22 mm of Hg in both eyes was found in 5.8% patients while 6.9% had >22 mm of Hg in one eye at the time of presentation. Regarding the management, 46.3% patients were advised surgery, 12.9% were treated medically, 24.7% were refracted, and 14.9% were referred to specialized clinics. Majority of the patients [48.31%] were from Rawalpindi / Islamabad. Cataract, glaucoma, retinal and corneal diseases are a major challenge to ophthalmologists in Pakistan because these diseases remain main causes of visual impairment in our elderly patients, thus affecting their quality of life. The elderly should be encouraged to come for annual ocular examination so that early detection of visual impairment is done and permanent visual loss is prevented
ABSTRACT
Keratoplasty is the leading organ transplant procedure in the world. Keratoplasties are being regularly performed at Al-Shifa Eye Hospital Rawalpindi since 1992. Results of our experience of 509 penetrating keratoplasties performed at our institution from 1992 to 2000 are being presented. A total of 509 Keratoplasties were done on 476 patients including 308 [65%] males and 168 [35%] females. Post operative corrected visual acuity was 6/12 or better in 45% cases. Associated procedures were performed on 77 eyes. Most important complications seen were, graft rejection [13%], secondary graft failure [8%], secondary glaucoma [7%] and secondary cataract [5.5%]. We conclude that these results compare favourably with other studies in the region and penetrating keratoplasty can effectively be performed with good visual out come in low risk cases with acceptable morbidity. Various associated procedures can also be safely added to the primary procedure in selected cases