Comparison of the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery

To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. A randomized controlled trial. Eye [B] Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B [p < 0.001]. At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups [p = 0.999 and 0.59 respectively]. Group A had better akinesia as compared to group B [p = 0.04]. There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A [p < 0.001]; in both groups, the intraocular pressure declined to its base level 10 minutes after the injection [p = 0.52]. Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia

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

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

Recurrence in primary pterygium excision with amniotic membrane grafts

Recurrence in primary pterygium excision with amniotic membrane grafts were studied. Patients presenting to the outpatients clinic of ophthalmology department in Khyber teaching hospital with primary pterygium were included in this study. 22 [41%] cases were treated as inpatients and 32 cases [59%] as outpatient. They were all having primary pterygium. Cases were randomly selected on the basis of inclusion and exclusion criteria and details were recorded on a pre developed proforma. All patients underwent surgical excision of the pterygium. The pterygia were excised to bare sclera and the conjunctival defects closed with amniotic membrane grafts using 10/0 nylon suture. Each patient was followed for a period of six months. The primary outcome was to measure pterygium recurrence. The recurrence is defined as the 2mm or more regrowth of the fibro vascular tissue over the cornea. Out of the 54 cases by six months post op four [7.40%] developed corneal recurrence. No association was found between pterygium recurrence and pterygium size, amniotic membrane graft dimension, patient age or patient sex. The amniotic membrane is an effective and safe procedure for the treatment of primary pterygium. Absorbing excessive stem and progenitor cells may be one of the mechanisms of reducing the recurrence rate using amniotic membrane