Risk factors of preseptal and orbital cellulitis

To estimate the frequency and major risk factors of preseptal and orbital cellulitis. A cross-sectional analytical study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant [p > 0.5]. Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II

Demography of patients with periocular dermoid cysts

To study the demographics of patients admitted in the hospital with histologically proven periocular dermoid cysts. A retrospective descriptive case series. Department of Ophthalmology Khyber Institute of Ophthalmic Medical Science, Hayatabad Medical Complex, Peshawar from July, 2004 to March, 2007. Clinical characteristics of patients with dermoid cysts admitted to the hospital were retrieved from patient charts. A note was made of its frequency, age, gender and laterality. Other features like site, size, depth, histology and presenting features were also looked for. Patient's age at the time of surgery was also noted. The frequency of dermoid cysts was 40.8% amongst orbital cases. Majority [65.7%] were females and 73.6% patients were below 15 years of age. The disease was right sided in 55.2%. Majority were superficial dermoids [71.0%] followed by conjunctival dermoids [15.7%] and deep dermoids [13.1%]. The most frequent clinical finding was a mass in 84.2%. Most patients [44.7%] were below 10 years at the time of surgery. The disease is more common in females and children. Superficial dermoids are more frequent. Presentation is usually with a subcutaneous mass and treatment of choice is surgical excision

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality

Protosis: etiology and demographic patterns

To determine the demographic pattern of patients presenting with proptosis and its etiology. A cross-sectional descriptive study. Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex, Peshawar from July 2001- December 2002. Sixty cases of proptosis presenting at KIOMS were included. Thirtysix patients were male while 24 were female. They were divided into two age groups; 0-15 years [paediatric group] and above 15 years [adult group]. An elaborate work up plan was formulated for all patients, which included detailed history, clinical examination [ocular, orbital and systemic], radiological and histopathological investigations. Neoplasms [33%] were the most common causes of proptosis in all the patients followed by orbital inflammations [23%], orbital infections [20%], structural abnormalities [12%], vascular abnormalities [7%] and trauma [5%]. Neoplasms were the most common cause of proptosis in both paediatric and adult group. Proptosis was the cardinal feature and visual deterioration was present in more than half of the patients. Timely referral, early diagnosis and appropriate management can result in reduction of visual morbidity

Pattern of pediatric ocular trauma in Hayatabad Medical Complex Peshawar

To determine the pattern and causes of pediatric ocular trauma in Hayatabad Medical Complex, Peshawar. A cross sectional descriptive study Department of Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from January 1999 to June 2004. The medical records of 481 children aged upto 16 years who suffered ocular trauma were reviewed retrospectively. Age and gender distribution, nature and source of trauma, presentation and ocular features were analyzed. Pediatric ocular trauma constituted 43.5% of total traumatic ophthalmic admission. Four children were victims of bilateral trauma. Male to female ratio was 3.3:1.Twenty five percent children were below 5 years of age, 47.8% were between 5 to 10 years of age and 27.2% were between 10 to 16 years. About 51% injuries were of open globe type and 37.6% closed globe, superficial non perforating injuries, burns and adnexal pathologies were present in 11.3%. Domestic injuries were more common [47.2%]. At the time of admission 14.6% eyes were infected, 2.3% required evisceration or enucleation. Majority [67.3%] of the children presented late [one week later] to the hospital. Male children were affected more than female by trauma. Half of ocular trauma resulted in open globe injuries and almost 50% of cases were related to domestic injuries. Majority of cases presented late and were secondarily infected

Prospective randomized comparison of dacryocystorhinostomy [DCR] with and without intubation

To compare Dacryocystorhinostomy [DCR] with and without intubation and see, their success rate, surgical duration, cost and postoperative complications. Prospective, randomized, hospital based study. D.H.Q Hospital Lakki Marwat from January 2000 to September 2002. Eighty traditional external DCR procedures with and without intubation were performed. Patients were randomly divided into two groups of 40 cases in each group. Group "A" was labeled as DCR with intubation and Group "B" as DCR without intubation. All the patients were followed for 1 year. Surgical duration, postoperative complications and the success rates were compared. The success rates at one year after surgery was 97.5% for DCR with intubation and 95% for DCR without intubation [not significant]. The surgical duration for DCR without intubation was 45 minutes [shorter] and that for DCR with intubation 55 minutes [longer]. DCR with intubation was more costly as compared to that without intubation. External DCR without intubation yielded equally good results as DCR with intubation. Both procedures were associated with minimal complications. DCR without intubation costs an extra amount of rupees 1800

review of 120 cases of dacryocystorhinostomies [Dupuy Dutemps and Bourguet Technique]

The study was conducted at the DHQ hospital Lakki Marwat from Jan, 1999 to Dec, 2002 to assess the intra and postoperative complications and success rate of external dacryocystorhinostomy [DCR] with suturing of the bridge between anterior flaps of nasal mucosa and lacrimal sac with the muscle layer. Method: We operated upon 120 patients suffering from chronic dacryocystitis [CDC]. Females were 81 [67. 5%] and males were 39 [32.5%]. Majority of the patients were between the age group 40 to 60 years. Indications for dacryocystorhinostomy [DCR] were epiphora, acute on chronic dacryocystitis and a mucocele. All the cases were operated under local anaesthesia with external approach and only anterior flap suturing and engaging it in the muscle layer. These patients were followed for a period of six months. The overall success rate was 98.33%. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing. Conclusions: Dacryocystorhinstomy is a safe procedure under local anaesthesia. It is associated with minimal complications, which can be easily managed. This technique has a very high success rate and a short learning curve

Corneal complications of vernal catarrh

To identify the magnitude and types of corneal complications of vernal catarrh and the extent of visual impairment caused by them. Design: A cross-sectional study. Place and Duration of Study: Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex [HMC], Peshawar, from March, 1999 to May, 2000. Subjects and All cases of vernal catarrh who agreed to an informed consent were included in the study. Patients who were difficult to be examined by a slit lamp were excluded from the study. The diagnosis was made mainly on the basis of history and clinical examination. Slit lamp examination was done in every case together with fluorescein staining of cornea. The variables were recorded and statistically analyzed. Superficial punctate keratitis [45%] was the most common corneal complication. Visual impairment was more pronounced in cases with shield ulcers [14%] and corneal plaques [8%]. A strong association with keratoconus [15%] was also noted. Corneal opacification [9%], hydrops [6%] and pseudogerentoxon [3%] were also found. Corneal complications in VKC are common, potentially serious and may cause marked visual impairment