Accuracy of straight leg raise test in patients with lumbar disc herniation keeping magnetic resonance imaging as a reference standard

Objective: To determine the accuracy of straight leg raise [SLR] test in patients with lumbar disc herniation keeping magnetic resonance imaging [MRI] as a reference

Study Design: Validation study

Place and Duration of Study: Radiology department of Combined Military Hospital [CMH], Quetta, over a period of 16 months from 1st Dec 2012 to 31st May 2013

Material and Methods: Total 225 cases with lower back pain were included through non probability-consecutive sampling. Informed consent was taken. The patients were assessed for positive or negative SLR test. Then all patients underwent MRI of lumbosacral spine. Data was collected through a specially structured proforma. Data was analyzed by SPSS version 10

Results: SLR test was found to be positive in 114 [50.7%] cases while negative in 111 [49.3%] cases. Lumbar disc herniation on MRI was found to be positive in 122 [54.2%] cases while negative in 103 [45.8%] cases. Sensitivity, specificity, positive and negative predictive values of SLR test were found to be 82.8%, 87.4%, 88.6% and 81.1% respectively. Accuracy of SLR test was found to be 84.9%

Conclusion: We concluded that SLR test is accurate enough to diagnose disc herniation with reference to MRI. Now we can advise SLR test for assessment of disc herniation where MRI is not available or unaffordable for the patients

Comparison of pressure lowering effects of timolol/dorzolamide combined preparation versus latanoprost in primary open angle glaucoma

To compare the intraocular pressure [IOP] lowering effect of Timolol/Dorzolamide combined preparation to that of Latanoprost in eyes with primary open angle glaucoma. Randomized control trial [RCT]. The Eye department, Military Hospital, Rawalpindi, over six months, from 9th June 2008 to 8th December 2008. Eighty Six patients included were divided into two equal groups. Initial IOP measurement was taken for every patient using Goldmann Applanation Tonometer with Fluorescein. Topical Antiglaucoma therapy was started in patients of either group. Group A patients were administered timolol/dorzolamide combined preparation where as latanoprost was administered to group B patients. Follow up IOP measurements were recorded at 4 week and 8 week interval for every patient and findings were endorsed on a pre-designed proforma. Data were analyzed using SPSS version 11.0. Eight week follow up IOP of Group A [14.51 +/- 2.54] was significantly lower than the initial IOP [19.37 +/- 2.49] [p<0.05]. For Group B, difference between initial IOP [19.53 +/- 2.69] and 8 week follow up IOP [14.09 +/- 2.23] was also statistically significant. The difference between mean IOP of the two groups at 4 week [p=0.284] and at 8 week [p=0.419] follow up was not statistically significant. Frequency of cases with >/= 4 mm Hg drop at 4 week follow up was 26 [60.46%] in group A as against 29 [67.44%] in group B [p=0.50], whereas at 8 week follow up it was 31 [72.09%] for group A and 34 [79.07%] in group B [p=0.451]. The results suggest that latanoprost monotherapy and timolol/dorzolamide combined therapy is equally effective in controlling IOP in patients with POAG.

Comparison between loss variance of tendency-oriented perimetry and normal strategy perimetery using octopus 32 program

To compare the values of loss variance [LV] obtained by a faster strategy- Tendency oriented perimetry [TOP] with those obtained by a standard stair casing strategy i.e. normal test strategy using OCTOPUS 32 program. Cross-sectional comparative study. Eye Department of Military Hospital Rawalpindi from February 15, 2007 to October 10, 2007. A total of 61 eyes were included in the study. Thirty with normal ocular examination and 31 with ocular pathologies producing visual field defects. Each eye was analysed with the normal [stair casing] test strategy and TOP strategy using 32 programs on Octopus 311 perimeter. LV was compared for two strategies. There was statistically significant difference between LV obtained from TOP and Normal strategy [p = 0.001]. TOP strategy tends to obtain fields with less pathological results especially for the calculation of the extent and depth of each scotoma in comparison with the normal strategy

Comparison of preoperative and intraoperative mitomycin C in prevention of pterygium recurrence and postoperative complications

To compare the frequency of recurrence and corneoscleral complications with pre-operative and intraoperative mitomycin C when used with excision of primary pterygium by bare sclera technique. Quasi experimental study. Armed Forces Institute of Ophthalmology Rawalpindi. Ten months [October 2006 to July 2007]. A total of 70 cases with primary pterygium were selected and divided equally into group A and B. in cases of group A, 0.1cc of 0.15 mg/ ml of MMC was injected sub-conjunctivally and pterygium excision with bare sclera technique, a sponge soaked in 0.04% MMC was applied over the bare sclera for three minutes intraoperatively. The patients were followed up to see recurrence and corneoscleral complications for three months. A total of 70 cases, 35 in each group were analyzed statistically. Mean age of group A was 40.83 +/- 12.655 years whereas that of group B was 44.57 +/- 13.718 years. Group A had 28 [80%] males and 7 [20%] females. Group B had 23 [65.7%] males and 12 [34.3%] females. Number of patients who presented with recurrence in group A was 1 [2.9%] and group B were 4 [11.4%]. In group A no patient presented with corneoscleral complications during the study whereas in group B these complications were seen in 7 [20%]. Chi-square test revealed no significant difference in recurrence [P=0.356] whereas it showed significant difference in corneoscleral complications between the groups [P=0.011]. Preoperative MMC is as effective as intraoperative MMC in preventing recurrence but it is much safer than intraoperative MMC causing less corneoscleral complications

Comparison of post-operative astigmatism following phacoemulsification with sutured versus un-sutured wound closure

To compare corneal astigmatism induced by sutured and sutureless wound closure of the main incision, after phacoemulsification, in patients attending the Eye department, Military Hospital, Rawalpindi. Quasi experimental study. Armed Forces Institute of Ophthalmology, Rawalpindi, from 20th May, 2006 to 19th May, 2007. Sixty patients were included in this study divided in two equal groups. Phacoemulsification with foldable IOL was done in all patients by the same surgeon with same surgical technique. Main incision was closed with a single suture in group A and left sutureless with stromal hydration in group B. Keratometry was performed preoperatively, at day one and 4 weeks post operatively. Postoperative astigmatism in sutured and sutureless groups at the end of first week was [1.00 D +/- 0.38] and [0.88 D +/- 0.35] respectively. At one month postoperatively astigmatism was [0.76 +/- 0.43] and [0.66 +/- 0.32] respectively in the two groups. There was statistically no significant difference between the postoperative astigmatism at one month between the two groups [p> 0.05]. There is statistically no significant difference between post-operative astigmatism after phacoemulsification between a 3.2 mm self-sealing incision whether closed without suture or secured by a single suture

Temporary tarsorrhaphy - use of commercial glue [ELFY]

To assess the use of commercial glue [Elfy] for achieving temporary tarsorrhaphy Case series Place and duration of study: Study was conducted at CMH Kharian from January to September 2008. Patients and Method: The various ocular surface disorders which were managed by the temporary tarsorrhaphy with the commercial glue [Elfy] were analyzed. The duration of lid fusion with Elfy and any adverse affects were also noted. Elfy was applied just below the margin of lower eyelid. Then, using a spatula, upper lid was apposed to the lower lid for 1-2 seconds in order to create fusion. If patient required topical treatment, lateral two thirds of the lids were fused and drops instilled through medial one third. In rest of the cases, full length fusion was achieved. In a total of 32 patients Elfy was applied. Eighteen [56%] were males and 14 [44%] were females. Age ranged from six years to seventy five years with mean age of 22.6 years [SD+21.84]. Ocular diseases requiring lid fusion included, infective corneal ulcer/abscess in 21 cases [65.6%], shield ulcer in vernal keratoconjunctivitis in 3 cases [9.4%], facial palsy in 2 cases [6.2%], alkali burns in 2 cases [6.2%], neurotrophic ulcer in 2 cases [6.2%], Mooren ulcer in 1 case [3.1%], Grave's disease in 1 case [3.1%]. Lid fusion persisted for a mean duration of 7.6 + 4 days [range 2 -20 days]. Duration of fusion was less if skin or lashes of upper lid were fused with only skin of lower lid. But it remained for longer duration when eyelashes of both the lids were stuck together. 6 [19%] patients had a burning sensation for fraction of a second, one patient [3%] complained of gritty sensation on skin due to which she removed the Elfy. All the corneal ulcer cases had clinical improvement. Commercial glue [Elfy] is useful as a temporary measure for tarsorrhaphy