Comparison of intraocular pressure lowering effect of Latanoprost and Timolol combination versus Latanoprost alone in Primary Open Angle Glaucoma

To compare the intraocular pressure [IOP] lowering effect of topical drug combination [Latanoprost and Timolol] with Latanoprost alone in patients of Primary Open Angle Glaucoma [POAG]. Randomized controlled Trials [RCT]. Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi from December 2009 to May 2011. A total of 240 eyes of 120 patients [68 males and 52 females] were included in the study. The patients were randomized into two groups of 60 each using random numbers table. Group A [60 patients, 12Q eyes] were put on topical drug combination of Latanoprost and Timolol eye drops and Group B [60 patients, 120 eyes] were treated with topical Latanoprost eye drops alone. IOP assessments were done at baseline, 2 weeks, 4 weeks and 8 weeks intervals after initiation of treatment. Both the groups were age matched with mean age in Group A was 56.39 +/- 8.50 years and in Group B was 55.61 +/- 8.95 years [p=0.09]. Both groups showed significant IOP decrease from the baseline at each follow up interval. However after 8 weeks of start of treatment, pressure lowering effect in group A [14.73 +/- 2.50 mmHg] was significantly more as compared to Group B [9.10 +/- 2.51 mmHg] [p<0.001]. Combination therapy of Latanoprost and Timolol is more effective as compared to monoyherapy with Latanoprost in lowering IOP of patients with POAG

Autologous serum eye drops for the treatment of persistent corneal epithelial defects

A series of 10 patients at Armed Forces Institute of Ophthalmology, Rawalpindi, from September 2009 to August 2010 is reported. Follow-up of patients were done till February 2012. Patients with persistent corneal epithelial defects [PED] of minimum 2 weeks duration, in whom conventional therapy had failed, were included in the study. They were prescribed 100% autologous serum eye drops on hourly basis. When PED healed within 02 weeks, it was labeled as effective and when it healed within one month, it was labeled as partially effective. Six weekly follow-up was done for 18 months for all patients to document any recurrence of PED. Eight out of 10 patients had successful outcome i.e. 80% of PED healed within one month, out of which 7 patients had 'effective' outcome. Autologous serum eye drops are safe, effective and minimally invasive modality in treating PED

Intralenticular foreign body with a clear lens

Intraocular foreign bodies [IOFBs] are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normally within 2 months

Management of periorbital defects with local flaps after resection of basal cell carcinoma eye lids

Basal cell carcinoma [BCC] is the most common malignant tumour of eyelids. In this study management of periorbital defects of patients treated for BCC is described. A prospective study. This study was done from June 2001 to October 2003 at CMH Quetta. This study included all the patients suffering from BCC who were treated for periorbital defects resulting from resection of BCC. Fifteen patients with periorbital BCC were included in this study. Eight were males and seven were females. Ages varied from forty to seventy years. These patients were treated by cheek flap, muscular flap, Glabellar flap and Tenzel flap. An early detection and timely management of eyelid BCC give excellent results and prevent disfigurement and morbidity

Refractory keratitis in hot climate

This article presents patients with unilateral painful red eye refractory to recommended standard treatment regimes in which staining, culture and sensitivity reports were inconclusive. On ocular examination hazy cornea with central corneal abscess was common in all cases. Corneal biopsy was reserved for cases with inconclusive laboratory reports as well as poor response to standard treatment regime. The former revealed fungal hyphae in all cases. Patients mentioned had general predisposition e.g. diabetes mellitus, hot climate [Multan] as well as predisposing factors such as contact lenses, dry eye syndrome, poor ocular hygiene, agricultural background were more prone to fungal keratitis, hence better diagnosed and confirmed early by contemplating corneal biopsy

Immunoglobulin E screening of serum and lacrimal fluid: a new dimension in the management of chronic conjunctivitis

The purpose of present study is to differentiate between allergic and environment related chronic conjunctivitis on the basis of the measurement of Immunoglobulin E levels in tears and serum. Forty specimens of tear and serum from drivers were sent for Immunoglobulin E assay. Samples were divided clinically into two categories. Group A included twenty four samples [60%] who were clinically chronic conjunctivitis [chronic conjunctivitis is defined here as conjunctival inflammation of period greater than a year, remissions and relapses, with no obvious cause/ophthalmic disease and patient on or off topical treatment] and group B included sixteen samples [40%], of clinically normal [normal having no ocular symptoms] [control]. Length of service as driver, hours of daytime driving, primary ocular symptom, history of atopy or allergy, tear film break up time [BUT] were emphasized at history and ophthalmic examination. None of the subjects had clinically obvious cause of conjunctivitis. The group-A [patients] were randomly treated with fluoromethalone and artificial tears. The patients were required to record the subjective improvement. Tear Immunoglobulin E values were normal [1-2ku/L] in both A and B groups. Serum Immunoglobulin E was elevated significantly in twenty samples [84%] in group A [clinically chronic conjunctivitis] whereas, it was elevated in six samples [38%] in group B [clinically normal group]. Serum Immunoglobulin E levels were normal in 16% and 62% of group A and B respectively. The recovery was significant with fluoromethalone use at 4 weeks as compared to that of artificial tears but at 8 weeks and 12 weeks, there was no significant difference between artificial tears group and fluoromethalone group. Serum Immunoglobulin E and tear Immunoglobulin E levels can be used to investigate the cases of chronic conjunctivitis as normalcy of tear Immunoglobulin E reasonably excludes local allergy. This enables the clinician to resort to tear replacement therapy rather thanprescribing steroids with accompanying side effects. However, there is no correlation of serum Immunoglobulin E with tear Immunoglobulin E

Role of mitomycin-C in prevention of pterygium recurrence

Prevalence of pterygium is quite high in Pakistan. Its pathogenesis is not well defined. Exposure to dust, dryness, wind and the sun are possible causative factors. Surgical excision of an established pterygium relieves the symptoms but has a high recurrence rate of between 30% and 70%, in 1-4 months time. Intraoperative application of a single 0.02% dose of mitomycin-C for 2 minutes after pterygium excision reduces the recurrence rate. In our study, 202 patients harbouring 259 pterygia were included, 106 in the control group [Gp-C] and 111 in the mitomycin-C treated group [Gp-M]. Two hundred and thirty four [90.34%] were primary pterygia while 25 [9.66%] were recurrent in nature. Two hundred and seventeen [83.78%] pterygia were operated upon using the bare-sclera technique, however, only 111 [51.15%] received a single intraoperative application of mitomycin-C as an adjunctive therapy. Follow-up was conducted for 3-17 months, with an average follow-up of 10.3 months. No recurrence occurred in Gp-M while 17 [16.04%] recurrences occurred, within 4 months of surgery, in Gp-C. Additional studies are required to determine a safe optimal dosage and to assess the long-term complications of mitomycin-C