Prevalence of ocular Leishmaniasis in district Chakwal

Cutaneous Leishmaniasis is endemic in Pakistan. The current study was undertaken in District Chakwal to measure the prevalence of ocular lesions in cutaneous leishmaniasis. A 60 years male presented to the Oculoplastic Clinic at Al- Shifa Trust Eye Hospital Rawalpindi, Pakistan, with an isolated chronic non-healing ulcerative lesion of left upper eye lid. Clinically suspected to be squamous cell carcinoma, it underwent total excision followed by Cutler-Beard reconstruction. The histopathology was cutaneous leishmaniasis. A team was dispatched to the health center, Choa Saiden Shah of the area to which the patient belonged [120 km southeast of Islamabad]. The area was found to be endemic for leishmaniasis. A total of 925 patients with known cutaneous leishmaniasis were registered for treatment at the health center and examined for ocular involvement. The prevalence of ocular lesions was found to be about 1%. Most of the lesions involved the skin of the upper eyelid. All the non-ocular patients were undergoing treatment with intralesional injection of Glucantime, while patients with exclusive ocular involvement were treated with intramuscular injections. Ocular involvement in Leishmaniasis is relatively rare, but it should be kept in mind in the differential diagnosis of ulcerative lesions of the eyelid especially in an endemic area

Sub-Tenon's vs. peribulbar anesthesia

Purpose of Study: To evaluate the efficacy of sub-Tenon's anesthesia as compared to peribulbar anesthesia during cataract surgery

Design: Prospective Clinical Trial

Participants: 200 consecutive patients undergoing extracapsular cataract extraction for uncomplicated senile cataracts in the Department of Ophthalmology, Pakistan Institute of Medical Sciences Islamabad. 100 in each group; one receiving sub-Tenon's and the other group receiving peribulbar anesthesia

Methods: Patient's pain and anxiety during administration of anesthesia, during surgery were assessed. Akinesia and surgical comfort was assessed by the surgeon just after the completion of anesthesia and at the end of the surgical procedure. In addition the method of administration of anesthetic, the anesthetic agents and volume used, the time between administration of anesthetic and operation and the type of surgery performed were all recorded

Results: Pain and akinesia scores were significantly lower for sub-Tenon's anesthesia compared with peribulbar technique. However, no significant difference was noted for anxiety status in both groups. Surgical comfort was present during surgery in 91% patients in sub-Tenon's anesthesia group and in 9% cases it was not present. In peribulbar anesthesia group it was present in 75% cases and not present in 25% cases. There was significant difference [p=0.002] in both groups

Conclusion: There was significant degree of advantage of sub-Tenon's anesthesia over peribulbar anesthesia in this study in almost all the aspects of the study that were pain and anxiety experienced by the patient, as well as preoperative akinesia and surgical comfort