Prevalence of ocular Leishmaniasis in district Chakwal

Cutaneous Leishmaniasis is endemic in Pakistan. The current study was undertaken in District Chakwal to measure the prevalence of ocular lesions in cutaneous leishmaniasis. A 60 years male presented to the Oculoplastic Clinic at Al- Shifa Trust Eye Hospital Rawalpindi, Pakistan, with an isolated chronic non-healing ulcerative lesion of left upper eye lid. Clinically suspected to be squamous cell carcinoma, it underwent total excision followed by Cutler-Beard reconstruction. The histopathology was cutaneous leishmaniasis. A team was dispatched to the health center, Choa Saiden Shah of the area to which the patient belonged [120 km southeast of Islamabad]. The area was found to be endemic for leishmaniasis. A total of 925 patients with known cutaneous leishmaniasis were registered for treatment at the health center and examined for ocular involvement. The prevalence of ocular lesions was found to be about 1%. Most of the lesions involved the skin of the upper eyelid. All the non-ocular patients were undergoing treatment with intralesional injection of Glucantime, while patients with exclusive ocular involvement were treated with intramuscular injections. Ocular involvement in Leishmaniasis is relatively rare, but it should be kept in mind in the differential diagnosis of ulcerative lesions of the eyelid especially in an endemic area

Pakistan earthquake 2005: the role of subspecialty hospitals in national disasters - the scope and limitations: modeling the Eye Hospital response

Purpose: To study the role of subspecialty hospitals in national disasters, its scope and limitations in context of an eye hospital response during Pakistan October 2005 earth quake

Study Design: A retrospective observational study

Subject and Method: The study was carried out at Al Shifa Trust Eye Hospital Rawalpindi [ASTEH] and comprises of the scope and limitations faced by ASTEH, a subspecialty eye hospital, when it offered its services to the victims of October 2005 earthquake. A special trauma management team from UK with over two dozen specialists joined the hospital voluntarily. A total of 156 patients admitted to the hospital were managed surgically and medically, the limitations and scope analyzed and the patients interviewed at the time of presentation regarding the age, district, mechanism of injury, time elapsed under debris, delay in reporting to the health care facility, type of injury and type of surgery undergone

Results: The limitations faced by the hospital included overwhelmed resources [ASTEH being a charity hospital], budget reallocation, emergency planning, collecting additional donations, funds and grants, providing medical and surgical care to a different class of patients, and provision of accommodation, food, water and electricity to the patients and their attendants. With the help of donations from Pakistan Red Crescent Society and Islamic Help Charity of UK as well as personal donations Al Shifa Trust Eye Hospital effectively managed all the patients. Psychological and emotional support was also provided. 59% of the affected were females. The most common injury was bony fractures in 64% of cases and the most common mechanism of injury was roof collapse. Among ocular injuries again fractures caused by roof collapse were more prevalent

Conclusion: Disaster management is everyone's responsibility. Being a specialized hospital should not bar any health facility to contribute to the national disaster management in hours of need. Al-Shifa Trust Eye Hospital effectively proved that with proper management and networking, a subspecialty hospital can play vital part in national emergencies. The pattern of ocular injuries observed was a unique opportunity for ophthalmic research workers and health policy makers

Outcome of phaco incision on steepest meridian in eyes with pre existing astigmatism

To determine keratometric outcome of a 5.5mm self sealing incision on the steepest meridian in eyes with preexisting astigmatism. A prospective study was carried out on 35 eyes with preexisting, with or against the rule astigmatism of 1.5-3.0 D. Bimanual phaco was performed using the incisions of 1.5mm, each approximately 120 degrees apart. The IOL was implanted through a third self sealing limbal incision created on the steepest meridian, which was assessed preoperatively by keratometeric readings. Postoperative automated keratometery was recorded at 12 weeks. The average reduction of pre-existing against and with the rule astigmatism was 1.15 [SD = 0.33] and 1.47 [SD = 0.32] respectively. It is possible to achieve negligible or low astigmatic outcomes in eyes with pre-existing with or against the rule astigmatism by predetermining the steepest meridian and placing a third incision of around 5.5mm on the respective meridian

Mortality from Diamox

To report life threatening acute confusional state as an adverse reaction of oral Acetazolamide in an eye care setup. Case Series Two elderly females [60 and 65 years] and one male [68 years] admitted for cataract surgery and prescribed with prophylactic Diamox presenting with identical symptoms. All presented with symptoms of acute confusion, altered awareness and irritability during admission in the ward. Two of these jumped out of ward windows and lost their lives. The third patient was overpowered and managed later thus preventing the fatal outcome. Acute confusion or delirium is a rare complication of Diamox. Never reported in ophthalmic literature and very infrequently reported in non-ophthalmic literature, these case reports display the need of nursing vigilance and awareness by ophthalmologists during the use of Diamox. Since these episodes, the practice of using pre-operative Diamox in cataract surgery patients has been abandoned at Al-Shifa Trust Eye Hospital

Sub-Tenon's vs. peribulbar anesthesia

Purpose of Study: To evaluate the efficacy of sub-Tenon's anesthesia as compared to peribulbar anesthesia during cataract surgery

Design: Prospective Clinical Trial

Participants: 200 consecutive patients undergoing extracapsular cataract extraction for uncomplicated senile cataracts in the Department of Ophthalmology, Pakistan Institute of Medical Sciences Islamabad. 100 in each group; one receiving sub-Tenon's and the other group receiving peribulbar anesthesia

Methods: Patient's pain and anxiety during administration of anesthesia, during surgery were assessed. Akinesia and surgical comfort was assessed by the surgeon just after the completion of anesthesia and at the end of the surgical procedure. In addition the method of administration of anesthetic, the anesthetic agents and volume used, the time between administration of anesthetic and operation and the type of surgery performed were all recorded

Results: Pain and akinesia scores were significantly lower for sub-Tenon's anesthesia compared with peribulbar technique. However, no significant difference was noted for anxiety status in both groups. Surgical comfort was present during surgery in 91% patients in sub-Tenon's anesthesia group and in 9% cases it was not present. In peribulbar anesthesia group it was present in 75% cases and not present in 25% cases. There was significant difference [p=0.002] in both groups

Conclusion: There was significant degree of advantage of sub-Tenon's anesthesia over peribulbar anesthesia in this study in almost all the aspects of the study that were pain and anxiety experienced by the patient, as well as preoperative akinesia and surgical comfort