Pattern of eye diseases at the primary health centers in a Pakistani district

Pakistan has an extensive network of public facilities aimed to provide primary health care including eye care. Yet no data exist on the number and purpose of eye visits to these facilities. This study aimed to describe the pattern of eye diseases in public primary care hospitals in a district in Pakistan's Sindh province. This study was conducted in 14 randomly selected government primary health care centers 10 Basic Health Units and 4 Rural Health Centers in district Nawab shah, a central district of Sindh province. Doctors in these centers were trained in diagnosis and management of common eye diseases at the primary level and requested to record data prospectively on the total number of patient visits, total number of eye consultations and reasons for eye consultation. Data were entered and analyzed using EPI Info Software. Over a period of one month, 9759 visits were made to the 14 selected primary health care centers. Eye diseases accounted for 1.8% of the total visits. Adults were more likely to have an eye consultation compared with children [Odds Ratio: 2.96; P < 0.01]. Conjunctivitis [34.1%], cataract [22.0%], and corneal problems [6.9%] were the most common reasons for eye consultations. Despite solid evidence of a high burden of eye diseases at the community level in Pakistan, eye diseases accounted for only a very small proportion of the total consultations in the primary health care facilities. Efforts are needed to assess barriers to optimal utilization of existing primary health care services for eye diseases

Complications of conventional sclera buckling occurring during and after treatment of rhegmatogenous retinal detachment

To identify and determine the frequency of the intra-operative and early postoperative compkicaitons of Cinventional Scieral Buckling [CSB] ans the primary surgical intervention in patients with Phegmatogenous Retinal Detachment [RRD]. A quasi-interventional study. Khyber Institute of Ophthalmic Medicl Sciences [KIOMS], Postgraduate Medical Institute [PGMI], Hayatabad Medical Complex [HMC], Peshawar, from April 2005 to June 2006. Fifty consecutive patients who underwent CSB and fulfilled the inclusion criteria, were included in the study. Operative details and any intra-operative complications were noted. The patients underwent another detailed clinical examination and pain assessment on the first postoperative day. All the patients were followed-up minimum for 3 months. Postoperative complications were identified and recorded. The data was analyzed on SPSS 120 for measures of central tendency and dispersion. There were 36 males and 14 female subjects. Mean age was 37.18 +/- 20.145 years. Encirclement [56%] was the most frequently used CSB technique, sixteen [32%] patients had at least one intra-operative complication. Intra-operative complications were iatrogenic sclera break [2%], accidental Sub Retinal Fluid [SRF] drainage [8%], choroidal haemorrhage [2%], subretinal haemorrhage [14%], retinal incarceration [2%], vitreous haemorrhage [6%], raised [4%] or very low [2%], intra-operative IOP and hyphema [2%]. Postoperative complications included systemic complications [24%], choroidal detachment [8%], vitreous haemorrahge [16%], raised IOP [22%], angle closure [2%] and explants exposure [6%]. Mean refractive change in spherical equivalent was -1.478 +/- 0.698 D. final re-attachment rate was [82%] and final BCVA of > 6/60 was achieved in 62% of the subjects in the treated eyes. CSB is a safe and effective option for treating uncomplicated RRD, but it is associated with certain complications. Sub-retinal bleed was the most common intra-operative complication. Raised IOP was most the common early postoperative complication followed by choroidal detachment

Risk factors of preseptal and orbital cellulitis

To estimate the frequency and major risk factors of preseptal and orbital cellulitis. A cross-sectional analytical study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant [p > 0.5]. Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II

Demography of patients with periocular dermoid cysts

To study the demographics of patients admitted in the hospital with histologically proven periocular dermoid cysts. A retrospective descriptive case series. Department of Ophthalmology Khyber Institute of Ophthalmic Medical Science, Hayatabad Medical Complex, Peshawar from July, 2004 to March, 2007. Clinical characteristics of patients with dermoid cysts admitted to the hospital were retrieved from patient charts. A note was made of its frequency, age, gender and laterality. Other features like site, size, depth, histology and presenting features were also looked for. Patient's age at the time of surgery was also noted. The frequency of dermoid cysts was 40.8% amongst orbital cases. Majority [65.7%] were females and 73.6% patients were below 15 years of age. The disease was right sided in 55.2%. Majority were superficial dermoids [71.0%] followed by conjunctival dermoids [15.7%] and deep dermoids [13.1%]. The most frequent clinical finding was a mass in 84.2%. Most patients [44.7%] were below 10 years at the time of surgery. The disease is more common in females and children. Superficial dermoids are more frequent. Presentation is usually with a subcutaneous mass and treatment of choice is surgical excision

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality

Prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in nrthern Karachi, Pakistan

Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. In summer 2002, five community-based eye camps were set up in Karachi, Pakistan's largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all participants at the examination site. Our main outcome measure was diabetic retinopathy, which was classified as non-proliferative diabetic retinopathy [NPDR], severe NPDR, and proliferative diabetic retinopathy [PDR]. Our grading was based on clinical examination. A total of 912 subjects were screened for diabetes mellitus. Of these, 160[17.5%] had diabetes- 1.8% had type I diabetes and 15.9% had type II diabetes. One hundred and eight individuals visited the hospital for ophthalmic examination. Of them, 15.7% had diabetic retinopathy. The prevalence of diabetic retinopathy was higher among individuals with type I diabetes, with greater duration of diabetes, and among women. The commonest form of diabetic retinopathy was non-proliferative [76.5% [mild: 35.3%, moderate: 29.4%, and severe: 11.8%]], followed by maculopathy [17.6%] and proliferative diabetic retinopathy [5.9%]. More systematic and population-based research is needed to estimate the prevalence of and identify risk factors for diabetic retinopathy in Pakistan

Pattern of pediatric ocular trauma in Hayatabad Medical Complex Peshawar

To determine the pattern and causes of pediatric ocular trauma in Hayatabad Medical Complex, Peshawar. A cross sectional descriptive study Department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 1999 to June 2004. The medical records of 481 children aged upto 16 years who suffered ocular trauma were reviewed retrospectively. Age and gender distribution, nature and source of trauma, presentation and ocular features were analyzed. Pediatric ocular trauma constituted 43.5% of total traumatic ophthalmic admission. Four children were victims of bilateral trauma. Male to female ratio was 3.3:1.Twenty five percent children were below 5 years of age, 47.8% were between 5 to 10 years of age and 27.2% were between 10 to 16 years. About 51% injuries were of open globe type and 37.6% closed globe, superficial non perforating injuries, burns and adnexal pathologies were present in 11.3%. Domestic injuries were more common [47.2%]. At the time of admission 14.6% eyes were infected, 2.3% required evisceration or enucleation. Majority [67.3%] of the children presented late [one week later] to the hospital. Male children were affected more than female by trauma. Half of ocular trauma resulted in open globe injuries and almost 50% of cases were related to domestic injuries. Majority of cases presented late and were secondarily infected

Classification of 154 clinical cases of vitamin A deficiency in children [0-15 years] in a tertiary hospital in North West Frontier province Pakistan

To share our experience of 154 cases of clinical vitamin A deficiency in Pakistani children. Methods and The data on age, sex, date of presentation and clinical stage of vitamin A deficiency was recorded. A total of 154 children aged 0-15 years suffering from clinical vitamin A deficiency [xerophthalmia] were recorded. One hundred and twenty three [79.9%] children were 0-6 years with 99 [64.3%] male children. Blinding xerophthalmia [corneal xerosis, corneal ulcers ad keratomalacia] was present in 94 [61%] children. Thirty nine% children presented in summer, 28% in autumn, 20% in winter and 13% in spring respectively. This report indicates that clinical cases of vitamin A deficiency in children do occur in Pakistan. Children under 6 years of age are the most vulnerable age group and there is a seasonal variation in presentation. Both life and sight of these children are at risk. Community based studies may be helpful to identify the magnitude of the problem and possible risk factors at national, provincial and district levels

Conventional retinal reattachment surgery

To evaluate the surgical outcome in rhegmatogenous retinal detachment [RRD] cases operated by conventional retinal reattachment techniques. Design: Descriptive study. Place and Duration of Study: This study was conducted at Eye Unit, Hayatabad Medical Complex [HMC], KIOMS, Peshawar, from July, 2002 to December, 2002. Materials and A retrospective analysis of ophthalmic record of rhegmatogenous retinal detachment operated by conventional retinal reattachment surgery was done. Anatomic outcome was evaluated in relation to duration of presentation and pre-operative proliferative vitreoretinopathy [PVR]. Postoperative visual acuity [VA] was compared to pre-operative VA. Complications and causes of failure of anatomic success were also analyzed. A total of 40 cases were studied. Male to female ratio was approx 2:1. Retinal breaks were localized in 70% cases, 37.5% cases had single break while 32.5% cases had more than one retinal breaks. Forty two% had total retinal detachment while 57.5% had less than total retinal detachment. Five% had attached macula at presentation. Immediate postoperative retinal reattachment was attained in 80% cases but ultimate anatomic success after at least 6 months of follow up was 72.5%. Patients who presented earlier [upto 1 year] had 75% anatomic success while those who presented later than 1 year had 50% success rate. Postoperative visual improvement was noted in 80% cases with flat macula, 65% had VA 6/60 or better after surgery. Most common cause of failure of anatomical reattachment was PVR [63.63% of failed conventional surgery]. Most common postoperative complication was raised intraocular pressure [> 21 mmHg] in 25 cases. There is more chance of retinal reattachment and visual restoration in cases that present earlier. PVR is the main cause of failure of conventional retinal reattachment surgery. Postoperative visual improvement is directly related to surgical reattachment of the macula

Causes of irreversible blindness

To find out the causes and risk factors of irreversible blindness in patients of different age groups and recommend strategies for its control. Design: It is a prospective study of one hundred consecutive blind cases, Place and Duration of Study: The study was conducted from January to June, 1999 at the Ophthalmology Department of Postgraduate Medical Institute, Peshawar. Subjects and A standard proforma was designed and entries were made regarding present, past and family history, thorough ocular examination of every patient was performed on slit-lamp with relevant biomicroscopic aids and posterior segment examination was conducted with direct as well as indirect ophthalmoscopes, biomicroscopy was performed as and when required. Intraocular pressure and ocular mobility were noted and relevant investigations were performed where needed. Of 100 patients 56% were males and 44% females. There were 3% hypertensive patients and 35% had diabetes mellitus. Etiologically 40% patients were blind due to glaucoma, 33% had diabetic retinopathy, 8% due to vitamin-A deficiency, 7% experienced trauma, retinitis pigmentosa was the cause in 3% patients, 3% had retinoblastoma and 6% were blind because of unknown or unidentified causes. Irreversible blindness is more common in people above fifty years of age and mostly males are affected. Glaucoma was the commonest cause followed by diabetic retinopathy in this study

Incidence of ocular complications of diabetes mellitus in Pakistan

We studied 150 patients, 122 with non-insulin-dependent diabetes mellitus [NIDDM] and 28 with insulin-dependent diabetes mellitus [IDDM], to determine the incidence of retinal and non-retinal ocular manifestations of diabetes mellitus in population visiting the Department of Ophthalmology, Lady Reading Hospital, Postgraduate Medical Institute, Peshawar. Corneal sensitivity was reduced in 62.3% of the NIDDM patients and in 35.7% of IDDM patients. Mature cataract of aphakia was present in 25.4% of the NIDDM and 14.2% of the IDDM patients. We found true diabetic cataract in only one patients, an 11-year old girl with IDDM in diabetic coma. Chronic open-angle glaucoma or ocular hypertension was present in 9% of the NIDDM patients but in none of the IDDM patients. Background diabetic retinopathy [BDR] occurred in 15% of the NIDDM and 11% of the IDDM patients with a diabetes duration of less than 5 years. With a duration of 5-10 years, this figure rose to 18% in the NIDDM group and to 28.5% in the IDDM group. The frequency increased to 66.6% in the NIDDM group and to 33.3% in IDDM group beyond 10 years of disease duration. Proliferative diabetic retinopathy [PDR] or preproliferative diabetic retinopathy [PPDR] was present in 5% of the NIDDM patients and in none of the IDDM patients with disease duration of less than 5 years. In the group with disease duration of 5-10 years, PDR or PPDR was present in 26% of the NIDDM patients, 14.2% of the IDDM patients. When duration of diabetes went beyond 10 years, this figure rose to 33.3% in both NIDDM and IDDM groups. Diabetic maculopathy was present in 11.6% of the patients with NIDDM and in no patient with IDDM with diabetes duration of less than 5 years. This figure increased to 20% in the NIDDM group and to 28% in IDDM group with a duration of 5-10 years. In patients with diabetes of more than 10-years duration, maculopathy was present in 25% of the patients in the NIDDM group and none in the IDDM group. [Pakistan Journal of Ophthalmology 8: 7-11, January, 1992]

Perforating eye injuries caused by disposable syringes

From September 1, 1989 to December 31, 1989, we handled 54 cases of unusual perforating eye injuries caused by disposable syringes. The typical mechanism of injury being that a carelessly discarded syringe, usually with the needle unremoved, falls into the hands of a child who uses it to squirt water on his friends. At some unfortunate moment the force of water stream dislodges the needle and makes it fly into the eye of the child who is the target of water squirting. An overwhelming majority of the patients [51 or 94.4%] were children of 15 or under, and more than two thirds [38 or 70.4%] were males. All had uniocular trauma. Only one in six patients presented within 24 hours after the injury. Thirty nine patients [72.2%] had received some kind of treatment at home or elsewhere before consulting us. Only four eyes [7.4%] could achieve a final visual acuity of 6/12 or better. In 26 [48.2%] of the eyes, the vision was lost to no light perception [NLP], and a tragic number of 50 [92.8%] eyes ended up legally blind. Based on various treatment modalities, there was no significant difference in outcome. In view of the uniformly grave consequences, a strong emphasis must be placed on preventive measures and the proper disposal of these syringes

YAG laser iridotomy for narrow angle glaucoma in pakistani patients

We undertook a study to evaluate the efficacy and complications of neodymium:yttrium, aluminum, garnet [Nd:YAG] laser iridotomy in the Pakistani patients. Neodymium:YAG laser iridotomy was performed in 43 [98%] out of 44 eyes of 36 Pakistani patients, ten [26%] of whom were men and 28 [74%] were women. Iridotomy was performed for acute angle closure attack in four [9%] eyes, for prodromal attacks in 10 [28%] eyes and as a prophylaxis in 30 [68%] eyes. The brown irides needed much higher total energy [304 mj] as compared to the blue irides [44 mj]. The immediate complications included small hyphema in 21 [48%] eyes, raised intraocular pressure in six [14%] eyes and iritis after 24 hours in one [2.3%] eye. We did not see corneal edema or cataract formation in any of the patients included in this preliminary report

Ocular war trauma in Afghan refugees of Russian invasion

From January 1978 to August 1984, the authors studied the pattern of ocular injuries in the Afghan refugees of the Russian Invasion at the Department of Ophthalmology, Khyber Hospital, Peshawar, Pakistan. Out of a total of 669 Afghans admitted to the eye department, 221 [33%] had eye injuries. One third of these also had facial and other associated injuries. Most of them [210 or 95%] were men, and a large majority of them [151 or 68.3%] were in the 16- 30-year age group. The commonest cause of injury [in 206 or 93.2% of the patients] were bomb and mine blasts. Corneoscleral perforation was the most prevalent injury, and was bilateral in 25 patients. The retained intraocular or intraorbital foreign body was present in 28 patients, eight of whom had it bilaterally. Intraocular infection occurred in 52 [20.7%] of the injured eyes. Although primary repair was possible in 201 [80.1%] eyes, 50 [19.9%] eyes required primary excision either due to irreparable damage or for severe endophthalmitis. In 10 patients, enucleation had to be performed bilaterally. Compared to other studies, rate of infection in this study is higher [52 or 20.7% of the eyes]. However, the incidences of loss of eye and of retained intraocular foreign body are similar to the past published reports