Outcome of recurrent pterygium with intraoperative 0.02% mitomycin C and free flap limbal conjunctival autograft

To determine the re-recurrence and the postoperative complications in recurrent pterygium cases treated by intraoperative 0.02% Mitomycin C [MMC] and conjunctival autograft [CAG]. Quasi-experimental. Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad and Chandka Medical College Hospital, Larkana, from January to December 2010. Cases with recurrent pterygium were included in this study. Cases with history of first time pterygium and pterygium with conjunctival scaring, dry eye, glaucoma and vitreoretinal disease were excluded. After topical and subconjunctival anaesthesia, pterygium was excised in single piece. Intraoperative 0.02% MMC was applied on bare sclera for 2 minutes. CAG was excised from supero-temporal conjunctiva, and implanted on bare sclera. All cases were followedup for 6 months. Re-recurrence was defined as postoperative fibrovascular re-growth of 1.0 mm or more crossing the corneo-scleral limbus. Data was analysed as descriptive statistics. A total of 65 eyes of 65 cases were studied having mean age of 43.26 +/- 12.81 years. Among those, 41 [63.1%] were males and 48 [73.8%] belonged to rural area. The size of pterygium on cornea was 2-3 mm in 44 [67.7%] cases and 4-5 mm in 21 [32.3%] cases. Re-recurrence of pterygium was seen in 3 [4.6%] cases. Postoperative complications included conjunctival granuloma in 2 [3.1%] cases, graft necrosis in 2 [3.1%] cases, graft oedema in 3 [4.6%] cases and graft displacement in 3 [4.6%] cases. The intraoperative application of 0.02% MMC with CAG markedly reduces the risk of re-recurrence of pterygium and postoperative complications

Role of latanoprost in the treatment of primary open angle glaucoma

The aim of this study was to observe the effect of Latanoprost in lowering intraocular pressure [IOP] in primary open angle glaucoma [POAG] patients. Prospective, open- label, Observational Study. This study was conducted at the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah Post-graduate Medical Centre, Karachi from February 2008 to July 2008. Thirty patients of POAG were enrolled and were treated with Latanoprost 0.005% eye drops for 12 weeks. The parameter examined was IOP by using Goldmann applanation tonometer. The results have been expressed as mean +/- SEM. The mean IOP of both eyes decreased significantly [from 27.16 +/- 0.19 mmHg to 17.94 +/- 0.23 mmHg; p<0.001]. The average percentage reduction in IOP was -33.94% from week 0 to week 12. Latanoprost 0.005% eye drops may become an important choice as a monotherapy for primary open angle glaucoma patients

Etiological diagnosis of microbial keratitis

To identify the different microbial pathogens in infective corneal ulcers. Observational study. Department of Ophthalmology Unit I, Eye Hospital, Liaquat University of Medical and Health Sciences, Hyderabad, Sindh, from April 2006 to September 2008. Patients above 15 years of age with suspected infective corneal ulcers were studied. After detailed history every patient underwent a comprehensive ophthalmic slit lamp bio-microscopical examination, for characteristics of the ulcer to locate the site, size, depth of ulcer and anterior chamber inflammation. After a detailed ocular examination corneal scrapings were collected under aseptic conditions under magnification of slit lamp or operating microscope. The scraping material obtained from leading edge and base of each ulcer was spread onto labeled slides for staining. Another portion was inoculated on to the surface of solid and the liquid culture medias. The inoculated medias were incubated at appropriate temperature for appropriate time. Of the 328 patients; 192 [64.99%] were male with age ranging from 15 to 80 years, and majority from rural population [64.99%]. Majority i.e. 201 [61.28%] were previously treated. Out of 328 patients, 161 cultured [49.10%] for bacteria, 87 [26.52%] for fungi, and 12 were found positive culture for both bacteria and fungi. The rest of 68 [20.73%] were culture-negative corneal ulcers. Of the 173 bacterial isolates, 119 [68.79%] had Gram positive cocci, most common isolated being Staphylococcus aureus in 82 [47.40%]; fungal pathogens were isolated from 99 corneal ulcers. The commonest organism isolated was Candida albicans in 75.76%, followed by Aspergillus flavus in 11.11% of the total fungal isolates. Staphylococcus aureus, Candida albicans and Aspergillus flavus were common causes of microbial infective keratitis in this series

Too late presentation of 53 patients with retinoblastoma: a big challenge / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the site, size,histology,and recurrence of the tumor.METHODS: We prospectively evaluated 53 patients with histological diagnosis of retinoblastoma involving the eye, orbit, intra cranial cavity and other tissues, at Department of Ophthalmology, Chandka Medical College Hospital, Larkana. To assess the extent of the tumor investigations, including X-ray-orbits, ocular B-scan, CT-scan/MRI-Oorbits-brain, whole body bone scanning, X-ray chest PA view, ultrasound abdomen, lumbar punc-ture, complete blood cell count, blood chemistry as-sessment, including renal and hepatic function para-meters, were performed. The selection of mode of treatment like surgical procedures, local radiotherapy and systemic chemotherapy used depend on the site, size, recurrence and metastasis of the tumor. The patients with local and systemic metastases were referred to the oncologist at the Larkana Institute of the nuclear medicine and radiotherapy for local radiation and systemic chemotherapy. Follow up examinations were carried out at 1, 3 , 6 and 12 months after the operation, and then annually for a further 5 years or longer. The tumor's site, size, histological type, and recurrence were evaluated.RESULTS: Of these 53 patients the age range was from 8 months to 8 years. 25 (47%) were male and 28 (53%) were female. The laterality of the tumor was in left eye 25 (47%) cases, right eye 19 (36%) cases, and both eyes 9 (17%) cases. The presentation of the patient at 1st visit was strabismus 3 (6%) cases, pseudohypopyon 4 (8%) cases, orbital pseudo orbital inflammation 6 cases (11%), mass with metastases 7 (13%) cases, fungating mass 8 (15%) cases, leu-kocoria 12(23%) cases and orbital invasion 13(25%) cases. The surgical procedures performed were enucleation alone in 19 (36%) cases, enucleation with modified exentration followed by local radiotherapy and systemic chemotherapy in 19 (36%) cases and enucleation with total exentration followed by local radiotherapy and systemic chemotherapy in 15 (28%) cases. The histological types of the tumor were well- differentiated retinoblastoma with abundant rosettes in 25 (47%) cases and highly undifferentiated retino- blastoma 28 (53%) cases . After primary surgery, the recu-rrences and metastases of the tumors were noticed in 37 (70%) cases due to optic nerve involvement beyond the point of surgical transaction, orbital invasion and sy-stemic metastasis.CONCLUSION: Any child with red eye or white pupillary reflex should be suspected of having retinoblastoma, until proved otherwise, and should be promptly referred to an ophthalmologist, because early presentation of patient in the initial stage of the tumor will result in decreased risk of tumor extension, recurrence and mortality.

Hospital-base epidemiology,risk factors and microbiological diagnosis of bacterial corneal ulcer / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the predisposing factors, clinical and microbial characteristics of bacterial corneal ulcer.METHODS: Three hundred patients (300 eyes) of clinically suspected microbial corneal ulcer were included in the study. Data was collected through history and slit lamp examination. Using standard techniques, corneal scraping was performed. A portion of each scraping was examined by direct microscopy for the presence of bacteria, fungi and acanthamoeba by using 100g/L potassium hydroxideand also by Gramand staining. Another portion was inoculated directly on the surface of solid media such as blood agar, Mac-Conkey agar, chocolate agar and Sabouraud's agar. A bacterial corneal ulcer was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping examination and cured with antibacterial therapy. RESULTS: Of the 300 patients, sixty were lost in follow up, they were excluded from study. Of the remaining 240, bacterial corneal ulcer was identified in 156 (65.0%) patients. The age of patients ranged from 14 to 74 (mean age of 48) years. Majority of them were male (102). Corneal localization of the ulcers was distributed as central in 96 (61.5%) patients and peripheral in 60 (38.5%) patients. Ulcer depth in 82 (52.6%) patients was less than 1/3 of corneal thickness. In 64 (41.0%) patients, anterior chamber inflammation was 1+ to 2+ Tyndall effect with 1+ to 2+ cells present. Bacteria were isolated in 125 (80.0%) patients from the corneal smears. Sixty-nine percent of isolated bacteria were Grams' positive, and 39% were Grams' negative. Gram negative bacteria were associated with severe anterior chamber inflammation (P=0.003) and depth more than 2/3 of cornea (P=0.001). The most frequent organism isolated was Staphylococcus aureus. Forty percent of patients had good visual outcome with visual acuity same or better than the level at admission. Among the others 60% patients, final outcome was poor.CONCLUSION: Bacterial corneal ulcer is aserious ocular infectious disease that remains a therapeutic challenge and vision threatening ocular condition. Rapid isolation of bacteria and treatment with intensive ocular antibiotics represent decisive steps in the management of such pathologies.

Incidence of refractive error among adult population: a Hospital base study / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To assess the incidence of refractive error among adult population: a Hospital base study.·METHODS: This Hospital based study was conducted between June 2008 to November 2008 at tertiary referral center, Liaquat University Eye Hospital, Hyderabad. All subjects underwent a complete ophthalmic examination. The best corrected visual acuity(BCVA) was ecorded. Refraction data are based on subjective refraction. Only the right eye of each subject was considered. Hypermetropia was defined as a spherical equivalent greater than +0.5 diopter sphere (DS). Emmetropia was defined as a spherical equivalent between -0.50 and +0.50DS, myopia was defined as a spherical equivalent worse than -0.50DS and a spherical equivalent or worse than -5.00 DS was classified as a high myopia. Astigmatism correction was prescribed in minus cylinder format, and astigmatism was defined as cylinder error worse than -0.50 diopter cylinder (DC) in any axis. ·RESULTS: Eight thousand and four hundred patients were attended the out patients department with age range of 20-60 years. The proportion of men and women was 61∶ 39. Both the rural and urban population were treated. Sixty seven percents of patients has completed their higher secondary education.Of the total 8 400 patients 2 719(32 37%) had BCVA 20/40 or better and remaining 5 681(67.63%) had BCVA poor than 20/40 due to different anterior and posterior segment eye pathologies, and were excluded from study. Of the 2 719 patients 1 065(39.17%) were phakic in right eye and making the 12.68% of total (8 400) examined patients, and remaining 1 654(60.83%) were pseudophakic. The result were analyzed for only 12 68(1 065 phakic ametropic patients) percent of total treated patients in last 6 months. There were 590(55.40% of phakic patients) men and 475(44. 60%) women.Hypermetropia was found in 300 patients (28.20% of phakic ametropic). Six hundred and ninety (64.80% of phakic ametropic) patients had myopia. The incidence of myopia increased significantly with age. High myopes constituted 7%(75) of the study population. Four hundred and five (38.03% of phakic) patients had astigmatism worse than 0.5D cylinder. There were 195(48.15%) men and 210(51.85%) women. ·CONCLUSION: Refractive error is a significant public health problem in our population that may be impact on visual function and activities of daily life. Optimal visual function may be compromised with uncorrected or under-corrected refractive errors.

Analysis of primary benign orbital lesions / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the pattern of presentation and to highlight the common causes of primary benign orbital lesions.of Jinnah Postgraduate Medical Centre Karachi from July 1997 to August 2001 and then from September 2001 to date (Continued) at the Department of Ophthalmology of Chandka Medical College & Hospital Larkana. Only patients with primary benign orbital lesions were included in this study. All the patients were admitted in eye ward from the out patients department. The diagnosis of the disease was based on the presentation, clinical examination, investigations and histopathology of excised mass. A total of 68 patients were included in this study. The age range was from 2 months to 60 years. Out of 68, 27 (39.7%) patients were male and 41 (60.3%) were female. The left orbit was involved in 35 (51.5%) and right orbit was involved in 33 (48.5%).revealed that superficial capillary hemangiomas of the eye lid were the most common lesion 26 (38.2%) followed by deep orbital cavernous hemangiomas 5 (7.4%), lymphangiomas 5 (7.4%), orbital varices 4 (5.9%), gliomas 7 (10.3%), meningiomas 5 (7.4%), neurofibromas 5 (7.4%), neurofibromatosis 4 (5.9%), schwannomas 2 (2.9%), and pleomorphic adenoma (benign mixed cell tumor) of lacrimal gland 5 (7.4%) cases.treatment can prevent the patient from visual and life threatening complications.

Efficacy of probing in the treatment of congenital nasolacrimal duct obstruction in three age groups / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the success rates of probing for the treatment of congenital nasolacrimal duct obstruction in children divided into three age groups.METHODS: One hundred and eighty children with uncomplicated congenital nasolacrimal duct obstruction underwent probing in Eye Hospital of Liaquat University of Medical and Health Sciences Hyderabad, Sindh, Pakistan from March 2005 to January 2008. The children were divided into three groups: Group Ⅰ (aged 4-6 months), Group Ⅱ (aged 7-12 months) and Group Ⅲ (aged 13-24 months). Success was defined as complete resolution of signs and symptoms. The chi-square test was used to analyze the results.RESULTS: The success rate was 100.0% in Group Ⅰ, 88.5% in Group Ⅱ and 82.3% in Group Ⅲ. The overall cure rate for the entire study was 90.7%.CONCLUSION: The efficacy of probing decreases with the increasing age. However, when probing is done within six months of age, it is highly effective and results in complete resolution of symptoms.

Fungal keratitis:84 cases report in Southern Pakistan / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To identify the predisposing factors,causative fungi and to improve the facilities for the laboratory diagnosis of fungal keratitis.METHODS:Two hundred and forty eyes of 240 patients of clinically suspected microbial corneal ulcer were included in the study.Data was collected through history and slit lamp examination.Using standard techniques,corneal scraping was performed.A portion of each scraping was examined by direct microscopy for the presence of fungi,bacteria and acanthamoeba by using 10% potassium hydroxide and also by Gram and Giemsa stainings.Another portion was inoculated directly on the surface of solid media such as Blood agar,Mac-Conkey agar,chocolate agar and Sabouraud agar in C-shaped streaks for culture.RESULTS:A total of 240 patients with suppurative corneaI ulcer were enrolled in the study,out of which fungi were identified in 84(35%)patients.Of these,48(57.1%)were males and 36(42.9%)females.The age ranged between 22-80 years.Sixty patients(71.4%)belonged to rural population and twenty four(28.6%)to urban population.Trauma with vegetative material was the most frequent cause noted in eighteen(21.4%)patients.Peak incidence was in the months of October-Nevember.Out of 84 eyes with fungal keratitis,fungi alone were the etiologic agents in 74(80.10%)cases and bacteria with fungi were identified in 10(11.90%).The most frequently isolated organism was Candida albicans which was found in 66(78.6%)patients.CONCLUSION:Fungal keratitis is the leading cause of infective corneal ulcer and Candida albicans being the most commonly isolated pathogen in the patients belonging to Southern Pakistan.The direct microscopic examination with potassium hydroxide 100mL/L method is a simple,rapid,inexpensive and reliable method in the diagnosis of this infection.

Clinical analysis of 124 patients with penetrating ocular injuries in Hyderabad Pakistan / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To assess the common causes of penetrating ocular injuries and to determine the visual outcome of these cases.·METHODS:A total of one hundred and twenty four eyes of 124 patients suffering from penetrating ocular injury between the ages 6-60 years, presenting to the Department of Ophthalmology,Liaquat University of Medical and Health Sciences were assessed clinically to determine the common causes of the penetrating intraocular injury and the final visual outcome.·RESULTS:One hundred and twenty four eyes with penetrating ocular injuries were enrolled in the study.The mean age was 35 years,(range 6 to 60 years).Males were predominant 86.3% with most of the patients less than 20 years of age (71%).Occupational class was mostly affected by the intraocular injuries accounting to 76%.51% patients had best corrected final visual acuity between perception of light to 6/60.Among the 124 patients in whom both initial and final visual acuities were reliably recorded,there was a correlation between poor initial visual acuity and poor final visual acuity.·CONCLUSION:Penetrating eye injury is a common incident, predominantly in young males and often resulting in poor visual outcome in the injured eye.Labour work without protective measures and children playing with hazardous objects are associated with more frequent and severe ocular injuries.

Efficacy of intravitreal ceftazidime in acute postoperative endophthalmitis

To assess the efficacy of intravitreal ceftazidime in acute postoperative endophthalmitis. Quasi experimental study Department of Ophthalmology Unit I, Eye Hospital, Liaquat University of Medical and Health Sciences, Hyderabad, from November 2004 to November 2006. Twenty-one eyes of 21 patients of acute postoperative endophthalmitis were treated with intravitreal antibiotic ceftazidime. The inclusion criteria of the patients was the clinical diagnosis of acute postoperative endophthalmitis within 15 days of postoperative period with visual acuity better than or equal to hand movement close to face. After enrollment, vitreous tap was carried out in all cases followed by intravitreal ceftazidime injection. The outcome was measured in terms of clinical resolution of endophthalmitis and postresolution best corrected visual acuity. Mean of difference was tested by paired t-test. Nineteen eyes [90.5%] responded to intravitreal ceftazidime therapy alone, while an additional pars plana vitrectomy was required in one eye. Sixteen eyes [84%] retained a visual acuity of 6/60 or better at 3 months after the initiation of the therapy [p<0.001]. Retinal detachment developed in one eye receiving intravitreal therapy. Ceftazidime was effective as intravitreal therapy for the management of acute postoperative endophthalmitis

Isolated eyelid tuberculosis

We report a case of a seventy years old lady of poor socioeconomic background who presented with painless swelling of the right upper lid since one year. No other local or systemic features were associated. An incisional biopsy was performed under local anaesthesia. Histopathological examination revealed epitheloid granuloma with Langerhan's giant cells suggestive of tuberculosis of lid skin. The clinical events and pathological findings were suggestive of Mycobacterium tuberculosis as the cause of infection. After diagnosis, the patient was referred to physician for anti-tuberculosis therapy. The eyelid swelling resolved gradually and was completely normal after 9 months of chemotherapy