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

Pseudoexfoliation syndrome and its effects on intraocular pressure

To see the frequency of occurrence of pseudoexfoliation syndrome and its effects on intraocular pressure. This prospective study was done at the Department of Ophthalmology, Saidu Teaching Hospitals, Saidu Medical College, Saidu Sharif, Swat from March 2003 till December 2005. A total of 5581 patients aged 30 years and above were examined for evidence of pseudoexfoliation syndrome and those found positive for the disease were subjected to further examination. One hundred and nine patients [1.9%] had pseudoexfoliation syndrome, of whom 83 patients were males [76.1%] and 26 females [23.8%] with a male to female ratio of 3:1. The frequency of disease in males was 3.1% and in females 0.9%. The disease was bilateral in 84 [77%] and unilateral in 25 [22.9%] patients. A total of 193 eyes were affected. The frequency increased with age. Glaucoma was found in 9.3% [18 eyes], cataracts were found in 64.7% [125 eyes], lens dislocation in 7.7% [15 eyes] and lens subluxation was found in 4.1% [8 eyes]. Other findings were pupillary ruff defects in 7.2% [14 eyes], iris sphincter transillumination defects in 9.3% [18 eyes], increased pigmentation of the chamber angle in 15.% [29 eyes], poor pupillary dilation in 80.8% [156 eyes] and angle width less than Grade-II in 8.2% [16 eyes]. For cataracts in pseudoexfoliation syndrome with normal intraocular pressure extracapsular cataract extraction with intraocular lens implant was performed, sixteen eyes [17.3%] got posterior capsular tears and 17 eyes [18.4%] got zonular dialysis, while vitreous loss occurred in 26 eyes [28.2%]. Twenty six patients were implanted anterior chamber intraocular lenses.For glaucoma, cataract and pseudoexfoliation syndrome, combined extraction with intraocular lens implant was done in ten eyes and trabeculectomy done in five eyes with glaucoma, with satisfactory results. Surgery gave satisfactory results in these cases in short-term follow up. Follow up of these patients was poor and efforts are required to make the public aware of the benefits of early presentation and regular follow up to prevent visual morbidity and mortality

Fracture neck of femur in elderly patients: mechanism of injury and clinical presentation

This descriptive study was conducted in the Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar from July 2000 to June 2003 to ascertain the mechanism of injury and clinical presentation of elderly patients with fracture neck of femur. During the study period 119 patients with age 65 years or above who had fracture neck offemur were admitted. However, the complete record of only 98 patients was available. Among these 39 % were males and 61% females, with a female to male ratio of 1.5:1. The average age was 71 years and 71% of the patients had co-morbidities. The most common mechanism of injury was a fall indoor or outdoor without any extrinsic cause in 84.7% of patients. The consistent clinical symptoms were pain in the region of hip or groin and inability to bear weight present in 100% and 96% of patients respectively. The examination findings included tenderness over the greater trochanter and limitations of hip movements. Shortening and external rotation of extremity were not consistent signs being present in only 49% and 37% of patients respectively. Majority of patients [43%] had falls early in the morning