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AIM: To determine the predisposing factors, clinical and microbial characteristics of bacterial corneal ulcer.METHODS: Three hundred patients (300 eyes) of clinically suspected microbial corneal ulcer were included in the study. Data was collected through history and slit lamp examination. Using standard techniques, corneal scraping was performed. A portion of each scraping was examined by direct microscopy for the presence of bacteria, fungi and acanthamoeba by using 100g/L potassium hydroxideand also by Gramand staining. Another portion was inoculated directly on the surface of solid media such as blood agar, Mac-Conkey agar, chocolate agar and Sabouraud's agar. A bacterial corneal ulcer was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping examination and cured with antibacterial therapy. RESULTS: Of the 300 patients, sixty were lost in follow up, they were excluded from study. Of the remaining 240, bacterial corneal ulcer was identified in 156 (65.0%) patients. The age of patients ranged from 14 to 74 (mean age of 48) years. Majority of them were male (102). Corneal localization of the ulcers was distributed as central in 96 (61.5%) patients and peripheral in 60 (38.5%) patients. Ulcer depth in 82 (52.6%) patients was less than 1/3 of corneal thickness. In 64 (41.0%) patients, anterior chamber inflammation was 1+ to 2+ Tyndall effect with 1+ to 2+ cells present. Bacteria were isolated in 125 (80.0%) patients from the corneal smears. Sixty-nine percent of isolated bacteria were Grams' positive, and 39% were Grams' negative. Gram negative bacteria were associated with severe anterior chamber inflammation (P=0.003) and depth more than 2/3 of cornea (P=0.001). The most frequent organism isolated was Staphylococcus aureus. Forty percent of patients had good visual outcome with visual acuity same or better than the level at admission. Among the others 60% patients, final outcome was poor.CONCLUSION: Bacterial corneal ulcer is aserious ocular infectious disease that remains a therapeutic challenge and vision threatening ocular condition. Rapid isolation of bacteria and treatment with intensive ocular antibiotics represent decisive steps in the management of such pathologies.
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AIM: To compare the success rates of probing for the treatment of congenital nasolacrimal duct obstruction in children divided into three age groups.METHODS: One hundred and eighty children with uncomplicated congenital nasolacrimal duct obstruction underwent probing in Eye Hospital of Liaquat University of Medical and Health Sciences Hyderabad, Sindh, Pakistan from March 2005 to January 2008. The children were divided into three groups: Group Ⅰ (aged 4-6 months), Group Ⅱ (aged 7-12 months) and Group Ⅲ (aged 13-24 months). Success was defined as complete resolution of signs and symptoms. The chi-square test was used to analyze the results.RESULTS: The success rate was 100.0% in Group Ⅰ, 88.5% in Group Ⅱ and 82.3% in Group Ⅲ. The overall cure rate for the entire study was 90.7%.CONCLUSION: The efficacy of probing decreases with the increasing age. However, when probing is done within six months of age, it is highly effective and results in complete resolution of symptoms.
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AIM:To identify the predisposing factors,causative fungi and to improve the facilities for the laboratory diagnosis of fungal keratitis.METHODS:Two hundred and forty eyes of 240 patients of clinically suspected microbial corneal ulcer were included in the study.Data was collected through history and slit lamp examination.Using standard techniques,corneal scraping was performed.A portion of each scraping was examined by direct microscopy for the presence of fungi,bacteria and acanthamoeba by using 10% potassium hydroxide and also by Gram and Giemsa stainings.Another portion was inoculated directly on the surface of solid media such as Blood agar,Mac-Conkey agar,chocolate agar and Sabouraud agar in C-shaped streaks for culture.RESULTS:A total of 240 patients with suppurative corneaI ulcer were enrolled in the study,out of which fungi were identified in 84(35%)patients.Of these,48(57.1%)were males and 36(42.9%)females.The age ranged between 22-80 years.Sixty patients(71.4%)belonged to rural population and twenty four(28.6%)to urban population.Trauma with vegetative material was the most frequent cause noted in eighteen(21.4%)patients.Peak incidence was in the months of October-Nevember.Out of 84 eyes with fungal keratitis,fungi alone were the etiologic agents in 74(80.10%)cases and bacteria with fungi were identified in 10(11.90%).The most frequently isolated organism was Candida albicans which was found in 66(78.6%)patients.CONCLUSION:Fungal keratitis is the leading cause of infective corneal ulcer and Candida albicans being the most commonly isolated pathogen in the patients belonging to Southern Pakistan.The direct microscopic examination with potassium hydroxide 100mL/L method is a simple,rapid,inexpensive and reliable method in the diagnosis of this infection.
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·AIM:To assess the common causes of penetrating ocular injuries and to determine the visual outcome of these cases.·METHODS:A total of one hundred and twenty four eyes of 124 patients suffering from penetrating ocular injury between the ages 6-60 years, presenting to the Department of Ophthalmology,Liaquat University of Medical and Health Sciences were assessed clinically to determine the common causes of the penetrating intraocular injury and the final visual outcome.·RESULTS:One hundred and twenty four eyes with penetrating ocular injuries were enrolled in the study.The mean age was 35 years,(range 6 to 60 years).Males were predominant 86.3% with most of the patients less than 20 years of age (71%).Occupational class was mostly affected by the intraocular injuries accounting to 76%.51% patients had best corrected final visual acuity between perception of light to 6/60.Among the 124 patients in whom both initial and final visual acuities were reliably recorded,there was a correlation between poor initial visual acuity and poor final visual acuity.·CONCLUSION:Penetrating eye injury is a common incident, predominantly in young males and often resulting in poor visual outcome in the injured eye.Labour work without protective measures and children playing with hazardous objects are associated with more frequent and severe ocular injuries.
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·AIM: To evaluate the extent of significant posteriorcapsule opacification (PCO) after implanting polyme-thylmethacrylate (PMMA) and soft acrylic intraocular lenses.·METHODS: A total of one hundred patients (110 eyes) undergoing intraocular lens (IOL) implant surgery were randomly divided into two groups based on the type of IOL's implanted. Group Ⅰ: AcrySof (SA60AT) and Group Ⅱ: PMMA (LX10BD). The density of posterior capsular opacification (PCO) was assessed 3, 6, 12 and 18 months after surgery by taking best corrected visual acuity (BCVA) and the digital photographs.·RESULTS: At the end of 3 months postoperatively, the PCO density in the Group Ⅰ (PMMA) increased significantly (3.6%) while no increase was found in the Group Ⅱ (Acrylic). By the end of 18 months follow up, the incidence of significant PCO was found to be less in the acrylic group (14.5%) as compared to the PMMA group (34.5%). On the basis of density, the PCO was more extensive with the PMMA lens than the AcrySof lens, which led to more severe visual loss.·CONCLUSION: The intraocular implantation of the AcrySof IOL helps to reduce the incidence of PCO to a greater degree as compared to the PMMA IOL.
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To assess the efficacy of intravitreal ceftazidime in acute postoperative endophthalmitis. Quasi experimental study Department of Ophthalmology Unit I, Eye Hospital, Liaquat University of Medical and Health Sciences, Hyderabad, from November 2004 to November 2006. Twenty-one eyes of 21 patients of acute postoperative endophthalmitis were treated with intravitreal antibiotic ceftazidime. The inclusion criteria of the patients was the clinical diagnosis of acute postoperative endophthalmitis within 15 days of postoperative period with visual acuity better than or equal to hand movement close to face. After enrollment, vitreous tap was carried out in all cases followed by intravitreal ceftazidime injection. The outcome was measured in terms of clinical resolution of endophthalmitis and postresolution best corrected visual acuity. Mean of difference was tested by paired t-test. Nineteen eyes [90.5%] responded to intravitreal ceftazidime therapy alone, while an additional pars plana vitrectomy was required in one eye. Sixteen eyes [84%] retained a visual acuity of 6/60 or better at 3 months after the initiation of the therapy [p<0.001]. Retinal detachment developed in one eye receiving intravitreal therapy. Ceftazidime was effective as intravitreal therapy for the management of acute postoperative endophthalmitis
Subject(s)
Humans , Male , Female , Postoperative Complications , Ceftazidime , Vitrectomy , Ceftazidime/administration & dosage , Risk Factors , Treatment OutcomeABSTRACT
Background: Conjunctival autograft and Mitomycin C are two useful adjutants in the prevention of pterygium recurrence
Objective: To compare the recurrence rate of conjunctival autograft and Mitomycin C adjuvant in primary pterygium excision. Design: Quasi-experimental study on patients of primary pterygium from November 2004 to November 2006. Setting: Department of Ophthalmology, Liquat University of Medical and Health Sciences Jamshoro/Hyderabad
Method: One hundred cases of primary pterygium were treated with conjunctival autograft and Mitomycin C 0.02% intra-operatively for 5 minutes at the bare sclera by cotton swab. Anesthesia used was topical proparacaine and local infiltration of lignocaine. Patients were followed postoperatively for 9-12 months to find the recurrence [defined as fibrovascular tissues invading the cornea 1mm or more] of pterygium and complications. All surgeries were performed by one surgeon
Results: Of the hundred cases 17 were lost in follow-up. In remaining eighty-three eyes received conjunctival autograft [CAG n=52] and Mitomycin C [MMC n=31]. There were 4 [7.69%] recurrences in group A [CAG] and 8 [16.13%] recurrences in group B [MMC]. There was statistically significant difference in the recurrence rate between the two groups. The post operative complications in MMC group were two punctate epithelial keratitis, one conjunctival granuloma and one has dellen. No significant complications were encountered in conjunctival autograft group
Conclusion: Simple excision of pterygium followed by conjunctival autograft has the lowest recurrence rate and minimal incidence of complications as compared to intraoperative Mitomycin C
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Tuberculosis has reemerged as a serious public health problem in recent years. The periorcular manifestations of tuberculosis are uncommon and diverse. We present two cases of periocular tuberculosis. One patient had a history of painless non-healing ulcer in the right periorbital region inferiorly and temporal fossa. Initially, it was on inferior side and, later on same type of lesion occurred in temporal fossa. Both the lesions developed communication in the form of sinus. Other patient was referred with the suspicion of chronic dacryocystitis with history of watering and painless swelling since 9 months and not responding to systemic antibiotics. Both cases had no known history of systemic tuberculosis, only the periorbital findings were presenting manifestations of systemic tuberculosis. In both cases anti-tuberculosis regimen was advised. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as a dacryocystitis or non-healing ulcer in periorbital region. A high degree of clinical suspicion is important in cases not responding to antibiotics
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A young man working in a workshop sustained penetrating injury to his left eye and reported within 12 hours to Eye Hospital. Plain X-ray orbit confirmed the presence of intraocular foreign body near pars plana. Corneal wound of entry was repaired with 10/0 suture. The intraocular foreign body was removed by magnet through trans scleral magnet via pars plana approach without 3 port vitrectomy procedure. Mild traumatic endophthalmitis was controlled by intravitreal injection of Vancomycin 1mg/0.1ml, along with topical antibiotic and steroid therapy. After 6 weeks, extraction of soft traumatic cataract and posterior chamber lens implantation was done. Best-corrected vision of 6/12 was achieved