Visual outcome after pars plana vitrectomy in diabetic vitreous hemorrhage

Objectives: To determine visual outcome and frequency of complications after pars plana vitrectomy in diabetic vitreous hemorrhage

Methodology: This was interventional case series conducted at department of ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 2013 to June 2014. Known diabetic patients above 16 years of age, having vitreous hemorrhage were included. Standard three ports pars plana vitrectomy [PPV] with membrane peeling, endolaser and without endotamponade by single study surgeon was done in all patients. Best corrected visual acuity was noted pre operatively and on 1st day, 2nd week and 8th week post operatively. P- value <0.05 was considered statistically significant. Post-operative complications and visual improvement were noted at final visit

Results: Total of 50 patients having diabetic vitreous hemorrhage were included in the study. Mean age was 41.4 years. Male patients were 66%. Clear lens was present in 46% patients and cortical lens vacuoles in 36% patients. Fresh vitreous hemorrhage was present in 80%. Baseline and final post-operative best corrected visual acuity logarithm minimal angle of resolution was 1.01 +/- 0.17 and 0.74+/- 0.25 respectively. The difference in pre and post-operative best corrected visual acuity logarithm minimal angle of resolution was 0.045 which was statistically significant. There were no post-operative complications in 82% patients. Visual improvement was observed in 82%

Conclusion: Most patients with diabetic vitreous hemorrhage regain or retain useful vision after PPV. Many patients may suffer late complications like recurrent vitreous hemorrhage and retinal detachment after successful initial surgery requiring secondary intervention

Causes of visual impairment in children with low vision

To determine the main causes of visual impairment in children with low vision. To assess the need of spectacles and low vision devices [LVDs] in children and to evaluate visual outcome after using their LVDs for far and near distance. Observational study. Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan, from June 2006 to December 2007. The clinical record of 270 children with low vision age 4-16 years attending the Low Vision Clinic were included. All those children, aged 4-16 years, who had corrected visual acuity [VA] less than 6/18 in the better eye after medical or surgical treatment, were included in the study. WHO low vision criteria were used to classify into visually impaired, severe visually impaired and blind. Results were described as percentage frequencies. One hundred and eighty nine [70%] were males and 81 [30%] were females. The male to female ratio was 2.3:1. The main causes of visual impairment included nystagmus [15%], Stargardt's disease [14%], maculopathies [13%], myopic macular degeneration [11%] and oculocutaneous albinism [7%]. The percentages of visually impaired, severe visually impaired and blind were 33.8%, 27.2% and 39.0% respectively. Spectacles were prescribed to 146 patients and telescopes were prescribed to 75 patients. Spectacles and telescope both were prescribed to 179 patients while Ocutech telescope was prescribed to 4 patients. Retinal diseases nystagmus and macular conditions were mainly responsible for low vision in children. Visually impaired children especially with hereditary /congenital ocular anomalies benefit from refraction and low vision services which facilitate vision enhancement and inclusive education

Anti vascular endothelial growth factor [bevacizumab] in central retinal vein occlusion: an interventional case series

Vascular endothelial growth factor plays major role in ocular angiogenesis and retinal edema production and is a step forward in the management of ocular neovascularization and retinal edematous pathologies. To determine the efficacy and safety of intra-vitreal Avastin [Bevacizumab] in cases having central retinal vein occlusion. A prospective interventional study. This study was done at Said Anwar Medical Centre, Dabgari Gardens, Peshawar from June, 2007 to September, 2009. All patients with central retinal occlusion occurring in the past 3 months and seen between the study period were included in the study. Diagnosis of central retinal vein occlusion was made clinically by slit lamp biomicroscopy with 78D examination Patients who had received any treatment for and eyes which already had developed Anterior Segment Neovascularization, Neovascularization elsewhere or Neovascularization on disc at presentation were excluded. Dose of 0.05 ml [1.25mg] of Avastin [Bevacizumab] was used as intra vitreal injection every month for 3 months in cases that presented within a month of occlusion and less injections were given in dose presenting later. Follow-up was done at 30th, 60[th], 90[th] and 120[th] day after the onset of disease. Visual outcome was defined as Snellen's or LogMar Best Corrected Visual Acuity at final follow up, of 120[th] day, compared to the visual acuity at presentation. Data were analyzed by SPSS version 17. Total of 17 eyes of 17 patients were included in this study. Eleven [64.7%] patients were males while 6 [35.3%] were females. Total of 40 intra-vitreal injections of Avastin were given to patients with a mean of 2.35 injections per eye. Good visual outcome was achieved in 10 [58.8%]] eyes, while 7[41.2%] had stable visual outcome. Mean initial Best Corrected Visual Acuity [LogMar] in all 17 eyes was 1.79 [SD +/- 0.87] which significantly improved to a mean of 1.18 [SD+0.77] at final follow up. Mean improvement in Best Corrected Visual Acuity [LogMar] after paired sample test in all patients at final follow up on day 120 was 0.61[SD+0.84]. Retinal hemorrhages and macular edema decreased clinically on examination on consecutive follow up visits. No eye developed neovascularization elsewhere, neovascularization on the disc, neovascularization, retinal tears, retinal.detachment, lens trauma, endophthalmitis or anterior chamber activity. Bevacizumab [Avastin] is an effective and safe treatment option for central retinal vein occlusion affected eyes and resulted in improvement in visual acuity. It reduced macular edema and prevented ocular neovascularization at least for short term

Visual rehabilitation of patients with Stargardt's disease

To assess the role of low vision devices in visual rehabilitation of patients with Stargardt`s disease. Descriptive study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan, from June 2003 to June 2005. Patients diagnosed as having Stargardt`s disease and confirmed by two senior ophthalmologists clinically and after fluorescein fundus angiography and Electro-Retinogram [ERG] when needed, were included in the study. Patients with fundus pathologies other than Stargardt`s disease were excluded. Each subject underwent an ophthalmic examination. Visual acuity was tested with a logarithm of the minimum angle of resolution chart; Feinbloom chart and Snellen type. Low vision assessment was performed on all individuals. SPSS version 10 was used for analysis of the data regarding the severity of visual impairment, visual acuity and devices used for aiding vision. Chi-square test was used for comparison of proportions. Of this cohort of 64 patients, 72% were aged between 7 to 15 years and 28% were 16 to 32 years. Using WHO low vision criteria, the percentage of visually impaired, severe visually impaired and blind [at the time of presentation] were 56.3%; 31.3% and 9.4% respectively. Among those patients, 3.1% had distance visual acuity of 6/18 or better in the better eye and 53% had normal near visual acuity of 1M [0.8 print size]. Telescopes were prescribed to 53% patients for enhancement of distance visual acuity to meet their needs. Stargardt's patients respond well to magnification. Simple bifocal glasses may be used in the early stages. Visual rehabilitation can help Stargardt's patients to learn independence in their activities of daily living

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Retrospective analysis of clinical presentation of children with diagnosed intussusception

To know the presenting clinical features of intussusception in children up-to the age of twelve years. The study was conducted at the Department of Paediatric Surgery, Post-Graduate Medical Institute, Lady Reading Hospital, Peshawar, over a period of 18 months. A total of 71 patients with diagnosed intussusception were included. The relevant data, both pre-operative and postoperative, of children who were operated for intestinal obstruction and finally turned out to be suffering from intussusception, was fed into a pre-designed proforma and the information so obtained was analyzed according to objectives of the study. The common presenting features were colicky abdominal pain in 70 [98:59%] cases, vomiting in 67 [94.36%] cases, abdominal distension in 67 [94.36%] cases, constipation in 63 [88.73%] cases, bleeding per rectum in 61 [85.91%] cases, palpable mass per abdomen in 56 [78.87%] cases and fever in 18 [25.35%] cases. In 11 [15.49%] cases there was a mass palpable per digital rectal examination and 05 [07.04%] patients had diarrhoea on presentation. Colicky abdominal pain, vomiting, abdominal distention, constipation, bleeding per rectum, palpable mass per abdomen are the commonest presenting clinical features of intussusception in children

Clinical profile of amblyopia in Pakistani children agy 3 to 14 years

To study the clinical profile of amblyopia in children age 3 to 14 years. A cohort study. The study was conducted over a period of two years from June 2001 to June 2003 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan. This study included 316 children. Visual acuity was tested with Snellen type and Lea symbols chart according to the level of cooperation of the children. Cycloplegic refraction and orthoptic assessment was performed on all children. One hundred and eighty-two children were between 3 to 8 years age and 134 were between 8 to 14 years. Mean age was 8 years. One hundred and twenty children had strabismic amblyopia, 136 children had anisometropic amblyopia, while 60 children had combined mechanism amblyopia [strabismus and anisometropia both]. The results indicate the importance of screening school-going children for refractive error and amblyopia and the importance of a future prospective study on the magnitude, cause and treatment of amblyopia at more treatable age