Visual outcome and complications after ND-YAG laser capsulotomy in patients with posterior capsular opacification

Cataract remains the most common treatable cause of blindness in the developing world including Pakistan. Posterior capsular Opacification is a natural consequence of extra capsular cataract extraction and phacoemulsification. To see complications during and after Nd-YAG laser capsulotomy and evaluate the visual outcome in aphakic and pseudophakic patients with posterior capsular Opacification. The study was conducted on consecutive aphakic and pseudophakic patients suffering from posterior capsular Opacification who were admitted for Nd-YAG laser capsulotomy at Ophthalmology Department of Saidu Teaching Hospital, Saidu Sharif, Swat, from November 2006 to May 2007. Out of 45 cases, 28 [62.2%] were males and 17 [37.8%] females. The mean age was 56 years and the mean time interval between cataract surgery and Nd-YAG capsulotomy was 31.2 months. Fifty eyes of 45 patients with posterior capsular Opacification underwent Nd-YAG laser capsulotomy, of which 27 [54%] were right and 23[46%] were left sided. Twenty nine [58%] eyes had capsular fibrosis, 14[28%] had Elschnig pearls, 6[12%] had both capsular fibrosis and Elschnig pearls and one [2%] eye had capsular wrinkling. Damage to intraocular lens in two eyes and corneal bum in one eye were procedural complications. Post-laser complications were raised intraocular pressure in 7 eyes, corneal oedema and anterior uveitis in two eyes each. Twenty five [50%] eyes had visual acuity of 6/60 or less before capsulotomy. The visual acuity after Nd-YAG laser capsulotomy was 6/60 or less in 15[30%] eyes. Four [8%] eyes had good pre-laser visual acuity of 6/6-6/12; while 14[28%] eyes had post laser visual acuity of 6/6-6/12. No case had further deterioration of visual acuity after Nd-YAG laser capsulotomy. Capsular fibrosis is the commonest presentation of posterior capsular Opacification. Damage to intraocular lens and corneal burn were encountered during procedure. Majority of patients had significant improvement in visual acuity. Raised intraocular pressure, corneal oedema and iritis were seen as post laser complications

Ocular sequelae of blast injuries: experience at a teaching hospital

To study the ocular sequlae of blast injuries, their management and visual outcome. Retrospective review of over 4 years of the records of the patients admitted during [1 January 2003 to 31 December 2006] with blast injuries in Ophthalmology Department of Saidu Teaching Hospital, Saidu Sharif, Swat. Files of patients with blast injuries of all ages and both gender were retrieved from the record room. A separate data collecting proforma was filled for every patient. Personal data, occupation, nature of blast, duration between the accident and presentation, ocular findings, management and visual outcome were recorded in all cases. A total of 7446 patients were admitted in the department during the study period of whom 34 had blast injuries [31 males and 3 females]. Nature of blast showed that 24 [70.6%] cases got injury while breaking stone in the marble and precious stone excavations or clearing the rocks for house building or road lying; while 6 [17.7%] cases had injury due to explosives planted by others for the same purpose. Three [8.8%] cases had accidental and 1[2.9%] battery blast injury. Ages of the patients ranged from 7 to 55 years [mean 27.4 years]. Of the 47 eyes affected bilateral ocular damage was seen in 13 patients [26 eyes] and unilateral in 21 patients [10 right eyes and 11 left]. Bilateral blindness was seen in 1 case [2 eyes] while 20 patients [20 eyes] got blindness in one eye. The frequency of blindness caused by bomb blast injuries is high and there is a high like hood of psychological trauma to the patient and their families which needs to be addressed

Active trachoma in an out patient clinic

To evaluate the presentation and outcome of active trachoma patients presenting to the Ophthalmology out patient clinic. Material and The study was conducted at Saidu Teaching Hospital, Saidu Sharif, Swat from 1st January 2000 to 31st December 2001. All patients attending the outpatient department of Ophthalmology unit were examined and screened for active trachoma [trachoma follicular and trachoma intense] presentation and outcome. The medical treatment advised was oral Azithromycin 1 gram as a single dose and Tetracycline eye ointment twice a day for 6 weeks. Out of 20193 OPD patients, patients with active trachoma were 52 [0.26%] ranging in age from 9 to 65 years. Trachoma was more common in females [90.4%] than males [9.6%]. Forty-one [79%] cases were bilateral and 11 [21%] were unilateral. 42 cases presented with history of sore eyes and mucopurulent discharge for one month or more. Complications observed were conjunctival scaring in 6 [11.54%] cases, trichiasis in 5 [9.61%] cases and corneal opacity in 3 [5.77%] cases. All the patients came for the 1st follow up visit after 4 weeks [100%] and seven [13.46%] patients had come for 2nd follow up visit after one year, with no signs or symptoms of active trachoma indicating 100% successful medical treatment. Bilateral sore eyes and mucopurulent discharge are the common presentations of Trachoma. Complications like conjunctival scaring, trichiasis and corneal opacity are still seen. Single dose treatment with oral Azithromycin is effective

Optic neuritis: a three years retrospective study

The aim of our study was to review our clinical experience with optic neuritis. A retrospective review of the medical records of patients admitted for optic neuritis from January 2000 through December 2002, in Ophthalmology Department of Lady Reading Hospital, Peshawar was undertaken. Out of 28 cases of optic neuritis, 10 [35.7%] were male whereas 18 [64.3%] were female. The mean age was 31.25 years. Eight [28.6%] cases had bilateral and 20 [71.4%] cases had unilateral optic neuritis. Nine [25%] eyes had retrobulbar neuritis, 24 [66.66%] eyes had papillitis and three [8.33%] eyes had neuroretinitis. Visual acuity [VA] at presentation was between no perception of light-hand movement in 11 [30.55%] eyes, counting finger-6/60 in 18 [50%] eyes, 6/36-6/18 in five [13.88%] eyes and between 6/12-6/6 in two [5.55%] eyes. Patients had mean follow-up of 39.67 days. Final unaided VA of eyes with optic neuritis was between no perception of light-hand movement in 5 [13.88%] eyes, counting finger-6/60 in 9 [25%] eyes, 6/36-6/18 in 4 [11.11%] eyes and between 6/12-6/6 in 18 [50%] eyes. Two [5.55%] cases had recurrence of optic neuritis during study period. Young females are more affected then males. Majority cases were unilateral. Presentation is slightly late with marked impairment of vision. Papillitis is common clinical type of presentation. Fifty percent of patients regain good vision [6/6 6/12]

Presentation of diabetic retinopathy

The aim of this study is to evaluate the presentation of diabetic retinopathy in diabetic patients presenting to Ophthalmology out patient.The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over a period of 1 year from January 1999 to December 1999. A total of hundred cases were evaluated. A thorough and complete history was followed by careful Ophthalmological examination. Systemic evaluation for diabetic complications was also carried out. Male to female ratio in our study was 1.4: 1. Ninety one [91%] were cases of non-insulin dependent diabetes mellitus [NIDDM] and only 9% cases were of insulin dependent diabetes mellitus [IDDM]. Non proliferative diabetic retinopathy [NPDR] was found in 28.6% of NIDDM cases and 22.2% of IDDM cases. Proliferative diabetic retinopathy [PDR] was found in 9.8% of NIDDM cases and 11% of IDDM cases. Diabetic maculopathy was found in 15.4% of NIDDM whereas it was present in 33.3% of IDDM cases. Diabetic retinopathy is common sequalae of diabetes. Its presence and complications are strongly related to duration and control of diabetes. Diabetic maculopathy is commonest cause of visual impairment in diabetic patients