Spectrum of optic disc changes in primary open angleglaucoma

To find out the patterns the optic disc changes associated with primary open angle glaucoma [POAG]. This descriptive study was conducted at Ophthalmology department, Hayatabad Medical Complex Peshawar from 1[st] January to 31[st] December 2009. All patients with diagnosed POAG, above the age of 30 years, having no lens or media opacity and ocular co-morbidity, were examined thoroughly for patterns of optic disc changes associated with POAG. Frequencies and percentages of the contour of neuroretinal rim, appearance of nerve fiber layer, presence of optic disc hemorrhages, colour of optic nerve head was noted. Descriptive statistics for disc were calculated for Vertical disc diameter [VDD], Cup/disc ratio [CDR], and Rim Disc Ratio [RDR]. Two hundred patients with POAG were included. Diffuse thinning and localized notching in the neuroretinal rim was noted in 188 [94%] and 86 [43%] patients, respectively. Optic disc hemorrhage, Optic disc pallor and Optic disc atrophy was seen in 80 [40%], 127 [63.5%] and 15 [7.5%] cases, respectively. Mean VDD was 1.76mm in both right and left eyes. Mean vertical and horizontal CDR was 0.73 and 0.57 in the right and 0.765 and 0.611 in the left eye, respectively. Mean vertical and horizontal RDR was 0.451 and 0.543 in the right and 0.368 and 0.486 in the left eyes, respectively. Majority of the patients showed changes in measurements of neuroretinal rim, so emphasis should be placed on the examination of neuroretinal rim in all patients of POAG

Complication rate in preliminary experience in phacoemulsification cataract surgery

To describe the perioperative and postoperative complications related to cataract surgery performed by phacoemulsification technique at Khyber Institute of Ophthalmic Medical Sciences [KIOMS], Hayatabad Medical Complex Peshawar. One hundred consecutive cataract operations using phacoemulsification were performed from January 2011 to December 2011 at the KIOMS. After thorough examination and investigations, patients were operated. Most were operated using peribulbar anesthesia. First examination was done on the first post-operative day and then patients were followed after three weeks and eight weeks. Their per-operative and postoperative complications were analyzed and compared with complication rates reported in other studies. Total 100 cases were included in the study with 30 patients having bilateral and 40 patients having unilateral cataract. The mean age of patients was 57.4 +/- 9.3 years. Posterior capsular rupture in 19 [19%] patients was the most common intraoperative complication. Corneal edema in 49 [49%] patients on first postoperative day was most common post operative complication. After three weeks the vision was 6/12 or better in 80 [80%] of cases. Posterior capsular rupture and corneal edema were most common intraoperative and postoperative complications respectively. Majority of patients had 6/6-6/12 vision by the end of first three weeks of cataract surgery

Factors predicting the outcome of anterior levator resection in congenital ptosis

Jo identify any consistent factors which may predict over or under correction of congenital ptosis treated by anterior levator resection. The study was conducted at Khyber Institute of Ophthalmic Medical Sciences Hayatabad medical Complex, Peshawar from January 1st 2006- December 31st 2006. The study was approved by the ethical committee of KIOMS A retrospective case note review of 50 consecutive patients undergoing anterior levator resection for congenital ptosis was performed to identify. 1. The amount of ptosis and degree of levator function present pre-operatively and 2. The surgical outcome. For unilateral ptosis, a successful result was defined as a lid level within 1mm of the fellow lid following a single operation. Fifty four eyelids of 50 patients [35 males and 15 females] with congenital ptosis were included in the study. Seventy seven percent [77.27%] of all unilateral patients had a successful outcome at 6 weeks following surgery, falling slightly to [73.52%] by 6 months. The most common complications at 6 months for all cases were under correction [20%] and over correction [7.5%,]. All patient under corrected at 6 months had pre-operative levator function in the range of 4-10 mm with a mean of 6.4 mm, whereas all those over corrected at 6 months had a levator function in the range of 9-15 mm with a mean of 12 2 mm. The degree of levator function was a predictor of increased risk of over correction, with a trend towards predicting under correction as well. In this series of patients, pre operative levator function was found to be the most significant predictor of surgical outcome for anterior levator resection

Frequency and visual outcome of traumatic cataract

To assess the frequency, causative agents, current treatment options, post-operative complications and final visual outcome of trauma related cataract. The study was conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from November 1999 to November 2001. Detailed history with special reference to age, sex, mode of injury, causes and circumstances of trauma were recorded. Indications for surgery were traumatic cataract with or without open globe injury. All patients had B scans [ultrasonography] to evaluate the posterior segment. All patients were operated under general anaesthesia. The patients were followed up for six months. Out of 77 patients with traumatic cataract [69 males and 8 females], about half of the patients were between 5-15 years of age Commonest trauma was sport related in 32 [41.5%] cases. Commonest etiological agent for blunt trauma was stone in 15 [19.48%] cases and for penetrating trauma was thorn in 9 [11.7%] cases. In 71 patients [92.20%] presenting visual acuity was less than 6/60. Fifty three patients [68.83%] had final visual acuity of 6/6-6/12 while only 03 patients [03.89%] had a final visual acuity of<3/60. Traumatic cataract is common cause of visual loss after trauma. Males are affected more than females. Nearly half of patients affected are children under the age of 16. Taking necessary precautions for sports and work can prevent nearly 54% of cataracts. Most common causative agents are stone and wooden sticks

Optimal standard intraocular lens power based on biometry assessment

To evaluate optimal standard intraocular lens power [IOL] for high volume, high quality cataract patients in community eye care centres. This retrospective study was conducted on patients having cataract from January 2004- June 2003 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex Peshawar. Medical record was reviewed and relevant data including patient's age, sex, eye examined, preoperative and postoperative visual acuity, keratometry [K1, K2], axial length and the IOL power used was analysed by an epidemiologist by using SPSS software database. Out of 500 patients with cataract 272 [54.4%] were males and 228 [45.6%]were females. The presenting pre-operative visual acuity was less than 3/60 in 77.6% patients. The post-operative visual acuity was 6/12 or better in 417 [83.4%] patients at the end of first week. Mean axial length was 23.00 mm [SD + 1.5]. For males mean axial length was 22.6824 +/- 1.0985 mm and for females it was 23.1914 +/- 1.6917 mm. Mean IOL power was 21.8 D [SD +2.8]. Mean IOL for males was 22.1952 +/- 2.9170 D and for females was 21.3985 +/- 2.6614 D. In 326 patients [65.2%], IOL used was in the range of 20.5 D to 22.5 D. Use of an optimal standard intraocular lens power based on biometry assessment, in community eye care centres would give optimal visual results. This study demonstrates that an IOL of +20.5- 22.5 dioptre power would leave most postoperative cataract patients with better vision