Visual outcome after phacoemulsification with lens implant in diabetic and non-diabetic patients; a comparative study

Objective: To compare the visual outcomes of phacoemulsification surgery with intraocular lens [IOL] in persons with and without diabetes at end of follow-up

Methods: This was a comparative, cross sectional, observational study with Non-probability, purposive sampling. After approval from "Research Ethical Committee of Isra Post-graduate Institute of Ophthalmology Karachi, 92 patients with cataract in one eye were selected. Patients were divided into two groups. Group A consisted of 48 diabetics and group B consisted of 44 non- diabetics with or without diabetes in the age group >/= 30 years were included. Patients with small Pupil, Pseudo exfoliation Syndrome, Diabetic Retinopathy, and positive history of Uveitis, Glaucoma, and Macular Degeneration were excluded. Data analysis was performed by SPSS Version 20.0

Results: Best Corrected Visual Acuity [BCVA] in diabetic patients improved from 0.813 +/- 0.181 Log MAR pre operatively to 0.183 +/- 0.143 after the period of six months post-operatively. Corresponding results in non-diabetics were 0.66 +/- 0.31 and 0.08 +/- 0.092 Log Mar [P value = 0.001]. If WHO criteria was considered, 87.5% diabetics and 92% non-diabetics achieved normal vision [Log Mar 0 to 0.5; >/= 6/12,] on the first postoperative day. Remaining 12.5% diabetics and 8% non-diabetics achieved moderate vision [0.6 to 1 Log MAR] on first post-operative day improving to normal vision within a week

Conclusion: Visual outcomes in diabetics after phacoemulsification with intra ocular lens implant is almost as good as that in non-diabetic patient if the diabetics have no retinopathy and have good glycemic control

Visual outcome of laser treatment in diabetic macular edema: Study from an urban diabetes care center

Objective: To determine the visual outcome of laser treatment in clinically significant macular edema

Methods:This interventional and qausi experimental study was carried out at Diabetic Association of Pakistan [DAP] during January 2011 and December 2012. Approval was taken from Research Ethical Committee of Isra Postgraduate Institute of Ophthalmology. Records of 925 eyes of 464 patients with "Clinical Significant macular edema" [CSME], treated with laser photocoagulation were analyzed. Bestcorrected visual acuity [BCVA] at the time of presentation and at the last follow up, minimum of one year and maximum of 45 months was recorded and compared. SPSS version 20.0 was used to analyze the data

Results:Diabetic retinopathy was found in 20.3% [1777] of 8742 diabetic attending DAP Hospital" amongst whom 39.6% [705] had Sight threatening diabetic retinopathy. Laser was advised in 96.4% [680] individuals, accepted by 70.5% [480] individuals. Amongst 960 eyes of 480 patients who accepted laser, 925 eyes had clinically significant macular edema and 35 eyes had PDR who are not included in this study. Amongst 925 eyes with CSME, Grid laser was done in 913 eyes [99%] and focal laser was done in 12 eyes [1%]. After a follow up of 12 to 45 months, it was found that best corrected visual acuity had declined in 2.4% [22] eyes, stabilized in 67% [619] eyes and improved in 30.7% [284] eyes. One line improvement on Snellen's chart was fond in 21.3% [197] eyes, 2 lines in 8% [74] eyes, 3 lines in 1.2% [12] eyes and 4 lines in one [0.1%] eye with p-value of 0.000

Conclusion:Laser therapy is an effective treatment in stabilizing/improving the vision in diabetic macular edema particularly at those centers where only Argon Laser is available and OCF, FFA facilities do not exist

assessment of knowledge, attitude and practices [KAP] towards diabetes and diabetic retinopathy in a suburban town of Karachi

To assess the Knowledge, Attitude and Practices [KAP] towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town [BQ], Karachi. An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of [BQ] Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data. Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 [39.2%] had diabetes. Lowest mean knowledge score [5.28 +/- 6.09] was seen in illiterate respondents. Male's Mean Knowledge score [7.61 +/- 6.600] was better than female's [5.46 +/- 6.21] with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 +/- 2.57. It was higher [6.62 +/- 2.03] in diabetic respondents as compared with non-diabetic respondents [4.70 +/- 2.59] with p < 0.000. In Practice module majority of the respondents [69.9%] did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes

Primary effects of intravitreal bevacizumab in patients with diabetic macular edema

To evaluate the efficacy of primary intra vitreal bevacizumab [IVB] injection on macular edema in diabetic patients with improvement in best corrected visual acuity [BCVA] and central macular thickness [CMT] on optical coherence tomography [OCT]. This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study [ETDRS] charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography [FFA] and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. The mean BCVA at base line was 0.42 +/- 0.14 Log Mar units. This improved to 0.34 +/- 0.13, 0.25 +/- 0.12, 0.17 +/- 0.12 and 0.16 +/- 0.14 Log Mar units at 1 month after 1[st], 2[nd] 3[rd] injections and at final visit at 6 months respectively, a difference that was statistically significant [P > 0.0001] from base line. The mean 1mm CMT measurement was 452.9 +/- 143.1 microm at base line, improving to 279.8 +/- 65.2 microm [P < 0.0001] on final visit. No serious complications were observed. Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME

Quantitative analysis of stress and cholesterol levels in university teachers and housewives of hyderabad-Pakistan

To evaluate environmental, psychological and physiological stresses in university teachers and housewives and correlate it with serum total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels. Eighty females from middle socioeconomic groups [40 university teachers and 40 housewives] aged between 30-45 years were selected for this study. All subjects were selected from Hyderabad and its adjoining areas. Environmental, psychological and physiological stress levels were measured using Likert scale. Total cholesterol, LDL cholesterol and HDL cholesterol were measured by CHOD-PAP method and triglyceride levels were measured by GPO method. Housewives had high levels of total cholesterol, LDL cholesterol and triglyceride but low levels of HDL cholesterol than the university teachers. Environmental, psychological and physiological stresses were also significantly high in housewives as compared to university teachers. High levels of total cholesterol, LDL cholesterol, triglyceride and low levels of HDL cholesterol in housewives correlated to their stressful lifestyle

Dacryocystorhinostomy without intubation with intraoperative mitomycin C

To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy [DCR] surgery. Quasi-experimental study. Isra postgraduate institute of Ophthalmology, Al-Ibrahim Eye Hospital, Malir, Karachi, from January 2003 to December 2004. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria.The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% [p-value< 0.001]. This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery