Types of traumatic lens dislocations at Larkana

The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% [n=36] males and 38.98% [n=23] females. Cause of trauma was wood or plant impalement in 35.6% [n=21] cases, cracker blast in 13.55% [n=8] cases, fall on ground in 11.86% [n=7] cases, penetrating injuries with needle, scissors or knife in 10.16% [n=6] cases, road traffic accidents in 10.16% [n=6] cases, sports injuries [cricket ball and gulle danda] in 8.47% [n=5] cases, firearm injuries in 5.1% [n=3] cases, and fist hitting in 5.1% [n=3] cases. Lens was dislocated posteriorly in 33.90% [n=20] cases, anteriorly in 25.42% [n=15] cases, inferiorly in 11.86% [n=7] cases, medially in 10.17% [n=6] cases, laterally in 10.17% [n=6] cases, superiorly in 6.78% [n=4] cases, and a single [1.69%] case of lenticele was seen

Ocular manisfestations in xeroderma pigmentosum; a series of 20 patients

To assess the various ocular manifestations in xeroderma pigmentosum seen at Eye and Dermatology Department of Chandka Medical College Hospital Larkana. Prospective study. This study was carried out at two Departments, i.e. at Departments of Dermatology and Ophthalmology of Chandka Medical College larkana from January 2013 to December 2014. Twenty cases were enrolled from outpatient of Eye and Skin Department, Chandka Medical College Hospital Larkana. Patients were subjected to detail history, complete eye and skin examination and relevant investigations. 20 patients, 12 [60%] males and 8 [40%] females with xeroderma pigmentosum in a gender ratio of 1.5: 1 were recruited. All patients had skin freckles and increased sensitivity to sun light. Photophobia and conjunctivitis was seen in 18 [90%] cases, keratitis and dry eyes was seen in 12 [60%] cases and 4 [20%] cases had malignancies of lids and conjunctiva proved on biopsy. Our cases belongs to larkana and sukkur division. The present study highlights the eye involvement in xeroderma pigmentosum and thereby early detection of eye disease prevent the malignancies and blindness

Efficacy of lodoxamide versus sodium cromoglycate in vernal keratoconj unctivitis

To determine efficacy of lodoxamide as compared to that of sodium cromoglycate when used for the treatment of vernal keratoconjunctivitis. Prospective comparative clinical trial. This study was carried out at the Department of Pharmacology and Therapeutics Basic Medical Sciences Institute [BMSI] in collaboration with Department of Ophthalmology Jinnah Postgraduate Medical Center [JPMC] Karachi from April 2010 to October 2010. A total of untreated 80 cases with clinical diagnosis of vernal keratoconjunctivitis [VKC] of 5-29 years of age and of both sexes were included in this study. Patients of other types of allergic conjunctivitis and of VKC already on medication were not included in this study. Follow up visits were carried out at fortnightly intervals for the period of at least three [03] months to rule out comparative efficacy of the two drugs. We studied a total of 80 cases, 56 males [70%] and 24 females [30%] with diagnosis of VKC. All cases were divided in two groups; group A and group B. Group A comprised of 40 patients who used lodoxamide whereas; Group B comprised 40 patients who used sodium cromoglycate. No significant difference in demographic features was found in two groups [p>0.05]. The results showed significant improvement in all symptoms and signs in 60 days of study in group A [lodoxamide] and in group B [sodium cromoglycate] improvement was observed in 90 days of the study [p<0.05]. Improvement in all the symptoms and signs was earlier [within 30 days of study] in group A than in group B

Outcome of recurrent pterygium with intraoperative 0.02% mitomycin C and free flap limbal conjunctival autograft

To determine the re-recurrence and the postoperative complications in recurrent pterygium cases treated by intraoperative 0.02% Mitomycin C [MMC] and conjunctival autograft [CAG]. Quasi-experimental. Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad and Chandka Medical College Hospital, Larkana, from January to December 2010. Cases with recurrent pterygium were included in this study. Cases with history of first time pterygium and pterygium with conjunctival scaring, dry eye, glaucoma and vitreoretinal disease were excluded. After topical and subconjunctival anaesthesia, pterygium was excised in single piece. Intraoperative 0.02% MMC was applied on bare sclera for 2 minutes. CAG was excised from supero-temporal conjunctiva, and implanted on bare sclera. All cases were followedup for 6 months. Re-recurrence was defined as postoperative fibrovascular re-growth of 1.0 mm or more crossing the corneo-scleral limbus. Data was analysed as descriptive statistics. A total of 65 eyes of 65 cases were studied having mean age of 43.26 +/- 12.81 years. Among those, 41 [63.1%] were males and 48 [73.8%] belonged to rural area. The size of pterygium on cornea was 2-3 mm in 44 [67.7%] cases and 4-5 mm in 21 [32.3%] cases. Re-recurrence of pterygium was seen in 3 [4.6%] cases. Postoperative complications included conjunctival granuloma in 2 [3.1%] cases, graft necrosis in 2 [3.1%] cases, graft oedema in 3 [4.6%] cases and graft displacement in 3 [4.6%] cases. The intraoperative application of 0.02% MMC with CAG markedly reduces the risk of re-recurrence of pterygium and postoperative complications

Analysis of retinal signs in patients with primary hypertension

OBJECTIVE OF STUDY: To detect retinal signs in patients with primary hypertension

DESIGN OF STUDY: Hospital based prospective study

PLACE OF STUDY: Department of Medicine Unit II, Chandka Medical College Hospital Larkana

DURATION OF STUDY: One year from January 2010 to December 2010

MATERIAL AND METHODS: Our study included evaluation of 495 patients of age greater than 20 years with primary systemic hypertension [BP>139/89mmHg] for presence of retinopathy

The hypertension was detected by physician with sphygmomanometer and the retinopathy was detected by ophthalmologist with fundoscopy. The type and severity of hypertensive retinopathy was graded on the basis of KEITH-WAGENER CLASSIFICATION. The investigations advised were complete blood cell count, complete urine examination; sugar fasting, lipid profile, blood urea, serum creatinine, electrocardiogram, echocardiography and X-Ray chest PA-view. Only known patients of primary hypertension were included in this study and patients of primary hypertension with other retinal vessel diseases and secondary hypertension were excluded

RESULTS: We evaluated 495 patients, 317[64.04%] males and 178 [35.95%] females aged 20 years and above. [P value=<0.001, X[2] Value=34.29, df=4]. The hypertensive retinopathy was present in 223[45.1%] patients and absent in 272[54.9%] patients [P value= <0.045, X[2] value=6.19, df=2]. The severity and grading of retinopathy seen was, grade-I hypertensive retinopathy in 108 [48.4%,n=223] patients, grade-II in 71[31.8%, n=223], grade-III retinopathy in 36[16.1%, n=223] patients and grade-IV in 8 [3.6%, n=223] patients. [P value=<0.0001, X[2] Value=52.76, df=6]

CONCLUSION: With early detection of retinal signs in primary hypertensive patients, the eyes and other systemic complications of primary hypertension can be prevented

Outcome of low dose intralesional steroid injections in superficial lnfantile capillary hemangioma [SICH] of eyelid

To evaluate the outcome of low dose intralesional steroid injections used in superficial infantile capillary hemangioma [SICH] of eye lid. Prospective Study. This study was conducted at Department of Ophthalmology, Chandka Medical College Hospital Larkana from September 2001 to October 2011. Only, patients with congenital SICH involving eye lids with closure of visual axis were included in this study and SICH involving eye lids without closure of visual axis were excluded from study. The diagnosis of disease was based on history and clinical examination. All the patients were treated by mixture of low dose intralesional steroids triamcinolone 20mg [0.5ml] and dexamethasone 4mg [1.0ml]. A total of three injections were given with interval of two months. After injection, the follow-up examinations were carried out at first week, every second month for six months and then annually. After treatment, outcome was recorded. The successful outcome was labeled when there was complete regression of lesion. Out of 37 patients 28[75.67%] were female and 9[24.32%] were male with female to male ratio of 3.1:1 and age range of 2 to 12 months. All the patients had unilateral growth; with left eye lid involvement in 22[59.45%] cases and right eye lid involvement in 15[40.54%] cases. The successful outcome seen was early regression of lesion in 24[64.86%] cases by age of 2.3 years and in 13[35.13%] cases by age of 3.1 years. The outcome of this study was that, early treatment of SICH of eye lid with intralesional steroid injections resulted reliable, quick, beneficial effects and good cosmetically functional eye lid by early involution of growth

Too late presentation of 53 patients with retinoblastoma: a big challenge / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the site, size,histology,and recurrence of the tumor.METHODS: We prospectively evaluated 53 patients with histological diagnosis of retinoblastoma involving the eye, orbit, intra cranial cavity and other tissues, at Department of Ophthalmology, Chandka Medical College Hospital, Larkana. To assess the extent of the tumor investigations, including X-ray-orbits, ocular B-scan, CT-scan/MRI-Oorbits-brain, whole body bone scanning, X-ray chest PA view, ultrasound abdomen, lumbar punc-ture, complete blood cell count, blood chemistry as-sessment, including renal and hepatic function para-meters, were performed. The selection of mode of treatment like surgical procedures, local radiotherapy and systemic chemotherapy used depend on the site, size, recurrence and metastasis of the tumor. The patients with local and systemic metastases were referred to the oncologist at the Larkana Institute of the nuclear medicine and radiotherapy for local radiation and systemic chemotherapy. Follow up examinations were carried out at 1, 3 , 6 and 12 months after the operation, and then annually for a further 5 years or longer. The tumor's site, size, histological type, and recurrence were evaluated.RESULTS: Of these 53 patients the age range was from 8 months to 8 years. 25 (47%) were male and 28 (53%) were female. The laterality of the tumor was in left eye 25 (47%) cases, right eye 19 (36%) cases, and both eyes 9 (17%) cases. The presentation of the patient at 1st visit was strabismus 3 (6%) cases, pseudohypopyon 4 (8%) cases, orbital pseudo orbital inflammation 6 cases (11%), mass with metastases 7 (13%) cases, fungating mass 8 (15%) cases, leu-kocoria 12(23%) cases and orbital invasion 13(25%) cases. The surgical procedures performed were enucleation alone in 19 (36%) cases, enucleation with modified exentration followed by local radiotherapy and systemic chemotherapy in 19 (36%) cases and enucleation with total exentration followed by local radiotherapy and systemic chemotherapy in 15 (28%) cases. The histological types of the tumor were well- differentiated retinoblastoma with abundant rosettes in 25 (47%) cases and highly undifferentiated retino- blastoma 28 (53%) cases . After primary surgery, the recu-rrences and metastases of the tumors were noticed in 37 (70%) cases due to optic nerve involvement beyond the point of surgical transaction, orbital invasion and sy-stemic metastasis.CONCLUSION: Any child with red eye or white pupillary reflex should be suspected of having retinoblastoma, until proved otherwise, and should be promptly referred to an ophthalmologist, because early presentation of patient in the initial stage of the tumor will result in decreased risk of tumor extension, recurrence and mortality.

Analysis of primary benign orbital lesions / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the pattern of presentation and to highlight the common causes of primary benign orbital lesions.of Jinnah Postgraduate Medical Centre Karachi from July 1997 to August 2001 and then from September 2001 to date (Continued) at the Department of Ophthalmology of Chandka Medical College & Hospital Larkana. Only patients with primary benign orbital lesions were included in this study. All the patients were admitted in eye ward from the out patients department. The diagnosis of the disease was based on the presentation, clinical examination, investigations and histopathology of excised mass. A total of 68 patients were included in this study. The age range was from 2 months to 60 years. Out of 68, 27 (39.7%) patients were male and 41 (60.3%) were female. The left orbit was involved in 35 (51.5%) and right orbit was involved in 33 (48.5%).revealed that superficial capillary hemangiomas of the eye lid were the most common lesion 26 (38.2%) followed by deep orbital cavernous hemangiomas 5 (7.4%), lymphangiomas 5 (7.4%), orbital varices 4 (5.9%), gliomas 7 (10.3%), meningiomas 5 (7.4%), neurofibromas 5 (7.4%), neurofibromatosis 4 (5.9%), schwannomas 2 (2.9%), and pleomorphic adenoma (benign mixed cell tumor) of lacrimal gland 5 (7.4%) cases.treatment can prevent the patient from visual and life threatening complications.