Visual outcome after phacoemulsification with lens implant in diabetic and non-diabetic patients; a comparative study

Objective: To compare the visual outcomes of phacoemulsification surgery with intraocular lens [IOL] in persons with and without diabetes at end of follow-up

Methods: This was a comparative, cross sectional, observational study with Non-probability, purposive sampling. After approval from "Research Ethical Committee of Isra Post-graduate Institute of Ophthalmology Karachi, 92 patients with cataract in one eye were selected. Patients were divided into two groups. Group A consisted of 48 diabetics and group B consisted of 44 non- diabetics with or without diabetes in the age group >/= 30 years were included. Patients with small Pupil, Pseudo exfoliation Syndrome, Diabetic Retinopathy, and positive history of Uveitis, Glaucoma, and Macular Degeneration were excluded. Data analysis was performed by SPSS Version 20.0

Results: Best Corrected Visual Acuity [BCVA] in diabetic patients improved from 0.813 +/- 0.181 Log MAR pre operatively to 0.183 +/- 0.143 after the period of six months post-operatively. Corresponding results in non-diabetics were 0.66 +/- 0.31 and 0.08 +/- 0.092 Log Mar [P value = 0.001]. If WHO criteria was considered, 87.5% diabetics and 92% non-diabetics achieved normal vision [Log Mar 0 to 0.5; >/= 6/12,] on the first postoperative day. Remaining 12.5% diabetics and 8% non-diabetics achieved moderate vision [0.6 to 1 Log MAR] on first post-operative day improving to normal vision within a week

Conclusion: Visual outcomes in diabetics after phacoemulsification with intra ocular lens implant is almost as good as that in non-diabetic patient if the diabetics have no retinopathy and have good glycemic control

Outcomes of intravitreal bevacizumab and macular photocoagulation for treatment of diabetic macular edema in a tertiary care eye hospital at Karachi

Objective: To study the outcomes of intravitreal injection of Bevacizumab and laser photocoagulation in the treatment of diabetic macular edema [DME]

Methods: Seventy-two eyes of 59 patients with diabetic macular edema were divided into two groups of 41 eyes [Group-A] and 31 eyes [Group-B]. Subjects in group-A were treated with three intravitreal injections of Bevacizumab [IVB], and that of group-B with macular photocoagulation. Duration of study was 9 months. Follow up pattern for both groups was 1,2,3 and 6 months. Best Corrected Visual acuity on log AAAR [BCVA] for distance as well as near in each visitwas recorded. Retinal OCT for central macular thickness [CMT] was performed on baseline. SPSS version 20.0 was used to analyze the data

Results: Mean age of the patients was 53.76 +/- 8.82 ranging to 36-71 years. Out of 59 patients, 40 [67.8%] were male and 19 [32.2%] female. It was observed that the difference of results among both groups was not significant. Fig.2 documents visual acuity recorded as Improved; Stable and Worse. in BCVA has been almost similar between both the treatment groups although it was noted that JVB group showed early improvement in BCVA at follow-ups of 1 and 3 months. A long term follow-up is required in these cases to see the effect of both these treatment strategies

Visual outcome of laser treatment in diabetic macular edema: Study from an urban diabetes care center

Objective: To determine the visual outcome of laser treatment in clinically significant macular edema

Methods:This interventional and qausi experimental study was carried out at Diabetic Association of Pakistan [DAP] during January 2011 and December 2012. Approval was taken from Research Ethical Committee of Isra Postgraduate Institute of Ophthalmology. Records of 925 eyes of 464 patients with "Clinical Significant macular edema" [CSME], treated with laser photocoagulation were analyzed. Bestcorrected visual acuity [BCVA] at the time of presentation and at the last follow up, minimum of one year and maximum of 45 months was recorded and compared. SPSS version 20.0 was used to analyze the data

Results:Diabetic retinopathy was found in 20.3% [1777] of 8742 diabetic attending DAP Hospital" amongst whom 39.6% [705] had Sight threatening diabetic retinopathy. Laser was advised in 96.4% [680] individuals, accepted by 70.5% [480] individuals. Amongst 960 eyes of 480 patients who accepted laser, 925 eyes had clinically significant macular edema and 35 eyes had PDR who are not included in this study. Amongst 925 eyes with CSME, Grid laser was done in 913 eyes [99%] and focal laser was done in 12 eyes [1%]. After a follow up of 12 to 45 months, it was found that best corrected visual acuity had declined in 2.4% [22] eyes, stabilized in 67% [619] eyes and improved in 30.7% [284] eyes. One line improvement on Snellen's chart was fond in 21.3% [197] eyes, 2 lines in 8% [74] eyes, 3 lines in 1.2% [12] eyes and 4 lines in one [0.1%] eye with p-value of 0.000

Conclusion:Laser therapy is an effective treatment in stabilizing/improving the vision in diabetic macular edema particularly at those centers where only Argon Laser is available and OCF, FFA facilities do not exist

assessment of knowledge, attitude and practices [KAP] towards diabetes and diabetic retinopathy in a suburban town of Karachi

To assess the Knowledge, Attitude and Practices [KAP] towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town [BQ], Karachi. An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of [BQ] Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data. Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 [39.2%] had diabetes. Lowest mean knowledge score [5.28 +/- 6.09] was seen in illiterate respondents. Male's Mean Knowledge score [7.61 +/- 6.600] was better than female's [5.46 +/- 6.21] with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 +/- 2.57. It was higher [6.62 +/- 2.03] in diabetic respondents as compared with non-diabetic respondents [4.70 +/- 2.59] with p < 0.000. In Practice module majority of the respondents [69.9%] did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes

Frequency, severity and risk indicators of retinopathy in patients with diabetes screened by fundus photographs: a study from primary health care

To determine the frequency, severity and risk indicators of diabetic retinopathy [DR] in patients with diabetes attending a primary care diabetes centre. This observational study was conducted at Diabetic Association of Pakistan - a World Health Organization collaborating center in Karachi, from March 2009 to December 2011. Registered patients with diabetes were screened by two field fundus photographs. Retina specialists graded the signs of retinopathy according to diabetic retinopathy disease severity scale. Of total registered diabetic patients [n=11,158], 10,768 [96.5%] were screened for DR. Overall DR was found in 2661 [24.7%] patients. DR was found in decreasing order of frequency in patients with type 2 [n= 2555, 23.7%] followed by patients with type 1 diabetes [n=101, 0.93%] and patients with gestational diabetes mellitus [GDM] [n=5, 0.46%]. Among patients with DR, signs of non-sight threatening retinopathy was dominant. Females and patients of working age group predominantly had retinopathy. Type 1 patients >16 years and type 2 patients < 5 years of history of diabetes had sign of retinopathy in increased frequency. Every forth patient with diabetes in this large cohort had signs of diabetic retinopathy. Females and patients in working age group predominantly had retinopathy. Type 2 patients with short while type 1 patients with long history of diabetes most frequently had DR. Dissemination of the present study findings may help in increasing the awareness of this serious complication of diabetes

Primary vaginal hydrocele; different surgical procedures: a comparative study

A hydrocele is a fluid - filled sac surrounding a testis that results in the swelling of scrotum. They can develop due to inflammation or injury within the scrotum. This study aimed to evaluate the efficacy and adaptation of different surgical procedures in the repair of hydrocele.Comparative, Retrospective study .The study was conducted at Fauji Foundation Hospital Karachi, Al-Tibri Medical College, Karachi and Civil Hospital Karachi from January, 2000 to December, 2013. Patients with primary vaginal hydrocele registered during the period of thirteen years in the out patient department of surgery were selected. A total of 300 patients were assessed clinically, diagnostically and radiologically about the status of hydrocele before the surgical procedures and anesthetic opinion. The different surgical technique were carried out in different group of patients asJaboulay's technique in 70 patients, Lord's procedure in 70 patients, Aspiration and Sclerotherapy in 05 patients, Window operation technique in 05 patients and the Hydrocelectomy by supra pubic procedure were carried out in 150 patients out of total 300 registered patients. The data collected and analyzed statistically in SPSS version 19.00. The different procedures have been adopted surgically in patients with primary vaginal hydrocele. The results showed that among the different operative techniques adopted, the best procedure regarding hydrocelectomy is the supra pubic approach line of treatment. It showed better result and recovery with very minimum complications and side effects as compared to other surgical procedure. The data thus concluded that hydrocelectomy done via supra pubic approach in number of patients proved to be the best procedure because of having very little complications

Primary effects of intravitreal bevacizumab in patients with diabetic macular edema

To evaluate the efficacy of primary intra vitreal bevacizumab [IVB] injection on macular edema in diabetic patients with improvement in best corrected visual acuity [BCVA] and central macular thickness [CMT] on optical coherence tomography [OCT]. This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study [ETDRS] charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography [FFA] and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. The mean BCVA at base line was 0.42 +/- 0.14 Log Mar units. This improved to 0.34 +/- 0.13, 0.25 +/- 0.12, 0.17 +/- 0.12 and 0.16 +/- 0.14 Log Mar units at 1 month after 1[st], 2[nd] 3[rd] injections and at final visit at 6 months respectively, a difference that was statistically significant [P > 0.0001] from base line. The mean 1mm CMT measurement was 452.9 +/- 143.1 microm at base line, improving to 279.8 +/- 65.2 microm [P < 0.0001] on final visit. No serious complications were observed. Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study

To determine the frequency of type-II Diabetes mellitus [DM] in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy [DR] in this group. Descriptive study. Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care [PHC] facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 [6.55%] known and 419 [2.18%] newly diagnosed cases. DR was seen in 460 [27.43%] of the Diabetic cases with 126 [7.51%] patients requiring urgent intervention for vision threatening complications. The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system

Quantitative analysis of stress and cholesterol levels in university teachers and housewives of hyderabad-Pakistan

To evaluate environmental, psychological and physiological stresses in university teachers and housewives and correlate it with serum total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels. Eighty females from middle socioeconomic groups [40 university teachers and 40 housewives] aged between 30-45 years were selected for this study. All subjects were selected from Hyderabad and its adjoining areas. Environmental, psychological and physiological stress levels were measured using Likert scale. Total cholesterol, LDL cholesterol and HDL cholesterol were measured by CHOD-PAP method and triglyceride levels were measured by GPO method. Housewives had high levels of total cholesterol, LDL cholesterol and triglyceride but low levels of HDL cholesterol than the university teachers. Environmental, psychological and physiological stresses were also significantly high in housewives as compared to university teachers. High levels of total cholesterol, LDL cholesterol, triglyceride and low levels of HDL cholesterol in housewives correlated to their stressful lifestyle

Dacryocystorhinostomy without intubation with intraoperative mitomycin C

To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy [DCR] surgery. Quasi-experimental study. Isra postgraduate institute of Ophthalmology, Al-Ibrahim Eye Hospital, Malir, Karachi, from January 2003 to December 2004. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria.The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% [p-value< 0.001]. This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery

Use of fresh water alga Spirogyra ellipsospora Transeau as feed supplement to broiler chicks

Attempts were made to formulate a feed ration to poultry birds, broiler [Indian River Variety FS99] in order to achieve a low cost feed with better potentiality. Algal material Spirogyra ellipsospora Transeau was used as feed supplement for broiler chicks. After necessary processing, four concentrations viz. 5%, 10%, 15%, and 20% of algal material were mixed up with commercial feed of chicks [starter and finisher feed]. Feeding 1 experiments were performed from the day old chicks to ten weeks. Biochemical parameters [ash, carbohydrate, fat, protein and water content] of liver of chicks fed on different algal compositions as well as control feed were also studied. It was observed that the birds which were fed on higher concentration [10%-20%] of algal feed showed best results in terms of quality and quantity of meat. Spirogyra ellipsospora [15%-20%] showed best growth. Mortality rate was zero as no chick died during the whole feeding trial. On the other hand chemical analysis of chick's liver showed that there were no significant differences in fat contents of liver in control and algal fed chicks