Anisometropia and ptosis in patients with monocular elevation deficiency

Objective: To determine the effect of ptosis on the refractive error in eyes having monocular elevation deficiency. Study Design: Case series. Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2011 to January 2014

Methodology: Visual acuity, refraction, orthoptic assessment and ptosis evaluation of all patients having monocular elevation deficiency [MED] were recorded. Shapiro-Wilk test was used for tests of normality. Median and interquartile range [IQR] was calculated for the data. Non-parametric variables were compared, using the Wilcoxon signed ranks test. P-values of <0.05 were considered significant

Results: A total of 41 MED patients were assessed during the study period. Best corrected visual acuity [BCVA] and refractive error was compared between the eyes having MED and the unaffected eyes of the same patient. The refractive status of patients having ptosis with MED were also compared with those having MED without ptosis. Astigmatic correction and vision had significant difference between both the eyes of the patients. Vision was significantly different between the two eyes of patients in both the groups having either presence or absence of ptosis [p=0.04 and p < 0.001, respectively]

Conclusion: Significant difference in vision and anisoastigmatism was noted between the two eyes of patients with MED in this study. The presence or absence of ptosis affected the vision but did not have a significant effect on the spherical equivalent [SE] and astigmatic correction between both the eyes

Ocular features, clinical profile and results of surgical intervention in a series of patients with Port Wine Stain and neurofibromatosis

To describe the ocular features, clinical profile and results of surgical intervention in a series of patients with facial port-wine stain [PWS] and neurofibromatosis [NF] in the pediatric age group. All consecutive patients having PWS and NF presenting between January 2011 and April 2012 were included. Their systemic and ocular features were recorded. Imaging study of brain and orbits was carried out where required. Appropriate surgical interventions were carried out as indicated. These included trabeculectomy, cycloablation, excision of episcleral haemangioma and vitreo-retinal surgery. Patients were followed up for complications and control of intra ocular pressure [IOP]. A total of 9 eyes of 8 patients were included. At presentation IOP in the involved eye ranged from 6 to 42 mmHg [mean 25.00 +/- 12.23]. Glaucoma was present in 6 eyes. Episcleral haemangioma was noticed in one patient, retinal detachment [RD] was seen in 2 patients. Diffuse choroidal thickening on B scan was noted in 5 eyes of patients with PWS. After applying the appropriate management option, IOP on last follow up ranged from 6 to 24mmHg [mean 13.44 +/- 5.43] in the involved eye the last follow up ranged from 6 to 24mmHg [mean 13.44 +/- 5.43] in the involved eye. The difference between IOP of the involved eyes at initial presentation and that recorded at the last follow-up was significant [p=0.005]. Patients with SWS and NF present with varied clinico-ocular profiles and therapeutic interventions are individualized according to the ocular involvement. Post operative complications after treatment of glaucoma in such patients can largely be prevented with special measures taken per-operatively

Distribution of corneal haze after Photorefractive Keratectomy in myopic eyes

Objective: To assess the incidence and distribution of corneal haze after photorefractive keratectomy [PRK] in low, moderate and high myopia in Pakistani population

Study Design: A prospective interventional study conducted during one year at Al-Shifa Trust Eye Hospital, Rawalpindi

Participants and Methods: Excimer laser PRK was performed on 118 eyes of sixty patients. 84 corneas were treated with multizone PRK in a single step, using three zones. Standard PRK was performed on 34 corneas. Cases were followed up to three to six months. Haze was graded subjectively on a scale of 1 to 4

Results: At the end of six months after PRK, one [8.34%] eye from low myopia group, 2 [5.71%] eyes from moderate myopia group and 6 [13.96 %] eyes from high myopia group had grade 1 corneal haze. Grade 2 corneal haze was found in 5 [14.30%] eyes from moderate myopia group and 6 [13.96%] eyes from high myopia group. Similarly 4 [11.42%] eyes and 10 [23.25%] eyes had grade 3 corneal haze from moderate and high myopia groups respectively. Grade 4 corneal haze developed in 21 [48.83%] eyes in high myopia group. The eyes undergone single zone PRK required deeper ablations with relatively denser postoperative corneal haze as compared to the eyes treated with multiple zone PRK

Conclusion: It is concluded that deeper the ablation required to correct myopia higher the incidence of corneal haze. Haze can be reduced by using such techniques which would correct more degrees of myopia with less depth of ablation

Excimer laser photorefractive keratectomy for 1.50 to 3.50 diopters of myopia - six months follow up

This study was designed to evaluate the efficacy and safety of excimer laser photorefractive keratectomy for myopia in Pakistani people. Prospective interventional case series. The study group consists of thirteen patients, comprising of 25 eyes, with refractive error ranging from -1.50 to -3.50 D.S [diopters sphere] and less than -1.50 D.C [diopters cylinder]. Candidates below the age of eighteen years or with unstable myopia during the last one year or having astigmatism more than -1.50 diopters were not included in this study. Similarly any ocular or systemic disease was considered as exclusion criteria. PRK was performed with PDA approved Omni Med U.V 270300 [Summit Technology Inc; Watham MA] excimer laser. Thirteen eyes [52%] could be followed up for three months while twelve eyes [48%]could be reviewed at six months after photorefractive keratectomy. At one month, eleven eyes [44%] and at three months, eight eyes [32%] were hypermetropic within +0.25 to +1.00 diopters of spherical equivalent .At six months only three eyes [25%] had hypermetropia within +0.25 to +1.00 diopters spherical equivalent. None of the eyes had any kind of astigmatism more than 1.00 diopter. No overcorrection of more than +1.00 diopter of spherical equivalent was observed in any case. At one month, three months and six months after photorefractive keratectomy, 88%, 80% and 100% eyes had 6/6 visual acuity respectively, without any optical aid. Hundred percent of the eyes showed complete healing of the epithelium on third post operative day. Moderate to severe postoperative pain was experienced by every one for three days with gradual reduction in intensity. Only one eye [8.33%] had grade 1 haze at six months. Rests of the eyes were clear .No vision threatening complications occurred. Despite the short term follow up, photorefractive keratectomy appears to be an effective arid safe procedure with good predictability for the correction of low myopia

Mortality from Diamox

To report life threatening acute confusional state as an adverse reaction of oral Acetazolamide in an eye care setup. Case Series Two elderly females [60 and 65 years] and one male [68 years] admitted for cataract surgery and prescribed with prophylactic Diamox presenting with identical symptoms. All presented with symptoms of acute confusion, altered awareness and irritability during admission in the ward. Two of these jumped out of ward windows and lost their lives. The third patient was overpowered and managed later thus preventing the fatal outcome. Acute confusion or delirium is a rare complication of Diamox. Never reported in ophthalmic literature and very infrequently reported in non-ophthalmic literature, these case reports display the need of nursing vigilance and awareness by ophthalmologists during the use of Diamox. Since these episodes, the practice of using pre-operative Diamox in cataract surgery patients has been abandoned at Al-Shifa Trust Eye Hospital

Excimer laser photorefractive keratectomy for 6.25 to 20.00 diopters of myopia - a six months follow up

To assess the efficacy and safety of excimer laser photorefractive keratectomy [PRK] for high myopia in Pakistani population. A prospective study Forty nine [49] laser-operated eyes were enrolled in this study with a refractive error ranged from -6.25 to -20.00 diopters. Range of the astigmatism was from -0.50 to -4.0 diopters giving an average of 0.93. Only 06 eyes [12.24%] did not turn up for final visit and 43 eyes [87.76%] eyes were followed till last visit at six months after photorefractive keratectomy. At one month, three months, and six months after PRK, 14.28%, 20.40% ,and 20.78% eyes achieved 6/6 visual acuity without glasses. It was found that 10 eyes [23.20%] were hypermetropic and another 10 eyes [23.20%] were myopic between 1 to 4 diopters spherical equivalent at six months postoperatively. Four eyes [09.28%] had spherical equivalent refraction between -6.00 to -8.25 diopters six months after PRK. Again 10 eyes [23.20%] presented with astigmatism more than +1.0 DC, whereas 11 eyes [25.52 %] with more than -1.0 DC at the end of six months. All the eyes presented with various degrees of corneal haze at six months follow up visit. No serious complication was reported. The short term follow up revealed PRK to be less effective for the correction of high myopia mainly due to corneal haze and regression of effect