Impact of duration of macula off rhegmatogenous retinal detachment on visual outcome

To assess impact of,duration of macular detachment on visual outcome after scleral buckling for retinal detachment with macula off. Prospective, descriptive case series was conducted at Ophthalmology Department Dow University of Health Sciences, Civil Hospital Karachi and Al Noor Eye Clinic Karachi from May 2012 to June 2013. Five groups were made according to period of macular detachment. Best corrected Visual acuity [BCVA] was main outcome measure. P value < 0.001 was considered significant. Mean duration of macula off was 17.0 +/- 4.0 [SD] days. Mean pre-operative VA in patients with immediate, early, intermediate, delayed or late group were 2/60, 2/60, Counting figure [CF] 3 meters [m], CF2 m and Hand Movement [HM] respectively. Only 48.48% patients of those repaired within 7 to15 days had significantly better [P < 0.001] BCVA [6/9-6/18] than the other groups. Only 19.35% patients of intermediate group achieved BCVA 6/18-6/24 [P < 0.001] which was comparatively better than the delayed and late group. Scleral buckle surgery for macular-off Rhegmatogenous Retinal Detachment has good postoperative visual outcomes if repaired within two weeks

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

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.

Open globe injuries in the child population in hyderabad / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the causes, frequency, severity of eye injury, management, visual outcome and prevention in children with penetrating ocular injury.·METHODS: The study was conducted on patients under 15 years presenting with penetrating ocular injuries. Anterior segment slit lamp examination was performed for cornea and corneo-scleral penetration, hyphema, iris prolapse, etc. Posterior segment slit lamp examination wih 90D funduscopes was done in selected cases. After performing necessary investigations, urgent surgical intervention was carried out. ·RESULTS: Out of 43 (55%) registered patients; boys were 67%, and girls 33%. The agents of trauma were glass, pencil, stick, etc. The site of entrance through cornea was 62.7%, sclera 25.6%, and limbus 11.7%. The presenting visual acuity was 6/60 and above in 32.5% children, 6/24 in 9.3%, and 6/12 and above in 2.3% cases. 37.2% cases had perception of light. Out of 36 operated eyes, twenty-nine completed post operative follow up. 10 4% subjects had final visual acuity (FVA) of 3/60. 24 2% had FVA of 6/60. 17.2% children had FVA of 6/24 partial. In 34.4% subjects, the FVA was restricted to perception of light. 10.4% developed phthisis bulbi.·CONCLUSION: Ocular trauma is a significant cause of visual loss in child population. Preventive efforts are extremely important in domestic and outdoor activities.

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.

Surgical outcome of 21 patients with congenital upper eyelid coloboma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the surgical outcome of congenital upper eyelid coloboma repair.METHODS:All patients underwent complete ophthalmic and general examination before going to surgery,and then examination under anesthesia was performed to assess the site and size of eyelid defect,conjunctival involvement.The status of cornea and ocular motility with forced duction test was also being noted.The surgical procedure was performed according to the size of defect.RESULTS:Out of 21 cases of congenital upper eyelid coloboma,18 occurred in isolation with upper eyelid medial defect,13 were bilateral and 5 were unilateral.Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects.All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age.Cosmetically surgical results were acceptable,except one that was already presented with opaque corneal.CONCLUSION:In this study overall surgical results were satisfactory except one that was presented late with compromised cornea.

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.

Comparative incidence of posterior capsular opacification in AcrySof and PMMA intraocular lenses / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the extent of significant posteriorcapsule opacification (PCO) after implanting polyme-thylmethacrylate (PMMA) and soft acrylic intraocular lenses.·METHODS: A total of one hundred patients (110 eyes) undergoing intraocular lens (IOL) implant surgery were randomly divided into two groups based on the type of IOL's implanted. Group Ⅰ: AcrySof (SA60AT) and Group Ⅱ: PMMA (LX10BD). The density of posterior capsular opacification (PCO) was assessed 3, 6, 12 and 18 months after surgery by taking best corrected visual acuity (BCVA) and the digital photographs.·RESULTS: At the end of 3 months postoperatively, the PCO density in the Group Ⅰ (PMMA) increased significantly (3.6%) while no increase was found in the Group Ⅱ (Acrylic). By the end of 18 months follow up, the incidence of significant PCO was found to be less in the acrylic group (14.5%) as compared to the PMMA group (34.5%). On the basis of density, the PCO was more extensive with the PMMA lens than the AcrySof lens, which led to more severe visual loss.·CONCLUSION: The intraocular implantation of the AcrySof IOL helps to reduce the incidence of PCO to a greater degree as compared to the PMMA IOL.