Anterior lamellar marginal z-plasty with transverse tarsotomy for management of trichiasis with cicatricial entropion -a new surgical approach

Trichiasis is the main risk factor for corneal opacification. The primary treatment of trichiasis is surgical. Successful surgery is likely to halt the progression of corneal opacity. The aim of the study is to report the efficacy of the anterior lamellar marginal z-plasty combined with transverse tarsotomy in the management of severe trichiasis andcicatricial entropion of upper eyelid. A prospective study was carried out from January 2009 to June 2012, on 54 eyelids [44 patients] who underwent anterior lamellar marginal z-plasty with transverse tarsotomy for correction of trichiasis and cicatricial entropion involving upper eyelid with a minimum of 6 months' follow-up. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale [better, worse or no change]. Failure was defined as recurrent trichiasis with one or more lashes touching any part of cornea in primary position. Secondary outcomes were visual acuity and corneal opacification. At the end of six month period, none of patients had any trichiatic eye lash touching the cornea in primary position [100% success]. Forty-eight [88.9%] of the operated eyelids were free of trichiasis, while residual trichiasis was noticed only in 6 [11.1%] operated lids. At the end of six months, there was a significant reduction of lash burden from median of 12 trichiatic lashes from the base line to the median of 2. All the patients reported significant reduction in symptoms of irritation. Significant improvement in visual acuity [p<0.000] and reduction in the density of corneal opacity [p<0.000] was notified from the base line. Anterior lamellar marginal z-plasty combined with transverse tarsotomy seems to have promising surgical outcome for the correction of trichiasis and cicatricial entropion secondary to cicatricial trachoma.

Status of children in blind schools in the Northern Areas of Pakistan

Prevalence of blindness in Pakistan is estimated to be 0.9%, which comes to about 1.25 million persons. A significant number of these are persons under 20 years of age. To make these children useful citizens in future, special facilities are to be provided to these children for their education and training. A study was done to find out the visual status of the students studying in a blind school in Abbottabad, Pakistan, the only such facility in the region. A total of 50 patients were examined during our visit to the blind school in Abbottabad. Age of the patients ranged from 6 to 27 years [mean: 12.32 years]. All the students, who were otherwise healthy, were included in the study. The most common disorder identified was malformed globe or traumatic eyes [16 cases, 32%], in most of the cases, leading to phthisis bulbi. Other conditions noticed were Retinitis Pigmentosa [10 cases, 20%], Keratoconus, Optic atrophy, Buphthalmos [6 cases each, 12%], corneal opacity [4 cases, 8%] and retinal detachment [2 cases 4%]. We should work towards betterment of these schools by providing them with more funds, equipment and manpower. Regular visits of Ophthalmologists to these schools may be helpful. Genetic counselling should be arranged for the families

Recurrent episcleritis in children-less than 5 years of age

Episcleritis, though common in adults, is a rare disease in children. Episcleritis is associated with systemic diseases in a third of cases in adults. Here we describe systemic diseases associated with recurrent episcleritis in children less than five years of age. This Retrospective Observational case series study was conducted at the Department of Ophthalmology of Ayub Teaching Hospital, Abbottabad, from March 1995 till February, 2006. Six children diagnosed clinically with recurrent episcleritis were included in this study. Complete ophthalmologic as well as systemic evaluation was done in each case. This study was conducted on 6 children with a diagnosis of recurrent episcleritis. There were four boys and two girls, with an age range of 35-52 months. Right eye was involved in three cases, left eye in two cases while one case had a bilateral disease. Recurrence occurred in the same eye in all cases, with one bilateral involvement. Four children [66%] had a history of upper respiratory tract infection in the recent past. No other systemic abnormality was detected in any case. Two cases had a history of contact with a pet animal. Recurrent episcleritis in young children is a benign condition. Upper respiratory tract infection is the most common systemic association. Pet animals may be a contributory factor

Frequency of hypertension in stroke patients presenting at Ayub teaching hospital

Stroke is a frequent medical problem occurring in patients with hypertension and other risk factors. The objective of this study was to find the frequency of hypertension as important risk factor in stroke patients presenting at Medical 'B' unit of Ayub Teaching Hospital, Abbottabad from November 2003 to January 2005. Patients who clinically presented with features of stroke and then confirmed on C.T scan were included in this study. Other underlying risk factors were diabetes mellitus, smoking, cardiovascular disease and dyslipidemia. Hypertension was found to be the most common risk factor in current study. Out of 91 cases, 51 [56.04%] were suffering from hypertension. Thirty five patients were male and sixteen patients were female. Peak stroke prone age was 61-70 years in males and 51-60 years in females. Hypertension is the leading risk factor of stroke. It is therefore essential to detect and treat hypertension at its outset

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan

There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy [MDT]. Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes [including opacity, ulceration, and/or anaesthesia] in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 [11%] patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. Conclusions: A significant number of leprosy patients [73%] have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients