Visual outcome after pars plana vitrectomy in diabetic vitreous hemorrhage

Objectives: To determine visual outcome and frequency of complications after pars plana vitrectomy in diabetic vitreous hemorrhage

Methodology: This was interventional case series conducted at department of ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 2013 to June 2014. Known diabetic patients above 16 years of age, having vitreous hemorrhage were included. Standard three ports pars plana vitrectomy [PPV] with membrane peeling, endolaser and without endotamponade by single study surgeon was done in all patients. Best corrected visual acuity was noted pre operatively and on 1st day, 2nd week and 8th week post operatively. P- value <0.05 was considered statistically significant. Post-operative complications and visual improvement were noted at final visit

Results: Total of 50 patients having diabetic vitreous hemorrhage were included in the study. Mean age was 41.4 years. Male patients were 66%. Clear lens was present in 46% patients and cortical lens vacuoles in 36% patients. Fresh vitreous hemorrhage was present in 80%. Baseline and final post-operative best corrected visual acuity logarithm minimal angle of resolution was 1.01 +/- 0.17 and 0.74+/- 0.25 respectively. The difference in pre and post-operative best corrected visual acuity logarithm minimal angle of resolution was 0.045 which was statistically significant. There were no post-operative complications in 82% patients. Visual improvement was observed in 82%

Conclusion: Most patients with diabetic vitreous hemorrhage regain or retain useful vision after PPV. Many patients may suffer late complications like recurrent vitreous hemorrhage and retinal detachment after successful initial surgery requiring secondary intervention

Frequency and pattern of ocular emergency in district Swabi

Objectives: To determine the frequency and pattern of ocular conditions presented to the ophthalmic casualty room at a secondary care hospital in District Swabi

Study design: Descriptive Cross- sectional study

Place and duration of study: Eye Department of District Head Quarter Hospital, Swabi over a period of two years from 1[st] March 2010 to 28[th] February 2012

Methodology: Nine hundred and Sixty patients who presented either with acute ocular condition or ocular injury through the outpatient or emergency routes were included in the study. The patients demographic data, detailed history, examination and final diagnosis were recorded in a questionnaire. Statistical analysis was based on age, gender, presentation, ocular features and diagnosis

Results: In our study male were 57.8% [n=555] and female were 42.2% [n=405]. Five hundred and thirty Six[55.8%] patients were in traumatic group while four hundred and twenty four [44.2%] patients were in non-traumatic group. Infective conjunctivitis [62.2%], Stye [12.6%], corneal ulcer [10.10%], retinal vascular disease [1.2%], acute post operative endophthalmitis [1.1%], acute uveitis [2.6%] and acute glaucoma [1.0%] were the leading causes in the non-traumatic group. In traumatic group 94.2% patients were non-infected while 5.8% were infected. In non-infected patients, both globe and extra globe injuries [44.6%], extraglobe injuries [23.8%] and globe injuries[23%] were present. In globe injuries, open globe injuries [OGI] were 39.7%.Post traumatic endophthalmitis was reported in 54.8% of traumatic ocular infection. Mechanical injuries [70.7%] were leading the list of traumatic ocular emergency. Work place [31.5%] was the most common place for ocular trauma

Conclusion: Common non- traumatic ocular emergency were Infective conjunctivitis, infective keratitis, acute glaucoma and acute uveitis. Females mostly middle age housewives had non-traumatic ocular emergencies. Traumatic ocular emergency commonly reported were both globe and extra globe injuries and open globe injuries. Males mostly young workers had traumatic ocular emergency. Mechanical injuries mostly the result of occupational accidents in workers

Bilateral irreversible blindness

To find out the causes of bilateral irreversible blindness in patients of different age groups in District Swabi. It is a prospective observational study of one hundred and eighty nine consecutive blind cases. The study was conducted from July 2010 to June, 2012 at the Ophthalmology Department of District Headquarter Hospital, Swabi. Informed consent was taken from the patient or guardian of the patient. Patients fulfilling inclusion and exclusion criteria were included in the study. A standard proforma was designed and entries were made regarding present, past and family history, thorough ocular examination of every patient was performed on slit-lamp with relevant biomicroscopic aids and posterior segment examination was conducted with direct as well as indirect ophthalmoscope. Biomicroscopy was performed as and when required. lntraocular pressure using schiotz tonometer, corneal diameters, retinoscopy and ocular mobility were noted and relevant investigations were performed when needed. Children and mentally retarded patients were examined using short general anaesthesia. Of 189 patients 61.4% were males and 38.6% were females. Congenital Causes were present in 49.7% and acquired causes in 50.3%. Diseases accounted for 88.9%, trauma in 10.1% and unknown causes in 1.1% cases. Congenital diseases included congenital glaucoma in 35.1%, retinitis pigmentosa in 29.7% and albinism in 19.1% cases. Acquired diseases included primary glaucoma in 33.8%, diabetic retinopathy 23 %, secondary glaucoma in 17.5% and childhood infection in 10.8% cases. Corneal findings included corneal opacity in 31.2%, corneal edema in 4.8% and absent cornea in 7.4%. Optic nerve findings included optic atrophy in 16.4%, glaucomatous optic atrophy in 16.9%, new vessels in 9.5%. Retina findings included retinal dystrophy in 14.3%, maculopathy in 5.3%, chorioretinopathy in 0.5%, vascular retinopathy and hypopigmentation in 9.5% each respectively. Irreversible blindness is more common in children and young adults and mostly males are affected. Glaucoma is the commonest cause followed by retinitis pigmentosa and albinism in this study

Pattern of ocular trauma in District Swabi

Background: Ocular trauma is a significant proportion of emergency presentations

Objectives: This study was conducted to determine the pattern of ocular trauma presented in the ophthalmic casualty room of the secondary care hospital in District Swabi

Subject and Methods: This cross-sectional, descriptive study was conducted at the Eye Department of District Head Quarter Hospital, Swabi, over a period of two years; from 1[st] March, 2010 to 28[th] February, 2012. Five hundred and Six patients who presented with ocular trauma either through the outpatient or emergency department were included in the study. The patients demographic data, medical history, detailed examination and final diagnosis were recorded in a questionnaire. Statistical analysis were based on age, gender, presentation, ocular features and diagnosis

Results: Total of five hundred and six patients were included in the study. Male were 77.7% [n=393] and female were 22.3% [n=113]. One hundred and forty five [28.7%] patients were workers while 17.8% [n=90] were housewife. Most of the patients [56.5%, n= 286] reported within few hours of trauma. Home [29.1%] and workplace [26.3%] was common place of injury. Mechanical trauma was observed in 80% [n= 405] of patients. Accidental trauma caused by wood [11.8%], assault due to finger/ fist [26%] and sports related trauma caused by ball [40%] was common. Presenting visual acuity was hand movement in 32% [n=162] patients. Both globe and extra globe injuries [44.5%], extra globe injuries [23.7%], globe injuries [23.3%] and complex injuries [8.5%] were noted. In globe injuries, open globe injuries [OGI] were 42.4%, corneal perforation was most common in 36% patients. Close globe injury was present in 28% patients, punctuate keratitis observed in 29.5% patients. Eyelid was commonly injured [63%] in extra globe injuries. Full thickness laceration was found in 38.9% patients

Conclusion: Traumatic globe, adnexal and open globe injuries are the main ocular emergencies seen. Majority of ocular trauma is preventable. It can be assumed that health education, as well as application of safety measures and regulations, will significantly reduce the incidence of ocular injuries

Clinical presentation of Vernal Keratoconjunctivitis in District Swabi

Objective: To determine the various clinical manifestations of Vernal Keratoconjunctivitis [VKC] in District Swabi

Subjects and Methods: This was a hospital based descriptive study, conducted at the Eye Department of District Head Quarter Hospital, Swabi from March 2010 to February 2012. Patients between age 5 to 25 years presenting with signs and symptoms of VKC belonging to different villages of district Swabi were clinically evaluated

Results: A total of 250 patients were examined. 179 patients [71.6%] were male and 71 patients [28.4%] were female. 154 patients [61.6%] came in the first decade of life. 153 patients [61.2%] had average monthly income between Rs. 2000- 5000. Regarding symptoms, 34% cases had combination of symptoms, 26.8% cases had itching and 10.4% cases had redness only. Seasonal variation was present in 88.4% cases, mostly occurred in spring in 48% cases for which prior treatment was received in 96.8% cases. 237 patients [94.8%] had no history of atopy and 246 patients [98.4%] had no family history of atopy. The commonest palpebral conjunctival sign was diffuse conjunctival hyperemia in 220 [88%] patients, giant papillae in 20 patients [8%] and cobblestones in 10 patients [4%]. Limbitis was present in 148 patients [59.2%]. Superficial punctate keratitis was most common corneal sign and was present in 89.2% patients

Conclusion: VKC is an allergic disorder commonly affecting male children usually after the age of 5 years with seasonal variation mainly in warm and dry climate. Disease is influenced by certain factors like age, gender, poverty, overcrowding, poor hygienic conditions, family history of atopy and previous treatment received. It has variable severity and sometimes it is a potentially blinding disease. There is a need to stage the disease severity in order to develop standardized therapeutic guidelines

Home remedies and traditional eye medicines used for the treatment of common eye aliments in district Swabi

To identify the different home remedies and traditional eye medicines used for the treatment of different common eye ailments in District Swabi. This was Cross Sectional study of fifteen months duration, from February 2010 to May 2011 conducted in out-patient department of District Headquarter Hospital Swabi. Initially different eye ailments and their home remedies and traditional eye medicines were identified by interviewing of the hospital staff belonging to different villages of district Swabi. 1500 patients, aged 20 years and above and also those patients who could answer were included in the study. The study comprised of 1500 patients belonging to different villages of district swabi. The mean age of patients was 42.33 years, ranging from 20 yrs to 80 yrs.818[54.5%] patients were male and 682[45.5] patients were female. The male to female ratio was 1.2: 1 .At least 7 common eye ailments and 11 home remedies or traditional eye medicines commonly used were recognized. The different home remedies and traditional eye medicines used in different eye ailments included surma [galena- lead sulfide] [39.24%], alum[6.70%], honey[14.30%], coldwater [5.69%], ice cube[0.93%], rose water[2.33%], black pepper[1.28%], turmeric paste[5.85%], hot fomentation[5.37%], olive oil[4.94%], goat milk[0.87%] and different combinations of these home remedies and traditional eye medicines[12.50%]. There is evidence of use of Home Remedies and Traditional Eye Medicines in Pakistan especially in rural population. Chemical substances and plant products are used frequently as Home Remedies and Traditional Eye Medicines