Fundus findings and visual functions in Pathological Myopia

Background: Visual function is a group of specific properties of eye which are essential for comprehensive vision of an individual. Pathological myopia is the condition of eye in which axial length of eye is more than 24mm and refractive error is more than -6 D

Objectives: To evaluate the visual functions in patients with high myopia and to find the most common finding of fundus in pathological myopia

Methodology: This was a descriptive cross sectional study which was conducted on seventy five subjects. Samples were selected by using non probability purposive sampling technique. Visual functions were assessed by using i.e visual acuity by Snellen chart, contrast sensitivity by lea numbers, visual field by confrontation method, color vision by D-15, glare by BAT [brightness acuity test], funds finding by indirect ophthalmoscope. Results: Study was conducted on 75 subjects [150] eyes. Best corrected visual acuity [BCV] was 6/6 to 6/9, 6/9 to 6/12 and 6/9 to 6/18 in myopes with -6.00DS to -8.00DS, - 8.00DS to - 10.00DS,-11.00DS and in -15.00DS respectively. Visual field in myopes from -6.00DS to -8.00DS was normal, it was constricted in myopes more than -9.00DS. Contrast sensitivity [CS] of Myopes having refractive error of -6.00DS to -8.0DS, - 9.00DS to -14.00DS and ? -14.00 DS had 1.25%, 1.25%-2.50% and 5% contrast respectively. 55 subjects having refractive errors from -6.00 DS to -12.00 DS had normal color vision for more than -12.00DS refractive errors. Color vision was defective in 45% subjects specially for blue color. Glare was present in 15 myopes with refractive error more than -14.00DS. The most common fundus findings in pathological myopes were myopic crescent, temporal tilting of optic disc and posterior staphyloma in severe pathological myopes. Conclusion: Visual functions were reduced in high degree of myopia. Myopic crescent, temporal displacement of disc and posterior staphyloma are most common fundus findings in pathological myopes

Astigmatism and early academic readiness in school children

Background: Astigmatism may effect schooling among children

Objective: To determine the effect of uncorrected astigmatism on the readiness of child to go to school

Methodology: This cross-sectional study was conducted on 61 children and vision screening was performed on these children admitted in nursery and prep class of Government Paisa and Akhbar School Lahore from 1 October to 30 November 2015. A questionnaire was asked from the in-charge of each class. The questions represented the different scales of academic readiness. These questions included physical health, personal and social development, academic performance, reluctance while coming to school, attention, language and literacy. The children with astigmatism [defined as >o.5 or equal to 0.5 in either eye] were compared with children who had no astigmatism. Association between the astigmatism and each scale of academic readiness was measured by applying qualitative chi square test. The effect of age and spherical refractive error was ignored. The data was entered and analyzed by using SPSS version 13

Results: A total of 61 students participated in this study. 21 students were of age 4 years and 40 children were of age 5 years. 35 children were non-astigmatic and 25 children were astigmatic. There was no significant effect of uncorrected astigmatism on health and development [P=0.2], reluctance to go to school [p=0.08] and school attendance [p=0.3]. This may be due to the fact that our schools are not that efficient to record theacademic performance across the developing years. There was a significant effect of astigmatism on academic readiness [p=0.02], language and literacy [0.05]

Conclusion: The study showed that there was significant effect of astigmatism on academic readiness, language and literacy whereas there was no significant effect on health and development, reluctance to go to school and school attendance. This study emphasized on the importance of early vision screening in preschoolers so that children can see clearly in early years of their visual development and academic learning

Frequency of visual disorders in school children of district Rahim Yar Khan

Background: Low vision is defined as visual acuity of less than 6/18, but equal to or better than 3/60, or a corresponding visual field loss to less than 20 degrees in the better eye with best possible correction

Objective: To determine the frequency of visual disorders in school children

Subjects and Methods: In this cross sectional study, 5360 students of different age groups and of both sexes from the urban and rural government schools of all the tehsils of district Rahim Yar Khan, were selected and screened out. Schools were selected in clusters through random sampling. Visual acuity of all the children was checked by using Snellen's Chart and children with refractive errors were refracted at the same place and prescribed the required number for glasses. The children with organic lesion or not improved with refraction were referred to Sh. Zayed Hospital, Rahim Yar Khan [SZH] for thorough assessment and management. The data was entered and analyzed by using SPSS 15

Results: Out of total 5360 children 256 [4.77%] have refractive errors and 33 subjects [0.61%] comprising 23 [69.69%] males and 10 [30.30%] females have low vision. The major cause of low vision was found to be Retinitis Pigmentosa [RP] which accounted 13 cases [39.39%] of the total low vision patients while 7 cases [21.21%] of congenital cataract, 4 [12.12%] Buphthalmos, 3 [9.09%] Optic Atrophy, 3 [9.09%] Albinism, 2 [6.06%] Maculopathy and 1 [3.03%] high Myopia [Chorioretinal degeneration]

Conclusion: Hereditary diseases have been found to be the major cause of low vision leading to blindness. The study also revealed that low vision is more common in males. There is high prevalence of refractive errors found in this study, giving the picture of the increased burden of eye problems in district Rahim yar Khan

Percutaneous tracheostomy in critically ill patients: 24 months experience at a tertiary care hospital in United Arab Emirates

We assessed the safety and complications related to percutaneous tracheostomy [PCT] without bronchoscopic guidance in our intensive care unit [ICU]. The prospective data over a period of 24 months were collected for patients who underwent PCT. Major, minor and long-term complications were recorded. The parameters recorded were: age, gender, Glasgow Coma Scale / [GCS] score on the day of tracheostomy, acute physiology and chronic health evaluation II [APACHE] score, and predicted mortality based on score on admission and on the day of procedure, total number of days in the hospital before the final outcome, number of successful decannulations and mortality. The patients were stratified in two groups of survivors and nonsurvivors. A total of 117 patients underwent PCT. Overall mean GCS and APACHE-II scores before PCT were 7 +/- 3 and 16 +/- 5, respectively. The only significant difference was APACHE-II score and the predicted mortality based on APACHE-II score on the day of PCT, which was higher amounts the nonsurvivors [P=0.008 and P=0.006]. All 57 [495] survivors were successfully decannulated with mean post tracheostomy days of 24 +/- 15. The major complication observed was three episodes of major bleeding. Only six patients had an episode of desaturation during the procedure and there were three episodes of accidental puncturing of endotracheal [ET] tube pressure cuff. During subsequent follow-up in hospital, six patients developed stoaml cellulitis. PCT without bronchoscopic guidance can be performed safely by carefully selecting patients and having an experienced team High APACHE score on the day of procedure may lead to poor outcome

Outcome of fixateur interne in thoracolumbar trauma

Spinal cord injury [SCI] is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional cost to individuals but also is a significant financial burden to society at large. The Objective was to study the outcome of spinal fixation with fixateur interne in cases of thoracolumbar spinal injuries in terms of neurological recovery and complications. This Descriptive study was conducted at Department of Neurosurgery, Hayatabad Medical Complex and Postgraduate Medical Institute, Peshawar, from March, 2006 to December, 2007 Study included patients admitted in Neurosurgery Ward HMC, with acute traumatic spinal injuries during the above mentioned period who underwent thoracolumbar spinal fixation with fixateur interne. Name, age, sex, other relevant data, history, examination findings and investigation results were recorded. Postoperative outcome was evaluated taking neurological status, and complications like infection, implant failure and other complications into consideration. Follow-up of 6 months was carried out. There were 31 patients, [18 male and 13 female]. Fall from height [48%], road traffic accidents [26%] and crush injuries [26%] caused the trauma. Most common age group was from 21-30 years age. Fractured vertebrae included 2 D11 fractures, 12 D12 fractures, 13 L1 fractures, 3 L2 fractures and 1 L3 fracture. Mean operative time 80 minutes, mean blood loss 200 ml, mean hospital stay 6 days and mortality rate was 0%. Number of patients with Frankel grade A reduced from 27 to 19 and in Frankel grade E increased from 0 to 4 patients. Only one patient had infection and one patient had implant removal. Fixateur interne is a useful and low-cost implant for fixation of thoracolumbar junction injuries with very easy availability and easy operative insertion and little blood loss. It has excellent post-operative outcome in terms of neurological improvement and a very low complication rate. Mortality rate is minimal

Comparison of visual outcome between superior scleral tunnel and temporal scleral tunnel approaches in Manual Small-Incision cataract surgery

To compare the postoperative visual acuity, per-operative and post-operative complications and the magnitude of the post-operative astigmatism in [Manual Small Incision cataract surgery [MSICS]] in superior and temporal scleral tunnel approach. A comparative interventional study. The study was conducted at LRBT Secondary Eye Hospital Lar, Multan from Jan 2008 to September 2008. 250 patients, aged from 45 to 90 years, were enrolled and divided into two groups, group A [N=125] and group B [N=125]. Group A underwent MSICS by superior while group B underwent MSICS by temporal scleral tunnel incision approach. The patients were followed up at 1st and 3rd post-operative days and 2nd, 4th and 6th postoperative weeks. 107 patients in group A and 119 patients in group B completed their 6 week follow up. The intraoperative complications, post-operative complications, postoperative visual acuity and magnitude of postoperative astigmatism were recorded at 6 week follow up and compared between two groups. At 6th week postoperatively, 46 of 107 [42.9%] of group A and 79 of 119 [66.1%] of group B had uncorrected visual acuity of 6/18 or better. 98 of 107 [91.3%] of group A and 110 of 119 [92.2%] of group B had best corrected visual acuity of 6/18 or better. There was no significant difference between the two groups for intra-operative and post-operative complications. Minimum and safe stigmatism is present in temporal approach. Both superior and temporal scleral tunnel approaches are safe and effective for MSICS but the temporal approach gives better un-corrected visual acuity and minimum and safe astigmatism

Correlation between central corneal thickness and endothelial cell density in non-glaucomatous pseudoexfoliative eyes - a comparative study

To describe correlation between central corneal thickness [CCT] and endothelial cell density [ECD] in non-glaucomatous pseudoexfoliative eyes and compare them with age-matched normal eyes. Cross sectional comparative study. Forty eyes of forty subjects with Pseudoexfoliation syndrome [Group A] and forty eyes of forty age-matched subjects without PXS [Group B] were included. Subjects suffering from diabetes, myopia, glaucoma, any pathology of anterior segment, ocular trauma, inflammation or surgery, and contact lens wearers were excluded. Included eyes underwent non-contact specular microscopic examination [Topcon SP2000.P, Topcon Corp. Japan.] to get data about CCT and ECD. CCT in group A was significantly lower than group B [484.68 + 19.727 Vs 500.25 + 24.777 [micro]m, p= 0.003]. ECD in group A was significantly lower than in group B [2124.60 + 251.818 Vs 2431.43 + 224.820 cells/mm2, p<0.000]. There was non-significant correlation between ECD and CCT in both groups. Non-glaucomatous pseudoexfoliative eyes have thinner corneas with decreased ECD. Knowledge of these parameters may be helpful in interpreting intra-ocular pressure and planning surgical procedures

Spectrum of ocular injuries presenting at emergency department of pakistan institute of medical sciences

To determine the proportion, pattern and burden of eye injuries presenting at emergency department [A and E] of Pakistan Institute of Medical Sciences [PIMS], Islamabad. Study Design: Observational case series. The study was carried out of all cases of ocular trauma presenting in PIMS via emergency department during a 1 year period. After presentation in the emergency department the detailed history of the patient was taken with particular reference to age, sex, mode of injury. Initial examination was carried out by using torch, slit lamp examination. Relevant investigations including X-ray orbit, B-scan of the orbit, X-ray skull and C.T-scan were also done where needed. Patient with superficial injuries were discharged after management, while those with serious injuries were admitted. 209 cases were enrolled in the study. Most were males [83.7%] between 16 and 30 years of age. The commonest place of injury was work place [30.6%] followed by home [30.1%]. 194 patients [92.8%] presented in emergency within 24 hours and only 15 patients [7.2%] came after one day. 202 patients [96.7%] presented directly to emergency and only 7 [3.3%] were referred by other hospitals. Visual acuity was 6/6 in 31.6% of patients while five patients [2.4%] had no light perception. Most of the patients were treated without hospitalization and only 58 patients [27.8%] were admitted in the hospital. The current burden of eye injuries presented to A and E department of PIMS had been estimated. Ocular trauma remained an important cause of blindness, particularly among younger age groups