ABSTRACT
Objective: To compare the difference in peripapillary Retinal Nerve Fibre Layer [RNFL] thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography [SD OCT]
Methods: This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups
Results: Mean age of study population was 44.63 +/- 4.30 years. Mean axial length was 23.46 +/- 0.59 mm. Mean peripapillary RNFL thickness was 126.98 +/- 10.07 µm in Group-A [normal individuals], and 120.77 +/- 5.41 µm in Group-B [Type-II diabetics]. Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically significant between both groups [p-value < 0.001]
Conclusion: Diabetic patients have thin RNFL as compared to normal individuals, and must be taken in account while making diagnosis of any disease based on thinning of RNFL.
ABSTRACT
Objective: To evaluate mean decrease in Corneal Endothelial cell Density [CED] after phacoemulsification in patients with different Anterior Chamber Depths [ACDs] and Axial Lengths [ALs]
Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. One hundred eyes of 90 patients, scheduled to undergo phacoemulsification surgery, were included. AL and ACD of each patient were calculated preoperatively using IOL Master. Cataracts were classified according toLens Opacities Classification System III [LOCS III] giving nuclear opalescence [NO] grades on slit lamp examination and only patients with grades NO2 and NO3 were included.Eyes were divided into two groups according to ACD and AL: Group-I: ACD 2.0mm - 3 mm and AL 22mm - 23.5mm; Group-II: ACD 3.1 mm -4.0 mm and AL 23.6mm - 25mm. CED measurements were done preoperatively and 2 month postoperatively using specular microscopy. The difference in CED change [Endothelial Cell Loss] between the two groups after surgery was analyzed using SPSS, v 22; IBM Corporation, Armonk, NY
Results: Differences in gender, laterality, age and preoperative CED between two groups were not significant. Difference in postoperative CED was also not significant, however difference in mean change and mean frequency change in CED between two groups was found to be statistically significant
Conclusion: ACD and AL affect the CED during phacoemulsification and Intraocular Lens[IOL] implantation and can be considered as risk factors of peroperative endothelial cell loss
ABSTRACT
Objective: To investigate the role of Intravitreal Bevacizumab [IVB], in preventing vitreo-retinal complications in patients of Eale's Disease [ED]
Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from May 2015 to December 2016. A total of 52 eyes of 26 patients, diagnosed with stage I or II of ED were randomly divided in two groups. Group A received monthly injections of IVB for 3 months, with steroids and laser photocoagulation. Group B received only steroids and laser treatment. Patients were followed for three months, and were analyzed for different clinical parameters
Results: Mean age of study population was 28.5+/-2.64 years. Difference in frequency of patients requiring PPV and showing regression in neovascularization was statistically significant between both groups [p=0.005 for both]. However, difference in frequency of patients showing progression in stage of ED, regression of vasculitis and best corrected visual acuity at 12 weeks between two groups was not statistically significant [p= 0.012, 0.579, 0.046 respectively]
Conclusion: Intravitreal Bevacizumab injection, given monthly in patients of ED results in significantly more regression in neovascularization, and less requirement for PPV, as compared to those receiving standard steroids and laser photocoagulation treatment
ABSTRACT
Objective: To compare the corneal endothelial cell density in patients of Pseudoexfoliation syndrome [PXS] with normal healthy controls. Study Design: Cross sectional comparative. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi from Mar 2016 to Jan 2017
Patients and Methods: Patients of PXS and healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included in the study. All the participants including controls and PXS patients were subjected to ophthalmic clinical examination including corrected distance visual acuity, slit lamp examination by the single trainee researcher to exclude bias. Participants in both groups were evaluated for corneal endothelial cell density [ECD] by using non-contact, TOPCON SP 3000P Specular microscope. Sampling bias was eliminated by analyzing 100 cells in the center of each specular microscope photograph and mean of three readings was analyzed
Results: Both the groups were similar with respect to gender and age. In our study sample there were 29 [58%] males in PXS group and 24 [48%] males in control group with no statistical significant [p-value > 0.05] difference between gender distributions of both groups. The mean age of the PXS group was 46.34 +/- 2.932 years, and in control group was 45.54 +/- 2.887 years [p-value >0.05]. The mean value of ECD was found to be 2021.548 +/- 528.142 cells/mm2 in PXS patients and the mean value of ECD in healthy subjects was noted to be 2772.692 +/- 383.395 cells/mm2, showing significantly lower ECD in PXS cases. Similarly, significantly higher number of cases 22 [44%] had CED <2000 in PXS as compared to normal healthy subjects
Conclusion: Corneal endothelial cell density decreases in patients of pseudoexfoliation syndrome and this must be considered while planning any intraocular surgery including cataract extraction
ABSTRACT
Objective: To compare mean plasma homocysteine [HCY] levels [measured in umol/L] of normal population with patients having pseudoexfoliation syndrome [PXS]. Study Design: Cross sectional comparative study. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2016 to Apr 2017
Patients and Methods: In this study 60 patients of PXS and 60 healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included. All the participants were subjected to ophthalmic clinical examination including corrected distance visual acuity and slit lamp examination. Participants in both groups were evaluated for plasma homocysteine levels, by collection into a heparinized tube and later transferred in ice blocks. The samples were centrifuged at 4000 rpm for 5 minutes and stored at -20°C until the biochemical assay. HCY levels were determined by high performance liquid chromatography [HPLC]
Results: Total 120 participants of both groups were similar with respect to gender and age [p-value>0.05]. There were 36 [60%] males and 24 [40%] females in PXS group and in control group there were 29 [48.3%] males and 31 [51.7%] females. The mean age of PXS group was 44.68 +/- 3.234 years and for healthy control group it was 45.0 +/- 3.13 years. The comparison of homocysteine level between healthy controls and PXS patients showed a highly significant [p-value<0.01] difference between both groups. The mean homocysteine level was [32.14 +/- 14.33] in PXS group as compared to healthy controls [14.41 +/- 4.51]. The comparison of proportions of homocysteinemia showed that the rate of homocysteinemia was significantly [p-value<0.05] greater among patients of PXS. There were 24 [40%] participants in healthy control group who had homocysteinemia in comparison with 58 [96.67%] patients who had homocysteinemia among PXS group
Conclusion: Plasma HCY levels were raised in patients of pseudoexfoliation syndrome as compared to normal population, hence these patients may be considered for further systemic investigations by a medical specialist
ABSTRACT
Objective: To compare corneal morphological parameters between diabetics and age matched non-diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of diabetes mellitus [DM], glycemic status and severity of diabetic retinopathy.[DR]
Methods: This cross sectional comparative study was conducted at the Department of Ophthalmology, PNS Shifa Karachi from February 2016 to January 2017. Patients with ages between 10 to 80 years of either gender who were diagnosed to have DM were recruited in the study. Control group comprised of age matched healthy volunteers who did not have DM. Corneal morphological parameters [CED, Average cell size, CV of cell size and hexagonality] was evaluated in each subject with non-contact specular microscope and findings were endorsed on a pre devised proforma
Results: Data of 298 eyes [149 diabetic patients and 149 healthy controls] was evaluated. Mean corneal endothelial cell density [CED] of diabetic population was 2494.47 +/- 394.10 cells/mm[2], while mean CED of control group was 2574.46 +/- 279.97 cells/mm[2] [p = 0.04]. Between group differences in mean average cell size, CV of cell size and hexagonality was statistically not significant. Analysis of corneal endothelial parameters among subgroups of patients with no DR, with NPDR and PDR did not show statistically significant difference. Moreover, patients with diabetes of more than 10 years duration had significantly lower CED [p <0.01] and larger average cell size [p= 0.03]. Duration of DM was significantly correlated with type of DR, HbA1c level, CED, polymegethism and hexagonality
Conclusion: Mean corneal endothelial cell density [CED] was found to be significantly lower in diabetic population as compared to healthy controls
ABSTRACT
Objective: To compare the effects of Pars Plana Vitrectomy [PPV] and Scleral Buckling [SB] with reference to Central Corneal Thickness [CCT], Corneal Endothelial-Cell Density [CED], Anterior Chamber Depth [ACD] and Axial Length [AL] in repair of Rhegmatogenous Retinal Detachment[RRD]
Methods: This comparative cross sectional analytical study was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from July 2013 to July 2015. A total of 69 eyes of 69 patients which underwent repair of RRD by either PPV or SB were analyzed to compare mean change in CCT, CED, ACD and AL between two groups
Results: Mean age of patients was 56.23+/-5.22 years. Mean pre-operative CCT, CED, ACD and AL in PPV group was 533.06+/-13.28micro m, 2231.67+/-164.57Cells/mm[2], 3.37+/-0.18mm and 23.66+/-0.76mm respectively. Mean post-operative CCT, CED, ACD and AL in PPV group was 534.81+/-11.83micro m, 2037.19+/-167.83 Cells/ mm[2], 3.24+/-0.13mm and 23.88+/-0.80mm respectively. Change in CED, ACD and AL from pre-operative value after PPV was statistically significant [p<0.001]. Mean pre-operative CCT, CED, ACD and AL in SB group was 530.73+/-12.59 micro m, 2161.79+/-161.96 Cells/mm[2], 3.343+/-0.14mm and 23.67+/-0.82mm respectively. Mean post-operative CCT, CED, ACD and AL in SB group was 532.76+/-7.74 micro m, 2158.27+/-156.58 Cells/mm[2], 3.24+/-0.10mmand 25.71+/-0.86mm respectively. Change in ACD and AL from pre-operative value after SB was statistically significant [p<0.001]. Mean change of CED, ACD and AL between two groups was also statistically significant [p<0.001]
Conclusion: Rhegmatogenous retinal detachment repair causes ocular changes, with significantly more decrease in corneal endothelial cell density after pars plana vitrectomy, and more increase in anterior chamber depth and axial length after scleral buckling
ABSTRACT
Objective:To evaluate the role of non-contact Pneumo-tonometry [PT] by comparing intraocular pressure [IOP] measurements with Goldmann Applanation Tonometry [GAT] and PT in healthy subjects, and patients with Primary Open Angle Glaucoma [POAG]
Materials and Methods: This prospective comparative study was conducted at PNS Shifa Naval Hospital, Karachi from January 2016 to June 2016. A total of 360 eyes of 180 patients were included, and IOP measurement was done using GAT and PT methods. The difference in readings between the two methods was calculated and analysed using SPSS version 17
Results: A total of 360 eyes were analysed. 90 healthy subjects [180 eyes] and 90 patients with diagnosed POAG [180 eyes] were included. Mean IOP measured in all eyes using GAT and PT was 16.32 +/- 5.31 mm of Hg and 18.16 +/- 6.76 mm of Hg respectively. Mean difference in IOP was 2.31 +/- 1.89 mmHg between two methods, with 278 [77.22%] eyes showing higher IOP reading than those measured using GAT. The difference of readings between two methods was statistically significant. The patients with POAG were divided into three groups. Group 1 had IOP less than 15 mm Hg, Group 2 had IOP between 15-25 mm Hg and Group 3 had IOP greater than 25 mm Hg. Mean difference in IOP between two methods was 1.38 +/- 1.85, 2.29 +/- 2.72 and 3.05 +/- 2.68 mm Hg in Group 1,2 and 3 respectively. The mean difference of IOP measurement using GAT and PT in these groups was statistically significant [P<0.001]
Conclusion: IOP measurement using PT overestimates the recorded IOP as compared to GAT, and the difference is more pronounced in eyes with higher than normal IOP