Stargardt's disease: clinical presentation and fundus fluorescein angiographic findings

Objective: To document the clinical presentation and fundus fluorescein angiographic findings in Stargardt's disease

Methodology: This descriptive study was conducted at the Department of Ophthalmology Unit-I Civil Hospital Karachi and Unit III Lyari General Hospital Karachi of Dow University of Health Sciences from June 2004 to May 2008. Patients were selected from the out patient department of Sindh Govt. Lyari General Hospital and Civil Hospital Karachi fulfilling the inclusion criteria. Sociodemographic data and family history were obtained and patients subjected to complete ophthalmic examination of anterior and posterior segment and Fundus Fluorescein Angiography

Results: Thirty patient were found to have Stargardt's disease. Mean age was 18.4 +/- 6.9 years. Twenty two [73.4%] patients were found to be 20 years of age or below. Males [18 [60%]] outnumbered the females [12[40%]]. Visual acuity at presentation revealed a symmetric loss of vision in right and left eyes [P=0.410 at 99% CI]. Macula showed atrophic lesion in 12 cases [40%], beaten bronze in 13 [43.3%] cases and varnished appearance in 5 [16.7%] cases. Retinal flecks were found in 18 [60%] patients only. Fundus fluorescein angiography revealed dark choroids and elliptical hyperfluorescent lesion at the macula in all the patients. Tiny hyperfluorescent areas not corresponding to the area of flecks were found only in 18 [60%] patients

Conclusion: We conclude that Stargardt's disease has varied presentation and there is a familial and genetic predilection

Clinical presentation of vernal keratoconjunctivitis [VKC]: a hospital based study

Objective: to determine the various clinical manifestations of Vernal Keratoconjunctivitis [VKC] in Civil Hospital Karachi

Design: descriptive

Method: this is a hospital based study that was conducted at the Eye Department of Civil Hospital Karachi among the patients attending hospital out patients. Patients presenting with signs and symptoms of VKC were clinically evaluated

Results: a total of 400 patients was examined. Two-hundred seventy-eight patients [69.5%] came in the first decade of life. Three-hundred and sixty-eight patients [92%] were males. One hundred and twenty-eight patients [32%] had family history of atopy. Study showed that palpebral VKC was the most common clinical form present in 216 patients [54%], followed by mixed VKC in 104 patients [26%] and limbal VKC in 80 patients [20%]. The symptoms and signs of the disease were present all around the year in 86% of patients with an increase in the summer

Conclusion: VKC is an allergic disorder affecting the children, more common in males than females. The onset of disease is usually after the age of 5 years. It resolves around puberty, rarely after the age of 30 years. Out of the three types, Palpebral VKC was the most common form

Corneal complications of vernal Kerato-conjunctivitis

Objective: to determine the magnitude and types of corneal complications of Vernal Kerato Conjunctivitis [VKC] and their effects on vision

Study design: descriptive case-series

Place and duration: this study was conducted from September 2007 to January 2009 at three institutions in Karachi; Department of Ophthalmology, Dow University of Health Sciences and Civil Hospital, Baqai Medical University Hospital and Sindh Government Qatar Hospital Orangi Town

Methodology: all cases of vernal kerato-conjunctivitis presenting from the different areas of Karachi was included in the study. The diagnosis was made mainly on the basis of history and clinical examination

Results: total 200 patients were examined. Superficial punctate keratitis was the most common corneal complication [46%]. Visual impairment was more pronounced in case of Schield ulcer [16%] and corneal plaques [8%]. Association with keratoconus [13%] was also noted. Corneal opacification [13%] and psuedogerontoxon [4%] were also observed

Conclusion: severe corneal complications of vernal kerato-conjunctivitis [VKC] were observed. Superficial punctate keratitis was the most common. Other complications are potentially serious causing visual impairment

Risk factors and presentation of giant retinal tear

Objective: to determine the risk factors, characteristics and presentation of Giant Retinal Tear

Design: descriptive case-series study

Setting: Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi; from January 2001 to July 2007

Methods: all patients diagnosed as having Giant Retinal Tear [GRT] in the Surgical Retina Clinic, were included in the study. The details of patients' demographics, ocular history, risk factors, refractive status, ocular examination, systemic examination, treatment offered and final outcome were recorded in a specially designed proforma

Results: a total number of 42 eyes of 38 patients with GRT was included in the study. The causative factors in our study were vitreo-retinal degeneration, blunt ocular trauma and complicated cataract surgery. Myopia was the most common ocular risk factor. Most of the patients presented to our hospital after 4 weeks of onset of symptoms with total retinal detachment, advanced proliferative vitro retinopathy and poor visual acuity. Pars Plana Vitrectomy with Silicone oil tamponade, with or without Scleral Buckling was performed in 35 eyes

Conclusion: the major risk factors for GRT are peripheral retinal degenerations, high myopia, ocular trauma, GRT in the fellow eye, family history of retinal detachment, complicated cataract surgery and connective tissue disorders. Various socio economic issues and inadequate patient counseling are responsible for late presentation of patients that leads to extensive PVR

Sheathotomy for treatment of branch retinal vein occlusion

Objective: To evaluate visual outcome after arteriovenous sheathotomy for the treatment of branch retinal vein occlusion [BRVO]

Design: A descriptive case review

Setting: Civil Hospital and Dow University of Health Sciences, Karachi, Sindh - Pakistan

Methods: A pars plana vitrectomy and dissection of the involved AV crossing site were performed consecutively in 20 eyes of 20 patients with BRVO and vision loss. The overlying retinal artery was dissected free from the retinal surface, and separation of the artery and vein at the crossing site was attempted

Results: In 19 of 20 eyes, the retinal artery was dissected around the crossing site. After a mean follow-up of 10.5 months, VIA improved by at least two lines or more in 16 eyes [80%], remained unchanged in two eyes [10%], and worsened by at least two lines in two eyes [10%]. Mean change [ +/- SE] in logMAR acuity was -0.28 +/- 0.11; two or three lines of improvement [P=0.016] at 1 to 2 months' follow-up and -0.44 +/- 0.14; three or four lines of improvement [P = 0.008] at the final follow-up. Cataract formation or progression occurred in 88% cases

Conclusion: A surgically important adhesion between the retinal artery and vein at proximal AV crossings was encountered in all eyes undergoing AV sheathotomy. Cataract formation was a frequent complication. Visual improvement may occur after vitrectomy and AV sheathotomy without separation of the retinal vessels