Correlation of intraocular pressure with ocular axial length after intravitreal injection of bevacizumab in diabetic macular edema

Objective: To determine the effect of Intravitreal injection of Bevacizumab on IOP in eyes of different axial lengths. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at AFIO Rawalpindi, from Sep 2013 to Jan 2014

Material and Methods: In this study 55 patients scheduled for intravitreal injection of bevacizumab for the treatment of diabetic macular edema were enrolled. An informed written consent was taken from all the patients. All patients underwent clinical ophthalmic examination including uncorrected distance visual acuity, corrected distance visual acuity, slit lamp bio-microscopy and fundus examination with 90 diopter lens. Axial length was measured before IVB using IOL master. Intra Ocular Pressure [IOP] was measured before and after 1 minute of administration of Intravitreal Bevacizumab [IVB] using Tono-Pen

Result: The mean age of patients was 54.51 +/- 7.53 years with minimum age of 43 years and maximum age of 70 years. There were 26 [47.3%] male and 29 [52.7%] female patients. The mean axial length of the examined eyes was 21.12 +/- 1.80 with range of 6 mm. Mean IOP before IVB was 13.09 +/- 1.62 mmHg. After 1 minute of IVB, mean IOP was 32.8 +/- 6.19 mmHg. A good correlation was observed between the axial length and intraocular pressure rise after 1 min i.e. Pearson correlation [r.] = -0.914 [p-value <0.001] with R2 = 0.835

Conclusion: There is significant rise in IOP after intravitreal injection of bevacizumab in patients with short axial length as compared to long axial length

Correlation between central corneal thickness and visual fielddefects, cup to disc ratio and retinal nerve fiber layer thickness in primary open angle glaucoma patients

Objective: To evaluate the correlation between Central Corneal Thickness [CCT] and Visual Field [VF] defect parameters like Mean Deviation [MD] and Pattern Standard Deviation [PSD], Cup-to-Disc Ratio [CDR] and Retinal Nerve Fibre Layer Thickness [RNFL-T] in Primary Open-Angle Glaucoma [POAG] patients

Methods: This cross sectional study was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from September 2015 to September 2016. Sixty eyes of 30 patients with diagnosed POAG were analysed. Correlation of CCT with other variables was studied

Results: Mean age of study population was 43.13 +/- 7.54 years. Out of 30 patients, 19 [63.33%] were males and 11 [36.67%] were females. Mean CCT, MD, PSD, CDR and RNFL-T of study population was 528.57 +/- 25.47microm, -9.11 +/- 3.07, 6.93 +/- 2.73, 0.63 +/- 0.13 and 77.79 +/- 10.44microm respectively. There was significant correlation of CCT with MD, PSD and CDR [r=-0.52, p<0.001; r=-0.59, p<0.001; r=-0.41, p=0.001 respectively]. The correlation of CCT with RNFL-T was not statistically significant [r=-0.14, p=0.284]

Conclusion: Central corneal thickness had significant correlation with visual field parameters like mean deviation and pattern standard deviation, as well as with cup-to-disc ratio. However, central corneal thickness had no significant relationship with retinal nerve fibre layer thickness

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

Objective: To determine the efficacy of topical Nepafenac [0.1%], administered post-operatively in prevention of Macular Edema [ME], after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy [NPDR]

Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness [CMT] of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography

Results: Mean age of study population was 60.97 +/- 4.91 years. Out of 60 patients, 34 [56.7%] were males and 24 [43.3%] were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5 +/- 10.86microm, 228.83 +/- 14.56 microm, 2.33 +/- 10.45 microm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93 +/- 11.69microm, 236.17 +/- 16.16 microm, 12.23 +/- 12.40microm and 5.51% respectively. ME was observed in one patient [3.3%] in Group-1, and seven patients [23.3%] in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant [p<0.05]

Conclusion: 0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy [NPDR]

Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results

Objective: The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking [TE-CXL] with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking[CXL] in adult Pakistani population with progressive keratoconus

Methods: This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel [[riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose] and vibeX Xtra [riboflavin 0.25%] [Avedro, USA]] were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities [UDVA, CDVA], spherical equivalent [SE], astigmatism, pachymetry at thinnest point [Pachy thin], apex keratometry [Kmax], simulated and steep keratometry [Sim K, steep K] were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm[2] for 10 min [total dose 30 mW/cm[2]]

Results: The mean age of the patient was 24.54 +/- 5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points [p=0.000, 0.004, 0.000, 0.004 respectively]. Kmax and pachy thin were significantly reduced over baseline at 1 year [p=0.000, 0.004 respectively]. Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported

Conclusion: Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus

Comparison of topical use of protamine and tranexamic acid in surgical patients requiring cardio-pulmonary bypass

To determine the effectiveness of local protamine in reducing post-operative blood loss compared to loca1 tranexamic acid. Randomized controlled trial. Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from January 2011 to September 2011. One hundred and twenty cardiac surgrcal patients were randomly divided into two equal groups, one receiving local protamine while the other group receiving local tranexamic acid before chest closure. The efficiency was measured as post-operative blood loss and requirement of blood and blood products in the post-surgical ICU. RAverage blood loss in protamine group was significantly less [252.97 ml] compared to tranexamic acie group [680.67 ml]. hTumber of patients requiring no post-operative blood transfusion was sigruficantly higher in protamine group [76.7%] compared to tranexamic acid group [53.3%]. Local protamine is more effective in reducing post-operative blood loss than local tranexamic acid

Comparison of rapid and conventional corneal collagen cross linking in patients having Keratoconus

To compare the effect of rapid and conventional methods of corneal collagen cross linking [CXL] on visual acuity [VA] and corneal parameters in Keratoconus. Randomized control trial. Armed Forces Institute of Ophthalmology, Feb 2012 to Apr 2013. Thirty patients, fifteen in each group, were randomized by non probability consecutive sampling to rapid or conventional CXL group. Pre and post operative [6 months] best corrected visual acuity [BCVA], anterior and posterior keratometric [K] values and pachymetry were recorded. Intra and inter group comparison of all these parameters were statistically analyzed. All thrty patients showed either stabilization or improvement in BCVA. Both groups showed comparable results in terms of improvement BCVA [p = 0.682], reduction in the corneal thickness at thinnest point [p = 0.062], anterior flat and steep K [p = 0.633, p = 0.443 respectively] and posterior flat and steep K values [p = 0.130, p = 0.068] at six months duration. Conventional and rapid methods of CXL are comparable in terms of their effect on VA and corneal parameters

Is declotting a better procedure than Redo MVR for stuck mitral valve?

To evaluate and compare the outcome of declotting versus Redo Mitral Valve replacement for stuck mitral valve in the early postoperative period. Retrospective interventional study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFICNIHD] Rawalpindi from 1[st] Jan, 2010 to 31[st] Oct, 2013. A total of 36 patients were selected. Group A [n = 28] underwent declotting and group B [n = 08] were treated by redo mitral valve replacement [MYR]. Diagnosis of prosthetic valve obstruction was made on the basis of history, clinical examination, echocardiography and fluoroscopy. All patients were operated under general anesthesia and cardiopulmonary bypass [CBP]. Total clamp and CPB time were recorded. Post operatively, patients were evaluated with daily progress parameter. The hemodynamic status, isotropic support, ventilation time, intensive care ward and total hospital stay were also recorded for comparison. Two-dimensional echocardiography was done before extubation and at discharge. Mortality rate was also compared in the two groups. No statistical difference was found on the basis of gender, age, interval between initial mitral valve replacement [MVR] and redo operation or decloting, anticoagulation status, New York Heart Association NYHA] functional class, international normalized ratio [INR] level, trans thoracic echocardiography and luoroscopy. The mean CBP time and cross clamp time was significantly less in group A than group B. Similarly mean ventilation time in group A was significantly less than in group B. The mean ITC stay was and mean hospital stay was not statistically significant. The mortality rate in group A and B was 7.14% and 50% respectively which was statistically significant. Prosthetic valve thrombosis is a life threatening complication after mechanical mitral valve replacement with high mortality without timely and effective surgical intervention. Declotting, being a less aggressive surgical technique is recommended because of better outcome in terms of morbidity and mortality in the early post-operative period

obscure cause of leg edema, non-Hodgkin's lymphoma

A 25-year-old female having asymptomatic edema of unilateral leg was provisionally diagnosed as a case of psoas abscess. Later, she turned out to be a case of non-Hodgkin's lymphoma. This presentation is contrary to usual age and mode of presentation of non-Hodgkin's lymphoma

Mastalgia comparison of topical non steroidal anti inflammatory drugs with evening primrose oil

Mastalgia is a common clinical symptom experienced by up to 70% of women at some stage of their life. A wide variety of therapeutic agents are available for the treatment of mastalgia. Both evening primrose oil and non steroidal anti-inflammatory drugs have been assessed in randomized controlled trials and demonstrated to be effective. The objective of this Quasi experimental study was to compare the efficacy and safety of topical nonsteroidal anti-inflammatory drugs with evening primrose oil in the treatment of mastalgia. We studied 90 females patients presenting the breast pain from 25 July 2006 to 25 July 2007 at the surgical outpatient department of CMH Kharian. The patients were divided into three groups. Group-1 was given capsule Effamol [evening primrose oil], group-2 topical brufen gel and group-3 topical Vaseline for two months. Patients were followed every two weeks for two months. Response was assessed using Cardiff breasts pain score. Side effects of drugs were recorded at each follow up. Out of 30 patients of group-1, 14 [46.6%] had clinically significant response at the end of 8 weeks treatment as compared to 27 [90%] in group-2. 5 [16.6%] patients of group-1 showed mild side effects while none in group-2 had any side effect. P-value was <0.0001 showing highly significant difference between 2 groups. Topical nonsteroidal anti-inflammatory drugs are safe and effective as compared to evening primrose oil in the treatment of mastalgia

Morbidity of mesh repair in inguinal hernias

Hernia is protrusion of any viscous or part of viscous from its proper cavity. Inguinal hernias are the commonest variety amongst all ages and both genders. The most widely practiced operation for inguinal hernia is Lichtenstein tension free mesh repair. Mesh repair, although is best known technique, it still has got morbidity in form of postoperative pain at operation site, urinary retention, scrotal hematoma, wound infection, testicular atrophy and recurrence. In experienced hands, however, this morbidity is significantly reduced. Bring to light the morbidity in our setup and then compare it with other studies available from eastern setup. We studied a total of 200 male patients having inguinal hernias, in CMH Kharian, from Mar 2005 to Mar 2007. Unilateral Lichtenstien tension free mesh repair was performed under general aneasthesia as indoor case. All patients were followed up in OPD, upto one year, to see any complication. 69 patients had mild pain, 113 patients had moderate pain and 18 patients had severe post op pain. Wound infection occurred in 03 patients. Scrotal hematoma formed in 05 patients. Urinary retention occurred in 07 patients, Testicular atrophy occurred in 01 patient. Chronic scar pain was reported by 02 patients. We came to the conclusion that mesh repair is the safest procedure having minimal morbidity

Comparison of efficacy of injection diclofenac sodium alone and with combination of phoroglucinol in the treatment of acute ureteric colic

To compare the efficacy of diclofenac sodium alone and with combination of phioroglucinol in the 4reatment of ureteric colic. This Quasi-experimental study was carried out in the Surgical Department, Combined Military Hospital, Kharian during the period from June 2006 to December 2006. A total of 60 cases of acute ureteric colic entered the study. Pain scores were measured both on 100 mm visual analogue scale and on categorical verbal scale as baseline and at 15, 30, 45, 60 and 120 minutes after administering the study drug, duration of analgesia was also noted. The efficacy of both the treatment groups was assessed by calculating the difference in mean pain scores, by noting the time when complete pain relief was achieved, by the duration of analgesia and by comparing the response of he drug. Mean pain score in patients treated with combination was significantly less than patients treated with diclofenac sodium alone [p<0.05]. Combination of diclofenac and phloroglucinol was better than diclofenac alone in achieving rapid and complete pain relief