Spectrum of optic disc changes in primary open angleglaucoma

To find out the patterns the optic disc changes associated with primary open angle glaucoma [POAG]. This descriptive study was conducted at Ophthalmology department, Hayatabad Medical Complex Peshawar from 1[st] January to 31[st] December 2009. All patients with diagnosed POAG, above the age of 30 years, having no lens or media opacity and ocular co-morbidity, were examined thoroughly for patterns of optic disc changes associated with POAG. Frequencies and percentages of the contour of neuroretinal rim, appearance of nerve fiber layer, presence of optic disc hemorrhages, colour of optic nerve head was noted. Descriptive statistics for disc were calculated for Vertical disc diameter [VDD], Cup/disc ratio [CDR], and Rim Disc Ratio [RDR]. Two hundred patients with POAG were included. Diffuse thinning and localized notching in the neuroretinal rim was noted in 188 [94%] and 86 [43%] patients, respectively. Optic disc hemorrhage, Optic disc pallor and Optic disc atrophy was seen in 80 [40%], 127 [63.5%] and 15 [7.5%] cases, respectively. Mean VDD was 1.76mm in both right and left eyes. Mean vertical and horizontal CDR was 0.73 and 0.57 in the right and 0.765 and 0.611 in the left eye, respectively. Mean vertical and horizontal RDR was 0.451 and 0.543 in the right and 0.368 and 0.486 in the left eyes, respectively. Majority of the patients showed changes in measurements of neuroretinal rim, so emphasis should be placed on the examination of neuroretinal rim in all patients of POAG

Complication rate in preliminary experience in phacoemulsification cataract surgery

To describe the perioperative and postoperative complications related to cataract surgery performed by phacoemulsification technique at Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex Peshawar. One hundred consecutive cataract operations using phacoemulsification were performed from January 2011 to December 2011 at the KIOMS. After thorough examination and investigations, patients were operated. Most were operated using peribulbar anesthesia. First examination was done on the first post-operative day and then patients were followed after three weeks and eight weeks. Their per-operative and postoperative complications were analyzed and compared with complication rates reported in other studies. Total 100 cases were included in the study with 30 patients having bilateral and 40 patients having unilateral cataract. The mean age of patients was 57.4 +/- 9.3 years. Posterior capsular rupture in 19 [19%] patients was the most common intraoperative complication. Corneal edema in 49 [49%] patients on first postoperative day was most common post operative complication. After three weeks the vision was 6/12 or better in 80 [80%] of cases. Posterior capsular rupture and corneal edema were most common intraoperative and postoperative complications respectively. Majority of patients had 6/6-6/12 vision by the end of first three weeks of cataract surgery

Effectiveness of sodium hyaluronate eye gel in patients with dry eye disease: a multi-centre, open label, uncontrolled study

To assess the effectiveness of sodium hyaluronate Eye Gel in Dry Eye Disease [DED] patients. A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were enrolled after obtaining a written informed consent. Ten patients were dropped out during the study period. All patients were assessed as per following criteria for enrolling a patient into the study: Tear Film Break - up time [TBUT]

Causes of visual impairment in children with low vision

To determine the main causes of visual impairment in children with low vision. To assess the need of spectacles and low vision devices [LVDs] in children and to evaluate visual outcome after using their LVDs for far and near distance. Observational study. Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan, from June 2006 to December 2007. The clinical record of 270 children with low vision age 4-16 years attending the Low Vision Clinic were included. All those children, aged 4-16 years, who had corrected visual acuity [VA] less than 6/18 in the better eye after medical or surgical treatment, were included in the study. WHO low vision criteria were used to classify into visually impaired, severe visually impaired and blind. Results were described as percentage frequencies. One hundred and eighty nine [70%] were males and 81 [30%] were females. The male to female ratio was 2.3:1. The main causes of visual impairment included nystagmus [15%], Stargardt's disease [14%], maculopathies [13%], myopic macular degeneration [11%] and oculocutaneous albinism [7%]. The percentages of visually impaired, severe visually impaired and blind were 33.8%, 27.2% and 39.0% respectively. Spectacles were prescribed to 146 patients and telescopes were prescribed to 75 patients. Spectacles and telescope both were prescribed to 179 patients while Ocutech telescope was prescribed to 4 patients. Retinal diseases nystagmus and macular conditions were mainly responsible for low vision in children. Visually impaired children especially with hereditary /congenital ocular anomalies benefit from refraction and low vision services which facilitate vision enhancement and inclusive education

Dialysis-related factors affecting quality of life in patients on hemodialysis

Treatment modalities for end-stage renal disease affect quality of life [QOL] of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Eighty-nine patients [71.2%] were men, 99 [79.2%] were married, 75 [60.0%] were older than 45 years, and 77 [61.6%] were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 [environment]. There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 [social relationship] of the patients at Mayo Hospital [a public hospital], which was significantly better. Nondiabetic patients had a better QOL in domain 1 [physical health] as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL

Sub-conjunctival anaesthesia in treabeculectomy an experience with 80 caases

To determine the patients tolerability, comfort, ease of application and surgeons convenience with sub-conjunctival anaesthesia for trabeculectomy in our clinical setup. Material and It was a prospective and observational study conducted at the department of Ophthalmology, Postgraduate Medical Institute, Hayatabad Medical Complex and Khyber Teaching Hospital, Peshawar. All patients were injected with up to 1 ml of a 1:1mixture of 2% lignocain with epinephrine and 0.75% bupivacaine sub-conjunctivally and operated for trabeculectomy. Intra-operative pain, presence of eye movements and complications of anaesthesia were monitored. Bleb leak and ptosis were assessed postoperatively. Patient discomfort was assessed intraoperatively and 24 hours postoperatively using a standardized verbal descriptive chart with 0 to 4 pain scoring levels. Eighty patients underwent sub-conjunctival anaesthesia for trabeculectomy. Sixty-eight [85%] patients remained comfortable throughout the procedure. Only 3 [3.75%] patients required supplemental subconjunctival anaesthesia block during surgery, while 7 [8.75%] patients required a facial block. Two [2.5%] patients needed retrobulbar block. No surgery was postponed and none of the patient required general anesthesia. Most common complication noted was chemosis of the conjunctiva [70%]. In two cases [2.5%] it interfered with the surgery and the surgery time was prolonged. Small sub-conjunctival hemorrhage developed in 43 [53.75%] patients; however, this did not interfere with the surgery. No case of postoperative bleb leak and ptosis was noted. The technique of subconjunctival anaesthesia is safe, effective, tolerable, and convenient. It is not associated with any remarkable postoperative complications because it is performed under direct visualization

Frequency and complications of ocular pemphigoid in N.W.F.P.

Objective: to study the frequency of "Ocular Pemphigoid" in the population of NWFP and to study the mode of presentation and presence of complications

Material and Methods: it is a retrospective case study conducted in the department of Ophthalmology, Hayatabad Medical Complex, during the period from January 1998 to December 2001

Results: during this period six cases were identified with the proven diagnosis of ocular cicatricle pemphigoid [OCP]. The incidence of OCP in the admitted patients was 1:2427. Fifty percent of them were male and 50% female. The mean age of presentation was 56.6 years. Sixty seven percent of the patients had systemic mucous membrane involvement. Only 17% had skin involvement. All of them were. previously treated as trachoma

Conclusion: this paper emphasizes the presence of ocular pemphigoid and should be kept in mind when dealing with the patients of trichiasis, entropion and dry eyes

Conventional retinal reattachment surgery

To evaluate the surgical outcome in rhegmatogenous retinal detachment [RRD] cases operated by conventional retinal reattachment techniques. Design: Descriptive study. Place and Duration of Study: This study was conducted at Eye Unit, Hayatabad Medical Complex [HMC], KIOMS, Peshawar, from July, 2002 to December, 2002. Materials and A retrospective analysis of ophthalmic record of rhegmatogenous retinal detachment operated by conventional retinal reattachment surgery was done. Anatomic outcome was evaluated in relation to duration of presentation and pre-operative proliferative vitreoretinopathy [PVR]. Postoperative visual acuity [VA] was compared to pre-operative VA. Complications and causes of failure of anatomic success were also analyzed. A total of 40 cases were studied. Male to female ratio was approx 2:1. Retinal breaks were localized in 70% cases, 37.5% cases had single break while 32.5% cases had more than one retinal breaks. Forty two% had total retinal detachment while 57.5% had less than total retinal detachment. Five% had attached macula at presentation. Immediate postoperative retinal reattachment was attained in 80% cases but ultimate anatomic success after at least 6 months of follow up was 72.5%. Patients who presented earlier [upto 1 year] had 75% anatomic success while those who presented later than 1 year had 50% success rate. Postoperative visual improvement was noted in 80% cases with flat macula, 65% had VA 6/60 or better after surgery. Most common cause of failure of anatomical reattachment was PVR [63.63% of failed conventional surgery]. Most common postoperative complication was raised intraocular pressure [> 21 mmHg] in 25 cases. There is more chance of retinal reattachment and visual restoration in cases that present earlier. PVR is the main cause of failure of conventional retinal reattachment surgery. Postoperative visual improvement is directly related to surgical reattachment of the macula

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

Orchidopexy: a technique to minimize vascular damage and subsequent testicular atrophy

Many techniques have been described to lengthen the cord and place the testis in the scrotum in case of mal-desended testicles. In all these procedures, the main danger is damage to the vascular supply of the testis and subsequent atrophy. A method has been described to lengthen the cord with minimal risk of damage to the vascular supply of the testis, thus avoiding post-operative testicular atrophy

4-year review of keratoplasty in Pakistan

From January 1, 1985 to December 31, 1988, we performed penetrating keratoplasty on 54 Pakistani patients, 38 men and 16 women, at the Postgraduate Medical Institute, Peshawar. The age of the donors ranged from 14 to 91 years and that of the recipients from 12 to 65 years. The time between enucleation and the surgery was 26 hours minimum and 72 hours maximum. Autografts were used in two patients. The size of the graft ranged from 5.5 mm to 10 mm with an average of 7 mm. Corneal scarring [35 cases, due to healed bacterial ulcer, small pox, measles, trachoma, or trauma], keratoconus [eight cases], aphakic or pseudophakic bullous keratopathy [three cases], dry eye syndrome [two cases], chemical burn [two cases], active bacterial corneal ulcer [two cases], corneal dystrophy [one case], or sclerokeratitis [one case] were the reasons for keratoplasty. After a followup period of six months to four years, 23 [42.6%] grafts remained clear. The lack of donor material of good quality, a large percentage of high risk recipient eyes, and technical surgical limitations [e.g. non-availability of viscoelastic material, fine sutures, etc.] resulted in 57.4% failure rate. Only four [7.4%] cases showed late rejection, which was successfully managed in two of them. Of the eight eyes with keratoconus, seven retained clear grafts