Peripapillary retinal nerve fiber layer [RNFL] thickness measurements by topcon SD-OCT in myopic patients

Objective: To evaluate the effect of low-to-moderate myopia on peripapillary retinal nerve fiber layer [RNFL] thickness measured by Topcon SD optical coherence tomography [OCT]. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Shifa Foundation Falahee Clinic, over a period of one year starting from June 2015

Methodology: A total of 43 eyes of 43 patients, having mild to moderate myopic refractive error, were enrolled in the study. Refractive error/spherical equivalent was calculated. RNFL thickness was obtained from all four peripapillary quadrants: temporal, superior, nasal, and inferior; and 12 sub-quadrants using Topcon SD OCT. Pearson correlation coefficients [r] were calculated to evaluate relationships between the RNFL thickness and spherical equivalent [SE] before and after adjustment for ocular magnification

Results: The study included 51.2% females and 48.8% males. Mean age was 30.9 +/- 6.45 years. Mean axial length was 24.25 +/- 0.91 mm. Mean SE was -3.25 +/- 1.93 DS. Mean of average RNFL thickness [with Littmann's correction] was 97.28 +/- 8.15 microm. Correlation analysis among all subjects showed that the average, mean nasal quadrant, upper nasal, and inferonasal sub-quadrant RNFL thickness had positive correlation with spherical equivalent [r = 0.31, p = 0.045]. However, correction of the magnification effect by applying Littmann formula eliminated this effect

Conclusion: In low-to-moderate myopia, RNFL measurements vary with refractive error of the eye. Since ocular magnification significantly affects the RNFL measurement, it should be considered in diagnosing glaucoma

Transient corneal edema after phacoemulsification

To determine the association between pre-operative and intra-operative factors leading to transient corneal edema after phacoemulsification. Cohort study. Department of Ophthalmology, Shifa Foundation Community Health Centre, Islamabad, from October 2011 to September 2012. Patients undergoing phacoemulsification and Intraocular Lens [IOL] implantation were enrolled in the study using consecutive non-probability sampling. Pre-operative risk factors including peripheral corneal degenerations, the type and density of cataract were documented. Surgical risk factors included the incision site, the type of intraocular lens, the phacotechnique and the phacopower time. Postoperatively the patients were assessed for corneal clarity and the degree of striate keratopathy. Statistical analysis was done using SPSS version 17. There were 43% male and 57% female patients [n = 182]. Mean age was 58.92 +/- 13.00 years [median and mode-60 years]. Factors which increased the risk of transient corneal edema after phacoemulsification included hypertension [p = 0.022], dense nuclear cataracts [p=0.006], divide and conquer technique [p = 0.008], duration of phacopower use [p < 0.001] and peripheral corneal degenerations [p < 0.001]. Patients with peripheral corneal degenerations and dense nuclear cataracts had significantly higher rates of postoperative corneal edema. Use of phaco-chop technique and less phaco-power time helps in decreasing corneal edema

Determinants of glaucoma awareness in urban Punjab

To assess the awareness about glaucoma and the factors affecting it in urban Punjab population. Cross-sectional study. Study was conducted in March-April 2011 in Rawalpindi District Punjab, Pakistan. Glaucoma awareness study was conducted on urban population of Rawalpindi, Islamabad, Lahore and Taxila. Individuals belonging to medical profession [doctors, nurses and paramedics etc] were not included. Demographic details and educational status of all participants were documented. A brief structured close-ended study questionnaire was used to collect information about their awareness of risk factors, treatment aspects and complication of glaucoma. There were 729 participants in the study. Majority were females [60.1%] and adults [76.1%]. Literacy level of 40.2% was up to matriculate level. The study indicated that the awareness level about glaucoma was low especially about the recognition of high-risk groups and symptoms. Only one-third of respondents i.e. 32.6% had an idea about the symptoms of the disease and 27.4% participants had awareness of glaucoma as a blinding eye disease. Determinants of glaucoma awareness amongst study participants were gender, age, education level and occupation. Awareness of glaucoma was quite low among the urban population in Punjab. There is need of increased public health education to reduce glaucoma associated blindness and its burden on society

Ophthalmic manifestations of Linear Nevus Sebaceous/Organoid Nevus Syndrome

Linear Nevus Sebaceous Syndrome [LNSS] is a rare sporadic oculoneurocutaneous disorder, also classified as Organoid Nevus Syndrome. It consists of a triad of midline facial linear nevus sebaceous, central nervous system and ocular abnormalities. To the best of authors' knowledge ophthalmic features of LNSS have never been reported in Pakistani population. We report two cases of LNSS, associated with multiple cutaneous nevus sebaceous lesions, complex ocular choristomas and rare bilateral presentation in one patient. Ocular choristomas included limbal dermoids, dermolipomas at superior fornices and chroidal choristoma. Ocular surface was successfully reconstructed by excision of limbal dermoids, partial keratectomy and amniotic membrane transplant

Reducing postoperative pterygium recurrence: comparison of free conjunctival auto-graft and conjunctival rotation flap techniques

To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Quasi-experimental study. Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of >/= 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group [n=26] cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group [n=31] cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences [SPSS] version 20. The median [and inter-quartile range] age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 [51.50 - 63.00] and 57 [45.00 - 60.00] years, 28.50 [27.00 - 30.50] and 16.00 [15.00 - 17.00] minutes respectively. Recurrence was seen in 2 [7.96%] and 3 [9.76%] cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups [p=0.60]. The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and complications are comparable

Comparison of Ciprofloxacin 0.3% and Moxifloxacin 0.5% eye drops in bacterial corneal ulcers

To compare the effect of Ciprofloxacin 0.3% and Moxifloxacin 0.5% eye drops in bacterial corneal ulcers. Prospective randomized trial Ophthalmology department of Pakistan Institute of Medical Sciences, Islamabad. The total duration of the study was 18 months. 100 patients of bacterial corneal ulcers were randomly assigned to two treatment groups: A [Ciprofloxacin 0.3%] and B [Moxifloxacin 0.5%] for the treatment of bacterial corneal ulcers. The outcome measures included size of epithelial defect, size of infiltrate and reaction in anterior chamber on day 1, 2 and 3 and week 1, 2 and 3 after the initiation of treatment. They were compared between the two study groups using Student t test and Chi-square test. SPSS version 13 was used for data entry and analysis. The mean age of patients in Group A was 37.6 [+/- 9.7 SD] years and in Group B was 37.4 [+/- 9.2 SD] years. There were 34 [68%] female and 28[56%] male patients in group A and B respectively. There were significant differences in terms of size of infiltrate [p value 0.030] and reaction in anterior chamber [p value 0.002] between the two study groups. A non-significant difference was observed in size of epithelial defect between the two groups [p value 0.158 after 2 weeks]. Our study showed that Moxifloxacin 0.5% is superior to Ciprofloxacin 0.3% eye drops in treating bacterial corneal ulcers in adult patients

Hypermetropia as a presentation of diffuse choroidal haemangioma in Sturge-Weber syndrome

A 16 years old male patient of Sturge-Weber syndrome was referred to glaucoma clinic for the management of unilateral glaucoma. There was also an ipsilateral hypermetropic shift. On detailed investigations, a diffuse choroidal haemangioma was diagnosed which induced this hypermetropic shift. Anisometropia in Sturge-Weber syndrome can give us clue regarding some underlying pathology, so unilateral myopia or hypermetropia should be thoroughly evaluated in such patients

Awareness of diabetic retinopathy among the known diabetic patients at a tertiary care eye hospital

To assess the awareness of diabetic retinopathy [DR] among the known diabetics at Al-Shifa Trust Eye Hospital [ASTEH] Rawalpindi. A cross sectional observational study. Study was conducted on 200 known diabetics from 1[st] April 2007 to 30[th] September 2007. Level of knowledge about DR was assessed on the basis of a face-to-face interview and graded according to the number of correct responses. All the information was recorded on proformas and data analysis was done using SPSS 13.0. There were 85 [42.5%] male and 115 [57.5%] female participants with a mean age of 56.0 [ +/- 9.740] years while mean duration of diabetes was 8.468 [ +/- 6.034] years. Knowledge of 72 [36%] patients was found satisfactory. Gender [p=0.000], socioeconomic status [p=0.000], education [p=0.001] and source of information [p=0.000] were significantly associated with awareness. Ophthalmologists were the major source of information for the patients. Awareness about DR is low in our diabetic patients. More emphasis should be given to health education of diabetics along with treatment

Risk factors for early posterior capsule opacification after cataract surgery

To determine risk factors for early posterior capsule opacification [PCO] following cataract surgery. Case-Control study. Patients developing PCO within and after 12 months of cataract extraction were selected as cases [early PCO] and controls [late PCO] respectively. PCO [central/ peripheral] was diagnosed by clinical examination with slit lamp biomicroscope under pupillary dilation. Operation notes were also reviewed from the hospital record. Risk factors including age of patient, surgical procedure, intraocular lens material, anterior capsulotomy/ capsulorhexis, duration since operated and experience of surgeon were observed. The study population was 146 patients, 73 in each group. There were 84 male and 62 female patients with mean age 59.33years + 15.76 SD. The study revealed significant risk of early PCO in patients who underwent standard ECCE versus Phacoemulsification [p value 0.000], PMMA vs. Acrylic IOLs [p 0.000], and can-opener capsulotomy vs. Continuous curvilinear capsulorhexis [p 0.001]. Experience of surgeon was not related with early onset PCO[p 0.184]. Early PCO has multifactor etiology; related to surgical technique and IOL implant. Meticulous surgical technique, performed under more physiological conditions, with minimum compromise of blood aqueous barrier, thorough removal of lens matter, implantation of an acrylic IOL into capsular bag are various factors that may retard the onset of PCO. These factors are interdependent and cannot slow down the process of PCO formation independently

Comparison of diode laser trans-scleral cyclo-photo-coagulation with cyclocryopexy in refractory glaucoma

To compare the efficacy and safety of diode laser trans-scleral cyclophotocoagulation [TDC] and cyclocryopexy in refractory glaucoma in term of intraocular pressure control, pain relief and complications. Retrospective Case Series. Medical records of 49 patients who underwent trans-scleral diode laser cycloablation [24 patients] and cyclocryopexy [25 patients] at the Al-Shifa Trust Eye Hospital during a 12 month period were analyzed. In diode laser TDC group mean pretreatment IOP was 50 mmHg with anti-glaucoma medication [SD 9.48, range 26-60] and 61 mmHg [SD 10.75, range 40-76] without medication. Mean postoperative IOP was 14 mmHg with medication and 20 mmHg without medication [SD12.73, range 2-50]. 70% eyes had IO P< 21 mmHg at 3 months. None of patients had deterioration of vision. Pain was absent in 96% at 6 weeks after single TDC session. In cyclocryopexy group mean pretreatment IOP was 49 mmHg with medication [Range 26-60, SD10.48] and 56 mmHg [Range 40-76, SD11.70] without medication. Mean postoperative IOP was 22 mmHg without treatment [range 2-75, SD 17.78]. 59% of patients had IOP < 2 ImmHg at 3 months. At 3 months, only 50% patients had significant pain reduction. 38% patients did not have any relief in pain. Postoperative complications were more frequent with cyclocryopexy and lasted longer than TDC. Neovascular glaucoma was the most common variety of refractory glaucoma in both groups. Our study confirms that in refractory glaucoma, TDC is more effective in decreasing intraocular pressure as compared to cyclocryotherapy. TDC also has a lower rate of complications and is relatively safer than cyclocryopexy