ABSTRACT
Objective: To determine correlation of anterior chamber depth with peripapillary nerve fiber layer thickness. Study Design: Descriptive cross sectional study. Place and Duration of study: Armed Forces Institute of Ophthalmology Rawalpindi, from Apr 2016 to Oct 2016
Patients and Methods: Anterior chamber depth and peripapillary nerve fiber layer thickness was measured in 200 eyes of 110 patients, between 10-40 years of age. Anterior chamber depth was measured in mm, by taking average of 3 readings, measured by optical biometry [IOL Master, Carl Zeiss Meditec, Dublin whereas average peripapillary retinal nerve fibre layer pRNFL thickness was obtained by taking average of 12 segments RNFL thickness measurement, calculated by Spectral domain optical coherence tomography [SD OCT] [3D OCT-1000 Markll, Topcon Co, Tokyo, Japan] after dilating pupils with one drop of 1% Tropicamide, instilled three times, 10 minutes apart. Three readings were taken for each eye. The mean of the three readings was used for the analysis. Pearson correlation [+1/-1] was calculated between anterior chamber depth, peripapillary nerve fiber layer thickness and age
Results: Two hundred eyes of 110 patients were included in the study. Both eyes were considered in 90% of the patient, however only Right eye was considered in 6.3% of the patients while left eye in 3.7% of the patients. Mean age of the patients was 26.58 +/- 8.88 years. Mean visual acuity of patients measured by log MAR was 0.52 +/- 0.12. Mean Anterior chamber depth [ACD] of patients was 3.41 +/- 0.35 while mean RNFL appeared to be 103.26 +/- 8.89 um
Conclusion: It was concluded that anterior chamber depth was neither related significantly with peripapillary nerve fiber layer nor with age
ABSTRACT
Objective: Correlation of age with central corneal thickness [CCT] and corneal endothelial cell density [ECD] in Pakistani population
Study Design: Descriptive cross sectional study
Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi from Apr 2016 to Oct 2016
Material and Methods: CCT and ECD was measured in 330 eyes of 165 patients, aged between 21-70 years of age. Patients were further divided into five age groups. Three readings were taken for each eye, and mean of three readings was used for the analysis. Pearson correlation was calculated between CCT, ECD and age
Results: A total of 330 eyes of 165 patients were studied. Out of study population, 81 [49.09 percent] were males and 84 [50.90 percent] were females. Mean ECD [cell/mm2] was 3063.85 +/- 234.65 cells/mm2 and 256.42 +/- 475.06 cells/mm2 in patients aged 21-30 years, and 61-70 years respectively. Mean CCT [micrometer] was 544 +/- 18 micrometer and 528 +/-21 micrometer in patients aged 21-30 years, and 61-70 years respectively. A statistically significant inverse correlation was observed between age and corneal ECD [r=?0.718, p<0.01] and age and CCT [r=?0.230, p<0.01]
Conclusion: Both CCT and corneal ECD decrease significantly with age in Pakistani population, with statistically more decrease in ECD with age, than CCT
ABSTRACT
Objective: To determine the visual outcome in patients with acute Central serous chorioretinopathy [CSCR] and to analyze the association of clinical, angiographic and tomographic factors with final visual outcome in Pakistani population
Methods: This study was conducted at AFIO Rawalpindi and PNS Shifa Naval hospital Karachi from November 2011 to August 2016. Fifty five eyes of 53 patients with acute CSCR were included. All patients underwent a detailed ophthalmic examination including SD OCT imaging at baseline, One month and three month and FFA was performed at baseline. Primary outcome measures were measurement of initial and final BCVA and CFT. SPSS 13.0 was used for the analysis of data
Results: Mean age of study population was 36.66 +/- 6.24 years. On OCT mean CFT at baseline was 467.49 +/- 144.80 microm in affected eye, whereas mean CFT measurements at final follow up was 244.67 +/- 32.99 microm [p <0.01]. Presenting mean log MAR BCVA was 0.47 +/- 0.25 and final mean log MAR BCVA was 0.18 +/- 0.14 [p <0.01]. Baseline BCVA showed statistically significant association with final BCVA [p=0.03]
Conclusion: Presenting VA of 6/12 or better is associated with favorable visual outcome in patients with acute CSCR
ABSTRACT
Objective: To evaluate the correlation between Central Corneal Thickness [CCT] and Visual Field [VF] defect parameters like Mean Deviation [MD] and Pattern Standard Deviation [PSD], Cup-to-Disc Ratio [CDR] and Retinal Nerve Fibre Layer Thickness [RNFL-T] in Primary Open-Angle Glaucoma [POAG] patients
Methods: This cross sectional study was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from September 2015 to September 2016. Sixty eyes of 30 patients with diagnosed POAG were analysed. Correlation of CCT with other variables was studied
Results: Mean age of study population was 43.13 +/- 7.54 years. Out of 30 patients, 19 [63.33%] were males and 11 [36.67%] were females. Mean CCT, MD, PSD, CDR and RNFL-T of study population was 528.57 +/- 25.47microm, -9.11 +/- 3.07, 6.93 +/- 2.73, 0.63 +/- 0.13 and 77.79 +/- 10.44microm respectively. There was significant correlation of CCT with MD, PSD and CDR [r=-0.52, p<0.001; r=-0.59, p<0.001; r=-0.41, p=0.001 respectively]. The correlation of CCT with RNFL-T was not statistically significant [r=-0.14, p=0.284]
Conclusion: Central corneal thickness had significant correlation with visual field parameters like mean deviation and pattern standard deviation, as well as with cup-to-disc ratio. However, central corneal thickness had no significant relationship with retinal nerve fibre layer thickness
ABSTRACT
Objective: To determine the efficacy of topical Nepafenac [0.1%], administered post-operatively in prevention of Macular Edema [ME], after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy [NPDR]
Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness [CMT] of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography
Results: Mean age of study population was 60.97 +/- 4.91 years. Out of 60 patients, 34 [56.7%] were males and 24 [43.3%] were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5 +/- 10.86microm, 228.83 +/- 14.56 microm, 2.33 +/- 10.45 microm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93 +/- 11.69microm, 236.17 +/- 16.16 microm, 12.23 +/- 12.40microm and 5.51% respectively. ME was observed in one patient [3.3%] in Group-1, and seven patients [23.3%] in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant [p<0.05]
Conclusion: 0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy [NPDR]
ABSTRACT
Objective: To determine the relationship between mean axial length and mean peripapillary retinal nerve fibre layer [RNFL] thickness using spectral domain optical coherence tomography [SD OCT] in healthy subjects
Study Design: Cross sectional study
Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015
Material and Methods: Data of 300 eyes of 300 healthy volunteers were collected at AFIO from December 2014 to August 2015 and analysed. Axial length and RNFL thickness of each volunteer was calculated using laser interferometer [IOL master] and SD OCT respectively. Eyes were divided in three groups based on axial length. Statistical analysis of the data were done using SPSS version 17.0
Results: Mean age of study population was 23.16 +/- 3.73 years. Mean axial length was 24.40 +/- 1.50 millimetres [mm]. Mean of average peripapillary RNFL thickness was 128.87 +/- 9.94 micrometres [micro m]. Mean peripapillary RNFL thickness of superior, inferior, nasal and temporal quadrant was 158.27 +/- 11.04 micro m, 152.92 +/- 14.54 micro m, 103.85 +/- 5.01 micro m and 100.45 +/- 11.59 micro m respectively. Mean RNFL thickness, as well as RNFL thicknesses of each quadrant was also significantly different between hypermetropic, emmetropic and myopic eyes [p-value<0.001]. There was also a strong negative correlation between axial length and peripapillary retinal nerve fibre layer thickness [r= -0.964, p-value<0.001]
Conclusion: Variation in axial length significantly affects the measurement of RNFL thickness and must be counted for, while diagnosing glaucoma on basis of thinning of RNFL
ABSTRACT
Objective: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration [ONSF] in patients with raised intracranial pressure [ICP]
Methods: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015.Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure
Results: Thirteen [72.22%] patients underwent ONSF bilaterally, while five [27.78%] underwent unilateral ONSF. Best corrected visual acuity [BCVA] improved in 24 [77.4%], remained stable in four [12.9%] and deteriorated in three [9.7%] patients. Papilledema improved in 27 [87.1%] while remained stable in four [12.9%] according to Frisenscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant [p<0.001]. There was significant negative correlation [r= -0.434, p=.017] between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia
Conclusion: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema
ABSTRACT
Objective: To compare the clinical profile, systemic risk factors, and characteristics of rhegmatogenous retinal detachment [RRD] in pseudophakic and phakic eyes
Study Design: Cross-sectional comparative study
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from August 2013 to August 2015
Methodology: A total of 164 eyes [96 pseudophakic patients and 68 phakic patients] with RRD were analyzed. Demographic data and associated known risk factors of study population were acquired. Retinal examination was done by single experienced retinal surgeon using indirect ophthalmoscopy for type of retinal break, location and number of retinal breaks, status of macula, morphological extent of RRD and retinal degenerations. All the findings were endorsed on a pre-devised proforma
Results: Mean age of patients in pseudophakic and phakic groups was 61.18 +/- 10.39 and 59.27 +/- 9.57 years, respectively. Frequency of male patients in pseudophakic and phakic groups was 74% and 57.4%, respectively. Mean axial length in pseudophakic and phakic groups was 23.13 +/- 2.18 mm and 21.9 +/- 2.01 mm, respectively. Difference in axial length and gender distribution between two groups was statistically significant [p < 0.05]. Difference in frequency of patients with history of hypertension and myopia between two groups was statistically significant [p < 0.05]. Characteristics of RRD [type, location and number of retinal breaks, macula status, and extent of RRD] between groups were not statistically significant
Conclusion: RRD is more common in pseudophakic patients with male gender, increased axial length, myopia, and hypertension
ABSTRACT
Objective: To compare the mean changes in central corneal thickness [CCT] and corneal endothelial-cell density [CED] after removal of silicon oil [ROSO] using anterior [limbal] versus posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery
Study Design: Randomized controlled trial
Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015
Material and Methods: Sixty eyes of 60 aphakic patients who underwent removal of silicon oil from December 2014 to August 2015 in AFIO after successful retinal re-attachment surgery were analysed. Thirty eyes underwent removal of silicon oil through anterior [limbal] approach [groupl] and 30 eyes through posterior [pars plana] approach [group-2]. Pre-operative central corneal thickness and corneal endothelial-cell density was measured and compared with central corneal thickness and corneal endothelial-cell density measurements 3 months after removal of silicon oil
Results: Mean age of study population was 49.93 +/- 5.18 years. Both groups were age and sex matched [p=0.694 and p=0.80 respectively]. In group 1, mean change in CCT was 1.80 +/- 6.58 micro meters [jum] and mean change in CED was 196.30 +/- 33.78 cells per millimetres square [mm[2]], while in group 2, mean change in CCT was 1.63 +/- 8.96 microm and mean change in CED was 60.20 +/- 39.75 cells/mm2 after 3 months of ROSO. Mean change in CCT between two groups was not statistically significant [p=0.935], however, mean change in CED between two groups was statistically significant [p<0.001]
Conclusion: Removal of silicon oil through anterior [limbal] approach causes significant reduction in CED, as compared to posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Endothelium, Corneal , Corneal Pachymetry , Aphakia , Retinal Detachment/surgery , Randomized Controlled Trials as TopicABSTRACT
Objective: To evaluate the efficacy and safety of transepithelial [TE] collagen cross-linking [CXL] in patients with progressive keratoconus [KC]
Methods:This Quasi Experimental Study was conducted at PNS Shifa Naval Hospital, Karachi from June 2015 to June 2016. Sixty eyes of 32 patients who underwent TE CXL for progressive KC from June 2015 to June 2016 were analysed to ascertain efficacy and safety of TE CXL procedure. Statistical analysis of the data was done using SPSS version 17.0
Results:Twenty eight [87.5%] patients underwent TE CXL bilaterally, while 4 [12.5%] underwent unilateral CXL. Mean change in astigmatism, Maximum simulated Keratometry value [Kmax], Spherical equivalent [SE] and Central Corneal Thickness [CCT] were -0.67+/-0.35D, 1.28+/-0.64D, -0.58+/-0.17D and 0.40+/-7.58micro m respectively, from baseline. Mean gain in lines on Snellen's visual acuity chart was 1.13+/-0.83 lines. Changes in astigmatism, Kmax and SE were statistically significant [p<0.001], while change in CCT was not statistically significant. The procedure had excellent safety profile, with no major complication till 6 months follow up period
Conclusion:TE CXL is a safe and effective procedure with statistically significant reduction in corneal astigmatism, Kmax and SE with reasonable gain in Snellen's visual acuity
ABSTRACT
Objective: To compare serum cholesterol, TG, HDL-C and LDL-C concentrations between type-2 Diabetes mellitus [DM] patients with retinopathy and without retinopathy and to study association between various modifiable risk factors of Diabetic retinopathy [DR]
Methods: The study included 300 patients with type 2 DM; 140 of them were without DR [Group-I] and 160 were with DR [Group-II]. Serum total cholesterol, LDL-C, HDL-C, and TG levels were determined. SPSS 17.0 for windows was used for statistical analysis
Results: Overall, mean age of study population was 48.86 +/- 5.62 years. Subjects with DR were older [P < 0.018], had higher fasting plasma glucose [P < 0.01] and higher HbA1c [P <0.01] concentrations compared with those without DR. Analysis of serum cholesterol, LDL-C, HDL-C and TG among subgroups of patients with no DR, with NPDR and PDR showed statistically significant difference [p <0.01]. There was strong positive correlation of severity of DR with BSF, HbA1c, serum LDL-C, total cholesterol and TG
Conclusion: The serum cholesterol, TG, HDL-C and LDL-C concentrations were found to be significantly deranged in patients with DR as compared to those without DR