Management of a congenital cyst of the orbit in a five year old

We report here the case of a 5 year old female child who presented at Eye department of Abbasi Shaheed Hospital with gradually increasing proptosis of left eye ball since birth. There was no light perception in the eyeball. Examination revealed a cystic swelling in inferolateral part of the orbit causing superomedial displacement of the orbit with restriction of extraocular movements. In addition there was microcornea, miccrophthamos and coloboma of iris extending posteriorly to the optic nerve. Right eye showed microphthalmos, microcornea, nystagmus on attention and a reacting pupil with visual acuity of finger counting at two feet. CT scan showed a large smooth walled hypodense lesion arising from inferolateral aspect of the orbit displacing the eye ball superomedially along with remodeling of adjacent bones.The cyst was successfully removed through subcilliary incision under general anaesthesia. Continuation of the cyst with optic nerve was seen peropeatively. Histopathology revealed a benign cyst with lining of single layer of epithelium and wall composed of aggregates of lymphocytes congested blood vessels and skeletal muscles. Findings were consistent with colobomatous cyst of the orbit

Evaluation of visual outcome of intravitreal injection avastin [bevacizumab] in proliferative diabetic retinopathy with vitreous hemorrhage

To report the visual outcome after intravitreal injection Avastin [Bevacizumab] in proliferative diabetic retinopathy with vitreous heamorrhage with 1 year followup. It was analytical observational type of study. The study was carried out at Eye department Abbasi Shaheed Hospital from July 2008-June 2010. 100 patients were selected through non-probability consecutive sampling technique from the diabetic eye clinic who presented with proliferative diabetic retinopathy and vitreous hemorrhage .Patients with vitreous hemorrhage in one eye and proliferative diabetic retinopathy or bilateral vitreous hemorrhage were included in the study. B scans were done in dense vitreous hemorrhage to exclude tractional retinal detachment. History was taken regarding duration of diabetes and decreased vision. Detailed ocular examination including visual aquity, intraocular pressure, detailed anterior segment examination on slitlamp and direct and indirect ophthalmoscopy was done. Other eye was also examined to exclude proliferative diabetic retinopathy in that eye. Patients were counselled for intravitreal injection Avastin [Bevacizumab]. After detailed examination patients were admitted in the ward and Intravitreal injection Avastin 1.25mg/0.05 ml was given in sterile environment in the operation theatre using fully aseptic technique. Patients were discharged on moxifloxacin eye drops and steroid antibiotic combination ointment at night time. Patients were followed up very next day, after 1 week, 6 weeks, 3 months, six months and 1 year. Snellens best corrected visul aquity was recorded at each visit along with fundus biomicroscopy and fundus flourescine angiography wherever possible. Other eye was also treated with intravitreal injection Avastin-[Bevacizumab], grid or focal laser treatment or panretinal fundus photocoagulation as and when required. 140 eyes of 100 patients were treated with intravitrea linjection Avastin [Bevacizumab] Followup ranged from 1st postoperative day to 1 year. Baseline visual aquity was PL/PR -perception of hand movement in 99 eyes, finger counting-6/60 in 27 eyes and 6/36 in 14 eyes. Improvement of vision was observed at 2 weeks. VA finger counting -6/60 was seen in 43 eyes, 6/36-6/18 in 63 eyes and there was no improvment in 14 eyes. After 6 month follow up FC-6/60 was seen in 18 eyes, 6/36-6/18 in 88 eyes, 6/12-6/9 was seen in 20 eyes. There was still no improvment in 14 eyes due to exudative maculopathyin 10 eyes and ischeamic maculopathy in 4 eyes. At one year followup VA finger counting-6/60 was seen in 14 eyes, 6/36- 6/18 in 87 eyes and 6/12-6/9 in 25 eyes. There was still no improvement in 14 eyes due to the above mentioned reasons. Vitreous hemorrhage resolved completely in 44 eyes, while 16 eyes had residual vitreous heamorrhage. Regression of neovascularization was observed in 120 eyes. Intravitreal injection Avastin [Bevacizumab] was repeated twice or thrice 6 weeks apart in patients with residual vitreous hemorrhage 11.4% [16 patients] and in patients with neovascularization at disc or elsewhere after 6 weeks of first injection30% [42 patients]. Some visual improvement was observed after repetition of the injection. Complications like cells in anterior chamber were seen in 5% of the eyes. Acute rise of intraocular pressure was seen in 15% eyes subconjunctival hemorrhage in 30% eyes. All the complications were managed successfully. It was concluded that Avastin is a promising drug for proliferative diabetic retinopathy. It is a very helping and simple procedure keeping in mind the long periods of absorption of vitreous hemorrhage and avoiding vitrectomy. Panretinal photocoagulation is recommended after clearance of vitreous hemorrhage

Visual outcome in panretinal photocoagulation in proliferative diabetic retinopathy at one year follow up [a study of 100 cases at Abbasi Shaheed hospital]

Purpose of our study was to evaluate the visual outcome with panretinal photocoagulation in proliferative diabetic retinopathy at one year follow up. It was retrospective, analytical, observational type of study. The study was carried out at eye department Abbasi Shaheed Hospital from March 2007-April2008. The results of our study are as follows: 150 eyes of 100 patients with type 2 diabetes mellitus were studied over a period of one year that is from March 2007-April 2008. 68% patients in our study were between 40-50 years of age and 32% between 50-60 years of age. 72% patients were males and 28% patients were females. 150 eyes of 100 patients were treated and they were followed up for 1 week, 3 months, 6 months and 1 year after PRP. Our study included 150 eyes of 100 patients 11 patients[16] eyes were in follow up. In our study 65% patients maintamed their visual acquity between 6/36-6/18.13% had improved visual acquity upto 6/12- 6/9 and 22% had their visual acquity deteriorated to 6/60- perception of hand movement. Causes of decreased vision in our study were progression of cataract 16%, lschaemic maculopathy 26%, vitreous heamorrhage 42% and preretinal fibrosis 16%. It was concluded that PRP should be initiated early to be most effective in management of PDR

Role of intraoperative application of mitomycin C to prevent recurrence of pterygium after excision using bare sclera technique [a study of 50 patients at Abbasi Shaheed hospital]

The objective of our study was to prevent the recurrence of pterygium with application of intraoperative Mitomycin C following pterygium excision using bare sclera technique. This was an observational study and carried out at eye department Abbasi Shaheed Hospital Karachi. Fifty patients were studied over a period of 9 months. Patient information regarding visual aquity, intraocular pressure, retinoscopy condition of cornea, conjunctiva and retina were recorded on a predesigned performa. Patients were admitted in the ward and operated in sterilized operation the-atre environment. Mitomycin C was applied on bare sclera in a concentration of 0.02% [0.2 mg/ml] for 2.5 minutes and irrigated with copious amount of normal saline afterwards. Patients were discharged next day on mild steroid like flouromethalone and an antibiotic ointment. Follow-up was done on first week, one month, 3 months and six months. Rate of recurrences and postoperative complications were noted down. There were 72% male and 28% female patients .Most common presenting age group was between 30-40 years of age [42%]. Primary pterygia included in the study were 90% [45 patients] and recurrent were 10% [5 patients]. Recurrence rate in primary pterygia was 6.6% [3 patients] and in recurrent pterygia 20% [1 patient]. No major complication was recorded. It was concluded that intraoperative application of Mitomycin C on bare sclera is safe and effective in preventing the recurrence of pterygium after excision provided potential complications of Mitomycin C are sufficiently addressed

Comparative study of diclofenac sodium with adrenaline for prevention of intra operative miosis

To determined the efficacy of adrenaline, when used in irrigation solution for prevention of preoperative meioses during cataract surgery. It is a comparative study. Study was conducted at Ophthalmology unit of Abbasi Shaheed Hospital from January, 2004 to July 2004. One hundred [100] patients were selected, who had cataracts without associated problems. In 50 patients Diclofenac Sodium 1% was used pre operatively 4 times together with tropicanamide 1% eye drops. In other 50 patients only tropicanamide 1% eye drops were used to dilate the pupil. In these patients, adrenaline 1 ml [1:100] diluted in 500 ml of ringers solution was used during surgery. In all these extracapsular cataract extraction with IOL were performed. Pupils were studied at the start and at the end of surgery. Before surgery pupil size was 8mm approximately. At the end of surgery pupil size was 5.5 mm with diclofenac sodium and 6.5 mm in those cases where adrenaline added in irrigation solution. Delivery of the large lens through semidiluted pupils leads to some trauma to the sphincter pupillae which reacts by constriction even in presence of adrenaline and use of diclofenac sodium 1% eye drops. This type of pupillary constriction is less in presence of adrenaline in infusion irrigation solution during surgery