Amniotic membrane transplantation in primary pterygium compared with bare sclera technique

To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation [AMT]. An experimental study. Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. A pilot study of 70 patients was conducted. Patients were divided in two groups. In group I, pterygium excision was done by bare sclera technique while in group II, AMT was done after excision. Patients were followed for 6 months. Proportion of recurrence of pterygium was noted in each group and compared with chi-square test with significance at p < 0.05. Number of patients who presented with recurrence of pterygium in group-I were 12 [37.5%] and in group-II were 4 [12.9%]. Chi-square tests showed that there was a statistically significant difference in frequency of recurrence between the two groups [p = 0.025]. AMT after excision of pterygium appeared to be safe and effective way of treating primary pterygium as compared to bare sclera technique due to lesser recurrence at 6 months

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness

Frequency of ocular manifestations of chronic graft versus host disease

With the advancement of techniques for haematopoietic cell transplantation, the number of transplant survivors is increasing rapidly and so are the chances of chronic graft versus host disease [cGVHD]. The ocular manifestations of this disease have not been explored in our local population. This study was conducted to determine the frequency of ocular complications in cases of cGVHD following successful bone marrow transplantation. Twelve diagnosed cases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestations were noted especially the ocular surface disorders, using double staining method with fluorescein and rose-bengal. Nine patients [75%] were having dry eyes, 7 [58.3%] with mebomian glands dysfunction, 4 [33%] with acute conjunctivitis, 2 [16.7%] with bilateral lacrimal canalicular occlusion, and 1 [8.3%] each of bilateral posterior subcapsular cataract, unilateral sterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema. The higher frequency of dry eyes along with other ocular manifestations in patients of cGVHD suggests the need of close ophthalmic monitoring in all such cases

Intralenticular foreign body with a clear lens

Intraocular foreign bodies [IOFBs] are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normally within 2 months

Spontaneous resolution of direct carotid cavernous fistula

Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind

Phthiriasis Palpebrarum

Phthiriasis palpebrarum [lice infestation of palpabrae] is a rarely reported disorder and may present as blepharo-conjuctivitis. It is usually seen in lower socioeconomic groups and spreads through either sexual contacts or directly through linen or clothing. We report a family with phthiriasis palpebrarum in which the primary source of infestation was the paternal uncle of two children. Mechanical removal proved to be quite effective in treating the disease and preventing its recurrence

Bilateral lacrimal bicanalicular obstruction in chronic graft versus host disease

Bone Marrow transplantation has been increasingly used for the treatments of various blood cancers for last two decades. As a complication, a variable number of patients develop Chronic Graft Verses Host Disease [cGVHD] six to eight months later. Ocular involvement occurs in 60 to 80% of patients with cGVHD. Though dry eye sensation is the most common ocular symptom of cGVHD we report here a case of excessive watering due to bilateral lacrimal bicanalicular obstruction secondary to ocular involvement in cGVHD along with onset of dry eye features

Hla typing in patients of Eales disease

To determine any predisposition of haplotypes with Eales disease. A case control study. This study was started in February 2002 and data collected till April 2003 at Eye Department of Military Hospital, Rawalpindi. The frequency of HLA antigens both class-1 and II by complement dependent st and ard lymphocytotoxicity test was studied in 32 patients of Eales disease [group-1] and 32 age and gender matched normal persons as controls [group-11]. Both patients and controls underwent complete ocular and clinical examination and were followed up for one year. Mean age was 30.8 years. HLA DR3 was found in 20 patients of group-1 and none in group-11. HLA types A1, B8, B5 [51] and DR 15 [2] were found in 12 out of 32 patients of eales disease and none in controls. HLA DQ2 and DR52 was found in 28 cases of group-l as compared to 18 cases of group-ll [p=.005]. HLA phenotypes HLA DR3, A1, B8, B5 [51] and DR 15 [2] occurred in majority of cases of Eales disease, whereas these were not found in controls which was statistically significant. Similarly, HLA DQ2, DR52 and Bw6 was found in higher frequency in Eales patients and thus strongly associated with it. We conclude that certain HLA haplotypes have a possible predilection for Eales disease

Serum electrophoresis in patients of Eale's disease

Eales disease is an obliterative vasculopathy that usually involve peripheral retina of young adults. It is thought to be a nonspecific tissue response to a number of agents and exact etiology remains unknown. Many diseases reflect some alterations in electrophoretic pattern of serum proteins. This study was carried out to investigate electrophoretic pattern of serum proteins in Eales disease so as to throw some light on possible etiological factors in these patients. Thirty-two patients of Eales disease constituted the subject material for this study. Paper electrophoresis of the sera was performed by cellulose acetate method on Whatman filter paper No.10 using barbitone buffer of pH 8.6. Both patients and controls underwent complete ocular and clinical examination and followed up for one year. This was a descriptive study. Ten patients [30%] had raised total serum proteins out of 32 patients and ten patients [30%] had raised gamma globulin. Serum albumin was decreased in seven patients [20%] out of thirty-two patients of Eales disease. In our study 30% increase in total serum proteins and gamma globulins in Eales disease patients points to a possible role of some immunological process which manifests as retinal perivasculitis in eyes. An increase in erythrocyte sedimentation rate in >85% of cases is consistent with this suggestion

Pseudoexfoliation syndrome and secondary catract

Pseudoexfoliation syndrome is a relatively common degenerative disorder, wherein a grey-white, fibrillogranular material is deposited in and around the anterior segment of the eye especially on the anterior lens surface, iris border and cornea. This can cause inflammation in the eye causing complicated cataract and secondary glaucoma We conducted this study to find out the frequency of complicated cataracts in such cases. Two hundred and seventy five cases with pseudoexfoliation syndrome presenting in the Dept of Ophthalmology, Military Hospital, Rawalpindi were taken up in the study and their detailed anterior chamber examination was done with special emphasis on the presence of cataract after maximal pupillary dilatation. Eighty cases [29.09%] showed the presence of cataract in their involved eyes. The occurrence of cataract in a significant number of cases suggests careful preoperative attention to zonular integrity if lens extraction is contemplated

Role of trabeculectomy in management of peseudoexfoliation glaucoma

Pseudoexfoliation syndrome is a relatively common but easily overlooked cause of chronic open angle glaucoma. When an eye with pseudoexfoliation develops secondary trabecular block glaucoma, the condition is referred to as pseudoexfoliation glaucoma. The response to medical treatment is generally not satisfactory and surgery has to be undertaken as a final resort. We conducted this study to find out the results of trabeculectomy in such cases. Fifty cases with pseudoexfoliation glaucoma presenting in the Dept of Ophthalmology, Military Hospital, Rawalpindi were initially treated with topical medications for three months. Twenty-nine cases that showed poor response to drugs were operated upon and a trabeculectomy was performed. Postoperative pressure readings were recorded twice weekly for the first two months and then once monthly for four months. After a follow-up of six months, twenty-one cases [72.41%] were effectively controlled without any added medications whereas eight cases [27.58%] required addition of a single drug to achieve the desired effect. Trabeculectomy seems a safe and effective operation in glaucoma associated with pseudoexfoliation of the lens capsule

Usefulness of laser photocoagulation in managing asymptomatic eyes of Eales disease

Eales disease is an idiopathic obliterative vasculopathy that commonly affects the peripheral retina of healthy young males characterized by recurrent vitreous haemorrhage. We did this study to evaluate the usefulness of prophylactic scatter photocoagulation in asymptomatic eyes of patients presenting with vitreous haemorrhage due to Eales Disease. Ninety nine patients with Eales' Disease demonstrable on the basis of 3 mirror fundus exam and Florescein Fundus Angiography with vitreous haemorrhage underwent either Pan retinal photocoagulation or vitrectomy in a span of 3 years. Their fellow asymptomatic eyes were grouped on the basis of their visual acuity, fundus findings and FFA picture. Group A comprising of forty-three cases underwent PRP whereas forty-three cases of Group B were not given any treatment. These cases were followed for at least three years [range 38'42 months]. Out of the forty-three cases of group A, thirty-nine [83.82%] showed visual improvement as compared to only nine cases in Group-B [p<0.001]. Vitreous involvement was present in only 16 cases in Group-A as compared to 33 cases in Group-B. Twenty-eight cases of Group-B showed signs of persistence of disease process in the retina compared to 13 cases in Group-A [p<0.005]. Prophylactic photocoagulation is an effective method of controlling the secondary complications in asymptomatic eyes of Eales disease especially if managed at an early stage. Regular checkup of peripheral retina by triple mirror examination should be performed in all asymptomatic fellow eyes of Eales disease to detect the disease process at an early stage and prevent further complications