Visual outcome and complications in Ab-externo scleral fixation IOL in aphakia in pediatric age group

To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens in pediatric age group [15 years or less]. This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2012 to December 2012. All cases included were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL under general anesthesia. Patients were followed up at 1stday, 1[st] week, 1[st] month, 2[nd] month and 3[rd] month. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Thirty patients were included in the study, with mean age of 8.6 years [ +/- 3.93569]. Most of the patients, 20 [66.7%], had visual acuities of 6/18 or better. No complication was seen in 18 [60%] of the patients intra operatively while soft eye was observed in 7 [23.3%] of the patients. Another complication noted was vitreous hemorrhage, which was seen in 5 [16.7%] patients. Most common post-operative complication was Uveitis followed by astigmatism. Lens dislocation and iris abnormalities were seen in only one patient. Most of the patients showed significant visual improvement after surgery. Ab-externo scleral fixation of an IOL was found to be safe and showed favorable postoperative results with fewer complications

Primary effects of intravitreal bevacizumab in patients with diabetic macular edema

To evaluate the efficacy of primary intra vitreal bevacizumab [IVB] injection on macular edema in diabetic patients with improvement in best corrected visual acuity [BCVA] and central macular thickness [CMT] on optical coherence tomography [OCT]. This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study [ETDRS] charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography [FFA] and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. The mean BCVA at base line was 0.42 +/- 0.14 Log Mar units. This improved to 0.34 +/- 0.13, 0.25 +/- 0.12, 0.17 +/- 0.12 and 0.16 +/- 0.14 Log Mar units at 1 month after 1[st], 2[nd] 3[rd] injections and at final visit at 6 months respectively, a difference that was statistically significant [P > 0.0001] from base line. The mean 1mm CMT measurement was 452.9 +/- 143.1 microm at base line, improving to 279.8 +/- 65.2 microm [P < 0.0001] on final visit. No serious complications were observed. Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study

To determine the frequency of type-II Diabetes mellitus [DM] in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy [DR] in this group. Descriptive study. Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care [PHC] facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 [6.55%] known and 419 [2.18%] newly diagnosed cases. DR was seen in 460 [27.43%] of the Diabetic cases with 126 [7.51%] patients requiring urgent intervention for vision threatening complications. The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system

Argon laser trabeculoplasty as primary therapy in open angle glaucoma

To determine the effect of Argon Laser Trabeculoplasty [ALT] as a primary mode of therapy in reducing the intraocular Pressure [IOP] of patients diagnosed with Primary Open Angle Glaucoma [POAG]. Quasi experimental study. The study was carried out at Isra Postgraduate Institute of Ophthalmology, Karachi, from July 2003 to July 2004. A total of 35 eyes of 35 patients with the gender distribution of 27 men and 8 women who were newly diagnosed with POAG, were included in this study. Mean age of the patients was 55.2 years with the range of 32 to 76 years. All of them were treated with argon laser trabeculoplasty as a primary mode of therapy. Intra ocular pressure was measured objectively using Goldman applanation tonometer, pre-and-post laser therapy. The pre-laser mean IOP was 27.63 mmHg [range 21-40 mmHg]. The post-laser mean IOP measured at 6 months follow up was 15.5 mmHg [range 11 - 33 mmHg] with mean decrease of 12.1 mmHg. The decrease in IOP was seen in 32 eyes [95%] with no change observed in 3 [5%] eyes. The result shows a marked decline in IOP in patients with POAG who underwent ALT as a primary mode of treatment. Further studies with large sample size and longer follow-up will help in making future recommendations

Value of ophthalmic examination in diabetics by house officers and patient awareness of complications

A cross-sectional, hospital-based study was conducted to assess the efficacy of ophthalmic examinations by house officers as part of the routine examinations of diabetic patients on a surgical ward. After obtaining a brief history of the illness, a questionnaire was completed, following which fundal examination of dilated pupils of each patient was made by the house officer. The patient was subsequently referred to the consultant ophthalmologist who also examined the patient in order to confirm or negate the house officer's findings. Of the 88 eyes examined by the house officer 50% were found to have an abnormality, of which 86% were successfully picked up by the house officer. The results of our study show that the sensitivity is high for the common presentations of diabetic retinopathy, such as background changes [right eye 88.8% and left eye 88.2%], and associated changes such as cataracts [right eye 86.6% and left eye 92.3%]. Sensitivity for the diagnosis of the normal fundus [right eye 85.7% and left eye 73.9%] was also high. The readings were not significant for the more difficult-to-detect changes, such as maculopathy, proliferarive retinopathy and previous laser therapy. Twenty one [47.7%] of the patients were aware of the effects of diabetes on the eye, while fifteen [34%] denied that diabetes had any effect and the rest were uncertain. Ophthalmic examination of the dilated eye should form part of the routine examination of diabetic patients. Every effort should be taken to screen and educate patients with diabetes