Vogt Koyanagi Harada disease: treatment and visual prognosis

Vogt Koyanagi Harada [VKH] disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases [100%]. One patient developed bilateral cataract, glaucoma and sub-retinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is generally favourable if the disease is identified early and adequately treated and the associated complications are addressed properly

Non-viral microbial keratitis: etiology, clinical features and visual outcome

To determine the etiology, clinical features and visual outcome in non-viral microbial keratitis. An observational study [case series]. Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from January 2007 to December 2009. Charts of all patients with infective keratitis treated at the department were reviewed. The data collected and recorded on a standardized form included age, gender, predisposing factors, microbiology results of culture and sensitivity, clinical features, treatment given, complications and visual acuity at last follow-up [at least 2 months]. Among a total of 228 cases, 148 were male [64.9%] and 80 were female [35.1%]. Mean age of the patients was 42.8 +/- 21.9 years. Trauma was the most common [31.5%] predisposing factor followed by previous ocular surgery [8.8%] and use of topical steroids [6.6%]. The most common isolate among positive cultures was Staphylococcus aureus isolated in 31.4% [11/35] eyes followed by fungal hyphae in 25.7% [9/35] and Gram negative bacilli in 17.1% [6/35] eyes. Visual outcome was good [> 6/18] in 19.6%, moderate [< 6/18 to 3 6/60] in 22% and poor [< 6/60] in 58.4%. The main predisposing factors in the studied group of patients with non-viral keratitis were ocular trauma and injudicious use of topical steroids. The most common microorganism involved was Staphylococcus aureus. Visual outcome was moderate to poor even after successful treatment

Inpatient consultation services in ophthalmology in a teaching hospital of North West frontier province, Pakistan

With the expansion of knowledge, medicine is divided into specialities and subspecialties. Human body is one unit and cannot be divided. Many diseases affect different systems and parts of the body at the same time. Moreover a patient may be suffering from more than one disease at one time, each related to a different consultant. Therefore, consultants of different specialities are dependant upon each other for overall management of certain patients. Consultants, other than ophthalmologists, may need the help of ophthalmologists in diagnosis and management of patients. Many systemic diseases have peculiar ocular signs, which are helpful in confirmation of diagnosis. Ophthalmological examination, in certain cases, can totally change the diagnosis and management. This study was performed to analyze the extent of help of an ophthalmologist in management of patients under care of other consultants and to document the COMMON diseases and specialities that need ophthalmologist help, This study was performed at department of ophthalmology Khyber Teaching Hospital Peshawar from June 2006 to December 2006. A standard proforma was designed and all the written requests from different units were included in the study. At the end of study results were analyzed by [SPSS] version 10 software. Total 86 patients were examined from other units on written requests. Forty nine [58.8%] were females and 37 [41.2%] males. Maximum i.e. 46 [54%] [calls] were from medical units, followed by 17 [20%] from paediatric units. Diabetes mellitus was the commonest condition [42%], which needed ophthalmologists consultation, followed by hypertension [25%]. In 30 [36%] patients a secondary ocular diagnosis added and in 11 [13.2%] patients the diagnosis totally changed. Ophthalmologists are very helpful in management of selected patients under care of other physicians. Burden of [calls] on ophthalmologists can be reduced by training the trainees from other units in Ophthalmoscopy

Clinical audit of glaucoma patients admitted in khyber teaching hospital Peshawar June 2002 May 2006

To determine the demographic pattern, types of glaucoma and to evaluate the different types of surgical procedures performed in terms of efficacy and safety. The medical records of admitted pts. for glaucoma during June 2002 to May 2005 [4 years] were studied in detail to see type of glaucoma; Management and their outcome. The main objective was intraocular pressure at the time of admission and discharge. Demographic pattern and therapeutic efficacy was determined. Out of 16425 patients hospitalized for various eye diseases, 775 [4.7%] patients with 1042 eyes suffered from various types of glaucoma 542 [69.93%] of patients were having primary glaucoma while 256 [31.07%] eyes were secondary types. Primary glaucoma is classified as primary angle closure glaucoma 38.5% primary open glaucoma 27.35%, congenital glaucoma 7.6% and absolute glaucoma 1.82%. Among secondary type, traumatic glaucoma was 6.42% lens induced glaucoma 5.37% steroid induced 4.35% neovascular glaucoma 3.45% pseudoexfoliatry type 2.5% and uveitic 2.01%. The numbers of male patients were more than female. The mean age at the time of admission was 42.6 years.Trabeculectomy was the main surgical operation [76.83%] Other surgical interventions were paracentasis with peripheral iridectomy, cyslocryopexy, lens extraction and pupulloplasty. Trabeculectomy was the most successful surgery in 84.41% for primary type of glaucoma. For secondary glaucoma paracentasis for hyphema related glaucoma, cyclorcyopexy, with or without cataract extraction for steroid induced glaucoma. Main post operative complications were shallow anterior chamber 12.65%, hyphema 10.27%, and uveitis 5.6%. Primary glaucoma is the leading cause of hospitalization followed by secondary glaucoma Trabeculectomy with or without antifibrotic agent is still the operation of choice and successful in 90% of cases. For secondary glaucoma, cause is treated and the various surgical offered are successful in 95% of cases

Evisceration, enucleation, and exentration: painful but life saving surgical procedures

To determine the indications for Evisceration, Enucleation and Exentration in patients operated at the eye department. It was a prospective study done at Khyber Teaching Hospital, Peshawar, from May 2001 to October 2003. A total of 110 cases comprising of 50 enucleations, 34 evisceration, and 26 exentration were seen. Ocular malignancy was the commonest cause for eneucleation while postoperative panophthalmitis and trauma were the reasons for evisceration and for exentration the indication was squamous cell carcinoma involving lid and conjunctiva followed by basal cell carcinoma. Only a minority of cases of eye globe surgery are preventable and/or treatable, while rest are due to malignancy. Early diagnosis in these cases is likely to make surgery easy with promising postoperative cure