Vernal keratoconjunctivitis; supratarsal injection of triamcinolone

Purpose: To find out safety and effectiveness of supratarsal injection of Triamcinolone in cobble stone papilla e in Vernal Keratoconjunctivitis [VKC]

Design: Prospective, uncontrolled trial

Period: June 2009 to January 2010

Setting: Department of Ophthalmology KMU Institute Of Medical Sciences Hospital KDA Kohat

Material and Methods: One hundred and fifty diagnosed patients of VKC, of both sexes and age group between 5 - 40 years were included in the study. Patients with glaucoma, or steroid responder, postherpetic corneal scar, active infection of cornea or conjunctiva, tightly closed eyelids, patients who lost follow-up, and patients unwilling to be enrolled in this study were excluded from the study. The patients were enrolled and informed consent was taken. Supratarsal injection of Triamcinolone was given. Their record was maintained and all the patients were followed up for six months for evaluating their effectiveness and side effects

Results: We treated two hundred and seventy five eyes of one hundred fifty patients. Among them 80% were males. Mean age was 14 years [range: 5-40 years]. All of the patients had itching of eyes, redness, watering, photophobia, cobble-stone papillae and Tranta's dots. Mean duration of disease was 27 weeks [Range: 4 weeks to 10 months]. Patients were followed up and multiple injections were given for controlling disease. Transient redness was the most common side effect of injection therapy. Study shows 100% effectiveness of supratarsal injection of triamcinolone acetonide in VKC although recurrence was seen

Conclusions: Supratarsal injection of Triamcinolone is safe, cost-effective and simple way of management of VKC

Frequency and visual outcome of anterior segment involvement in accidental ocular trauma in children

To analyze the frequency and visual outcome of anterior segment involvement in accidental ocular trauma in children. This descriptive case series was conducted in the Department of Ophthalmology Lady Reading Hospital, Peshawar from 15th June 2007 to 15th October 2008 on 200 cases of anterior segment involvement in children during accidental ocular trauma. Patients were admitted through casualty or Outpatient Department. After detailed history, systemic examination and complete ocular examination was done including visual acuity, slit lamp examination and examination under anesthesia when necessary. In this study, male children constituted 74.5% [149] and females 25.5% [51] of the total. Children between ages of 6-10 years are more vulnerable [42%]. Injury caused by blunt object was seen in 64.05% [129] of children and mostly it was due to stone in 21.50% [71]. The commonest place of injury was indoors in 38.50% [77], followed by playgrounds in 28.00% [56] and on streets and roads in 21.5% [43]. The visual acuity on arrival was PL+ ve in [35.5%] and open globe injury was observed in 36.0%. At the end of two months 13.5% eyes were phthisical. Blunt ocular trauma is a common ocular trauma in children with males more vulnerable. School going children are more at risk. Blunt trauma especially because of stone is the main culprit with devastating visual results

Risk factors of preseptal and orbital cellulitis

To estimate the frequency and major risk factors of preseptal and orbital cellulitis. A cross-sectional analytical study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant [p > 0.5]. Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II

Visual rehabilitation of patients with Stargardt's disease

To assess the role of low vision devices in visual rehabilitation of patients with Stargardt`s disease. Descriptive study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan, from June 2003 to June 2005. Patients diagnosed as having Stargardt`s disease and confirmed by two senior ophthalmologists clinically and after fluorescein fundus angiography and Electro-Retinogram [ERG] when needed, were included in the study. Patients with fundus pathologies other than Stargardt`s disease were excluded. Each subject underwent an ophthalmic examination. Visual acuity was tested with a logarithm of the minimum angle of resolution chart; Feinbloom chart and Snellen type. Low vision assessment was performed on all individuals. SPSS version 10 was used for analysis of the data regarding the severity of visual impairment, visual acuity and devices used for aiding vision. Chi-square test was used for comparison of proportions. Of this cohort of 64 patients, 72% were aged between 7 to 15 years and 28% were 16 to 32 years. Using WHO low vision criteria, the percentage of visually impaired, severe visually impaired and blind [at the time of presentation] were 56.3%; 31.3% and 9.4% respectively. Among those patients, 3.1% had distance visual acuity of 6/18 or better in the better eye and 53% had normal near visual acuity of 1M [0.8 print size]. Telescopes were prescribed to 53% patients for enhancement of distance visual acuity to meet their needs. Stargardt's patients respond well to magnification. Simple bifocal glasses may be used in the early stages. Visual rehabilitation can help Stargardt's patients to learn independence in their activities of daily living

Demography of patients with periocular dermoid cysts

To study the demographics of patients admitted in the hospital with histologically proven periocular dermoid cysts. A retrospective descriptive case series. Department of Ophthalmology Khyber Institute of Ophthalmic Medical Science, Hayatabad Medical Complex, Peshawar from July, 2004 to March, 2007. Clinical characteristics of patients with dermoid cysts admitted to the hospital were retrieved from patient charts. A note was made of its frequency, age, gender and laterality. Other features like site, size, depth, histology and presenting features were also looked for. Patient's age at the time of surgery was also noted. The frequency of dermoid cysts was 40.8% amongst orbital cases. Majority [65.7%] were females and 73.6% patients were below 15 years of age. The disease was right sided in 55.2%. Majority were superficial dermoids [71.0%] followed by conjunctival dermoids [15.7%] and deep dermoids [13.1%]. The most frequent clinical finding was a mass in 84.2%. Most patients [44.7%] were below 10 years at the time of surgery. The disease is more common in females and children. Superficial dermoids are more frequent. Presentation is usually with a subcutaneous mass and treatment of choice is surgical excision

Pattern of pediatric ocular trauma in Hayatabad Medical Complex Peshawar

To determine the pattern and causes of pediatric ocular trauma in Hayatabad Medical Complex, Peshawar. A cross sectional descriptive study Department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 1999 to June 2004. The medical records of 481 children aged upto 16 years who suffered ocular trauma were reviewed retrospectively. Age and gender distribution, nature and source of trauma, presentation and ocular features were analyzed. Pediatric ocular trauma constituted 43.5% of total traumatic ophthalmic admission. Four children were victims of bilateral trauma. Male to female ratio was 3.3:1.Twenty five percent children were below 5 years of age, 47.8% were between 5 to 10 years of age and 27.2% were between 10 to 16 years. About 51% injuries were of open globe type and 37.6% closed globe, superficial non perforating injuries, burns and adnexal pathologies were present in 11.3%. Domestic injuries were more common [47.2%]. At the time of admission 14.6% eyes were infected, 2.3% required evisceration or enucleation. Majority [67.3%] of the children presented late [one week later] to the hospital. Male children were affected more than female by trauma. Half of ocular trauma resulted in open globe injuries and almost 50% of cases were related to domestic injuries. Majority of cases presented late and were secondarily infected

Optimal standard intraocular lens power based on biometry assessment

To evaluate optimal standard intraocular lens power [IOL] for high volume, high quality cataract patients in community eye care centres. This retrospective study was conducted on patients having cataract from January 2004- June 2003 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex Peshawar. Medical record was reviewed and relevant data including patient's age, sex, eye examined, preoperative and postoperative visual acuity, keratometry [K1, K2], axial length and the IOL power used was analysed by an epidemiologist by using SPSS software database. Out of 500 patients with cataract 272 [54.4%] were males and 228 [45.6%]were females. The presenting pre-operative visual acuity was less than 3/60 in 77.6% patients. The post-operative visual acuity was 6/12 or better in 417 [83.4%] patients at the end of first week. Mean axial length was 23.00 mm [SD + 1.5]. For males mean axial length was 22.6824 +/- 1.0985 mm and for females it was 23.1914 +/- 1.6917 mm. Mean IOL power was 21.8 D [SD +2.8]. Mean IOL for males was 22.1952 +/- 2.9170 D and for females was 21.3985 +/- 2.6614 D. In 326 patients [65.2%], IOL used was in the range of 20.5 D to 22.5 D. Use of an optimal standard intraocular lens power based on biometry assessment, in community eye care centres would give optimal visual results. This study demonstrates that an IOL of +20.5- 22.5 dioptre power would leave most postoperative cataract patients with better vision

Frequency and visual outcome of traumatic cataract

To assess the frequency, causative agents, current treatment options, post-operative complications and final visual outcome of trauma related cataract. The study was conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from November 1999 to November 2001. Detailed history with special reference to age, sex, mode of injury, causes and circumstances of trauma were recorded. Indications for surgery were traumatic cataract with or without open globe injury. All patients had B scans [ultrasonography] to evaluate the posterior segment. All patients were operated under general anaesthesia. The patients were followed up for six months. Out of 77 patients with traumatic cataract [69 males and 8 females], about half of the patients were between 5-15 years of age Commonest trauma was sport related in 32 [41.5%] cases. Commonest etiological agent for blunt trauma was stone in 15 [19.48%] cases and for penetrating trauma was thorn in 9 [11.7%] cases. In 71 patients [92.20%] presenting visual acuity was less than 6/60. Fifty three patients [68.83%] had final visual acuity of 6/6-6/12 while only 03 patients [03.89%] had a final visual acuity of<3/60. Traumatic cataract is common cause of visual loss after trauma. Males are affected more than females. Nearly half of patients affected are children under the age of 16. Taking necessary precautions for sports and work can prevent nearly 54% of cataracts. Most common causative agents are stone and wooden sticks

Prospective randomized comparison of dacryocystorhinostomy [DCR] with and without intubation

To compare Dacryocystorhinostomy [DCR] with and without intubation and see, their success rate, surgical duration, cost and postoperative complications. Prospective, randomized, hospital based study. D.H.Q Hospital Lakki Marwat from January 2000 to September 2002. Eighty traditional external DCR procedures with and without intubation were performed. Patients were randomly divided into two groups of 40 cases in each group. Group "A" was labeled as DCR with intubation and Group "B" as DCR without intubation. All the patients were followed for 1 year. Surgical duration, postoperative complications and the success rates were compared. The success rates at one year after surgery was 97.5% for DCR with intubation and 95% for DCR without intubation [not significant]. The surgical duration for DCR without intubation was 45 minutes [shorter] and that for DCR with intubation 55 minutes [longer]. DCR with intubation was more costly as compared to that without intubation. External DCR without intubation yielded equally good results as DCR with intubation. Both procedures were associated with minimal complications. DCR without intubation costs an extra amount of rupees 1800

review of 120 cases of dacryocystorhinostomies [Dupuy Dutemps and Bourguet Technique]

The study was conducted at the DHQ hospital Lakki Marwat from Jan, 1999 to Dec, 2002 to assess the intra and postoperative complications and success rate of external dacryocystorhinostomy [DCR] with suturing of the bridge between anterior flaps of nasal mucosa and lacrimal sac with the muscle layer. Method: We operated upon 120 patients suffering from chronic dacryocystitis [CDC]. Females were 81 [67. 5%] and males were 39 [32.5%]. Majority of the patients were between the age group 40 to 60 years. Indications for dacryocystorhinostomy [DCR] were epiphora, acute on chronic dacryocystitis and a mucocele. All the cases were operated under local anaesthesia with external approach and only anterior flap suturing and engaging it in the muscle layer. These patients were followed for a period of six months. The overall success rate was 98.33%. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing. Conclusions: Dacryocystorhinstomy is a safe procedure under local anaesthesia. It is associated with minimal complications, which can be easily managed. This technique has a very high success rate and a short learning curve