ABSTRACT
Objective: To determine the role of hypertension, hyperlipidemia, smoking and positive family history of diabetes and hypertension in the development of diabetic retinopathy
Methods: This prospective cohort study was conducted at the Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi over 2 years period from June 2014 to June 2016. One hundred consecutive diabetic patients with no signs of diabetic retinopathy and good glycemic control [HbA1c<6.5%] were registered by non-probability convenient sampling after taking written informed consent. They were evaluated for hypertension, hyperlipidemia and smoking status. These patients were then followed 6 monthly for 2 years to look for the development of diabetic retinopathy
Results: The mean age of the patients was 50.72+/-9.29 years and there were 57 [57%] male and 43 [43%] female patients. Majority [82%] of the patients had NIDDM. The mean duration of diabetes was 8.31+/-6.83 years. 11% of the patients were smoker, 37% were hypertensive, 6% had hyperlipidaemia, 62% had family history of diabetes and 30% had family history of hypertension. At the end of follow-up, 9 [9.0%] patients had diabetic retinopathy. The frequency of diabetic retinopathy increased with increasing age of the patient; however, the difference was statistically insignificant. A comparatively higher frequency of diabetic retinopathy was also seen in patients with IDDM and those with positive family history of diabetes and hypertension yet again, the difference was statistically insignificant. Also, no significant difference was noted among male and female genders and smokers vs. non-smoker. However, the frequency of diabetic retinopathy increased significantly with increasing duration of diabetes. It was also higher among those with hypertension and hyperlipidemia
Conclusion: Higher patient age [>/=50 years], increasing duration of diabetes [>/=20 years], insulin dependent diabetes mellitus, hypertension, hyperlipidemia, and positive family history of diabetes and hypertension were found to be associated with increased frequency of diabetic retinopathy
ABSTRACT
Objective: To determine the Efficacy of Corneal Crosslinkage [CXL], using Corneal Topography, in eyes with progressive Keratoconus
Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from October 2013 to April 2014. A total of 60 eyes of 30 patients were included who presented with bilateral progressive Keratoconus. Each eye of the patient was randomized either to a treatment group [Group-A] or control untreated group [GroupB] of 30 eyes each. A written informed consent was obtained from each patient, following which corneal crosslinkage [CXL] with topical riboflavin eye drops was performed. Follow up visit was done at three months post operatively, Corneal topography was repeated and recorded
Results: The mean age of the patients was 23.13+/-7.62 years [range 13 to 39 years]. There were 26 males and 34 females patients. The mean simK value at the start of study was 50.94+/-4.84 diopters in Group-A and 49.73+/-5.24 diopters in Group-B. At three months follow-up, the mean simK value was significantly lower in Group-A [48.28+/-4.47] as compared to Group-B [51.11+/-4.85]. Keratoconus improved/ remained stable in 34 [56.7%] eyes while progressive disease was noted in 26 [43.3%] eyes. When compared between the groups, the frequency of efficacy was significantly higher in Group-A [86.7% vs. 26.7%; p=.000] as compared to Group-B
Conclusion: Corneal Crosslinking was found effective in causing regression or halting the progression of disease in patients with progressive Keratoconus at three months follow-up, however, the efficacy of corneal crosslinking was unaffected by patient's age and gender
ABSTRACT
Objective: To determine the etiology and severity of various forms of ocular war injuries in patients presenting at an Army Hospital in Pakistan
Methods: This cross sectional study was conducted at the Department of Ophthalmology, Combined Military Hospital, Peshawar over four years period from June 2012 through March 2016, Two hundred ten consecutive soldiers who presented with ocular war injuries were included for analysis after taking written informed consent. A predesigned proforma was used to record patient's demographic details along with the cause, side, type and severity of injury, ocular trauma score was also recorded at presentation
Results: The mean age of the patients was 29.34 +/- 5.35 years. All of them were males. Left side was more frequently involved [n=126, 60.0%] and the most frequent underlying cause was IED blast injury [n=114, 54.3%]. Closed globe injuries were more frequent and were recorded in 120 [57.1%] patients. Upon assigning Ocular Trauma Score, Grade-V [28.6%] injuries were the most frequent followed by Grade-I [25.7%], Grade III [25.7%], Grade II [11.4%] and Grade IV [8.6%]. When stratified for the type of injury, OTS Grade I injuries were highest [60.0%] among patients with open globe injuries, hence poorer prognosis, while OTS Grade V injuries were highest [50.0%] among patients with closed globe injuries [p=0.000]
Conclusion: IED blast injuries are most frequently encountered ocular war injuries often involving soldiers in the age group 20-30 years. These open globe injuries had worst clinical presentation to begin with and poorer prognosis than closed globe injuries
ABSTRACT
Objective: To determine mean change in visual acuity, corneal astigmatism and clinical appearance of pterygium after intralesional injection of 5-Fluorouracil
Methods: This was a Quasi experimental study conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from June 2014 to May 2015. Total 68 eyes of 54 patients were included in the study. Patients were treated by injecting 0.1 ml of 5-FU [5mg] weekly injections for 04 weeks. All the patients underwent ophthalmic clinical examination that included Uncorrected distant visual acuity [UCVA], corrected distant visual acuity [CDVA], keratometery with Auto Ref-keratometer [RK-F1, Canon] and slit lamp examination before and 04 weeks after the last injection
Results: Total 68 eyes of 54 patients [18 females and 36 males] were treated with intralesional injection of 5 FU. Out of total, 30 were right eyes while 38 were left eyes. Age of patients ranged from 23 to 53 years with mean age of 39.2 +/- 4.90 years. Mean UCVA and corneal astigmatism before treatment were 0.162 +/- 0.167 and 2.12 +/- 1.53 respectively while the same parameters 04 weeks after last injection of 5 FU were 0.166 +/- 0.168 and 1.92 +/- 1.45 respectively. The magnitude of induced change in astigmatism was [0.235 +/- 1.35]. Ninety seven percent of the patients showed improvement in clinical appearance
Conclusion: Intralesional 5-FU injection results in significant clinical and cosmetic improvement of primary pterygium
ABSTRACT
Retinal artery occlusion is an uncommon condition but can lead to grave consequences if not managed in time
Elderly population with other comorbid conditions like hypertension, ischemic heart disease, hyperlipidemia and stroke are commonly affected. However, this condition may affect younger population with entirely different systemic associations
Thromboembolism, which usually takes place secondary to cardiac emboli or hypercoagulable states cause retinal artery occlusion in young population
A 24-year lady presented with a short history of unilateral altitudinal visual loss
On examination, she was found to have hemiretinal artery occlusion. Ocular massage, anterior chamber paracentesis was performed initially, followed by Nd YAG laser embolysis, which led to successful restoration of retinal circulation and significant improvement in visual field loss
Detailed evaluation and systemic investigations were carried out to identify the underlying cause, but no systemic association could be found
ABSTRACT
To estimate the direct cost and its determinants in type2 diabetic patients visiting outpatient department of private tertiary care hospitals. A descriptive cross sectional study. This research was carried out in the diabetic outpatient department of Shifa international hospital and AN medical Centre from 15 November 2014 to 15 February 2014. The descriptive cross sectional study was conducted on 108 diabetic patients [male 52%, female 54%]. By employing simple random sampling technique the data was collected from patients having diabetes from at least 5 years, with age limit between 30 to 80 years, with or without having complications through pretested interview administered questionnaire. The structured questionnaire was used for collecting data. SPSS 20.0 was used forrflata analysis. The percentages and frequencies were drawn in order to draw the results. The results showed that the average direct cost spent by a patient was 7704 PKR per month. More than half [66.7%] of the study subjects have suffered from diabetes since 5-10years. A larger group of respondents [50%] was treating diabetes with oral hypoglycemic. Medication, consultation, and lab investigation charges were the main determinants of diabetic cost. Per month medication charges were 3997 PKR, followed by lab investigation charges of 2441PKR per visit and consultation cost was 1298 PKR. Most of the patients [86.1%] were having one complication due to diabetes. The cost of treatment increased with the increasing age and morbidities. Diabetes is very expensive disease to manage. The affluent charges of managing diabetes and its day by day increased cases will put tremendous burden on the society