Ptosis - types and operations for correction

To analyze the management of different types of ptosis of upper eyelid. Descriptive Study. Eye department CMH Kharian, from January 2006 to December 2007. Thirty six patients having ptosis of upper eyelid, managed in eye department, were analyzed to find out frequency of different types of ptosis. Fifteen patients [27 eyes] were managed surgically and the rest were managed medically. Results and complications of different procedures required for the surgical correction were also analyzed. Twenty [55.6%] cases were congenital and 16 [44.4%] were acquired. Eight [22.2%] patients had neurogenic ptosis, 5[13.9%] had mechanical ptosis, 17 [47.2%] cases had myogenic, 6 [16.7%] had aponeurotic ptosis. Twenty seven eye of fifteen patients were managed surgically. The procedures performed, included levator resection, which was done in 18 [66.7%] eyes, frontalis suspension done in 8 [29.6%] eyes, conjunctivomuller resection in one [3.7%] eye which had unilateral Horner's syndrome. Post operative complications occurred in 4 [14.8%] eyes requiring reoperation. These included development of exposure keratopathy due to dryness of eyes in both eyes of one patient, overcorrection in one eye of a patient and undercorrection with hypotropia in one eye of another patient. All achieved good results. Different types of ptosis should be identified. Levator resection and frontails suspension can effectively correct the ptosis in most of the cases. Complications of the surgery are infrequent

Temporary tarsorrhaphy - use of commercial glue [ELFY]

To assess the use of commercial glue [Elfy] for achieving temporary tarsorrhaphy Case series Place and duration of study: Study was conducted at CMH Kharian from January to September 2008. Patients and Method: The various ocular surface disorders which were managed by the temporary tarsorrhaphy with the commercial glue [Elfy] were analyzed. The duration of lid fusion with Elfy and any adverse affects were also noted. Elfy was applied just below the margin of lower eyelid. Then, using a spatula, upper lid was apposed to the lower lid for 1-2 seconds in order to create fusion. If patient required topical treatment, lateral two thirds of the lids were fused and drops instilled through medial one third. In rest of the cases, full length fusion was achieved. In a total of 32 patients Elfy was applied. Eighteen [56%] were males and 14 [44%] were females. Age ranged from six years to seventy five years with mean age of 22.6 years [SD+21.84]. Ocular diseases requiring lid fusion included, infective corneal ulcer/abscess in 21 cases [65.6%], shield ulcer in vernal keratoconjunctivitis in 3 cases [9.4%], facial palsy in 2 cases [6.2%], alkali burns in 2 cases [6.2%], neurotrophic ulcer in 2 cases [6.2%], Mooren ulcer in 1 case [3.1%], Grave's disease in 1 case [3.1%]. Lid fusion persisted for a mean duration of 7.6 + 4 days [range 2 -20 days]. Duration of fusion was less if skin or lashes of upper lid were fused with only skin of lower lid. But it remained for longer duration when eyelashes of both the lids were stuck together. 6 [19%] patients had a burning sensation for fraction of a second, one patient [3%] complained of gritty sensation on skin due to which she removed the Elfy. All the corneal ulcer cases had clinical improvement. Commercial glue [Elfy] is useful as a temporary measure for tarsorrhaphy

Posterior capsule tear in phacoemulsification of posterior polar cataracts and uncomplicated cataracts

The aim of our study was to document the difference in the incidence of posterior capsule tear in phacosurgery of the posterior polar cataract and uncomplicated cataract and to report the visual outcomes of these cases. A quasi-experimental study. CMH Rawalpindi, from Mar 2004 to Mar 2007. The medical records of all patients who had Phacoemulsification surgery during the study period were retrospectively analyzed. Only patients with posterior polar cataracts and uncomplicated cataracts were included. The data of eyes, which developed posterior capsule tear, were further analyzed. Hydrodissection was not done in the eyes with posterior polar cataracts instead gentle hydrodileneation and viscodissection was done. The incidence of posterior capsule tear and the visual outcome were recorded in the two groups. Out of the 2110 eyes of 1750 patients included in the study, 1735 patients [99.16%] had uncomplicated cataracts [2089 eyes/ 99.001%] and 15 patients [0.86%] posterior polar cataract [21 eyes/ 0.99%]. Posterior capsule rupture occurred in 33 eyes [1.56%] of all study patients. It was significantly high in patients with posterior polar cataract 7 cases [PP group] out of 21 eyes [33.33%] than in eyes with uncomplicated cataract 26 [UC group] out of 2089 eyes [1.24%] [P value <0.001]. The corrected visual acuity significantly improved inpatients of both groups; 6/12 or better in 21 eyes [80.76%] of 26 eyes in UC group and 5 eyes [71.4%] of 7 eyes in PP group postoperatively. Posterior capsule rupture occurred more frequently in posterior polar cataract than uncomplicated cataract. If managed by experienced surgeon, the visual outcome is good in both the groups

Types of procedures required for reconstruction and repair of eye lid defects

To analyze the causes of lid defects and different types of surgical procedures required for reconstruction / repair of these defects in a referral/teaching Armed Forces hospital. Retrospective noncomparative case series and retrospective, nonrandomized, comparative interventional case series Combined Military Hospital Kharian, One year - 2007. Thirty one procedures for lid repair /reconstruction done in 25 lids of 23 eyes [21 patients] were analyzed. Age ranged from six months to seventy five years. Only congenital, traumatic and post surgical [after removal of tumors / scars] lid defects were included. Cases of ectropion, entropion, ptosis, where there were no surgical defects, were excluded. All the patients were photographed pre and post operatively. Follow up ranged from 1 month to 22 months. Of 25 lids, defects were congenital in 4 [16%], after removal of scars in 3 [12%], after removal of tumors in 4 [16%] and traumatic in 14 [56%]. The 31 procedures included direct closure 38.7%, ateral canthotomy and cantholysis 12.9%, Tenzel semicircular flap 9.7%, canalicular intubation with DCR tube 6.4%, graft from buccal mucosa 6.4%, cartilage from nasal septum to correct posterior lamella defect 6.4%, separation of lid skin from conjunctiva/cornea 6.4%, posterior auricular skin flap to correct anterior lamella defect 9.7% and lids formation by suturing of the lid margin 3.2%. Trauma is the most common aetiology of lid defects and most of the lid defects can be managed by direct closure. However some require different additional procedures

Use of botulinum A toxin [BOTOX] in different types of facial dystonia

This study was carried out in the Eye Departments of Combined Military Hospital, Kharian and Military Hospital, Rawalpindi, from January 2007 to August 2008. To determine the effects of botulinum A toxin [Botox] injection in different types of facial dystonia. A total of 23 botulinum A toxin [Botox] injections were given in 13 patients including 7 males and 6 females. Patients were followed up at 1 week, 6 weeks and 6 months after the injection. The indications were essential blepharospasm in 4 [30.77%] cases and hemifacial spasms in 9 [69.23%] cases. Age ranged from 28 to 60 years [mean 41 +/- 12 years]. Four patients were given injections three times and 2 patients were injected twice. Onset of action of botulinum A toxin [Botox] was variable, starting on the same day in 3 patients while in the rest of patients it started on the next day. Mean duration of action was 12.77 weeks +/- 4.68 [range 6-23 weeks]. Dystonia improved in all the cases. Temporary slight facial paresis and lagophthalmos occurred in 3 [23%] cases while ptosis occurred in 2 [15.4%] cases. Two patients [15%] had mild ocular irritation and conjunctival congestion after injection, which settled with topical mild steroid [fluorometholone]. Botulinum A toxin [Botox] is useful treatment for different types of facial dystonia

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous