effects of reducing the exposure time of mitomycin C in glaucoma surgery

Topical application of mitomycin C has significantly increased the success rate of trabeculectomy. However the optimum exposure time of mitomycin C to the filtration site is not known. The purpose of this study was to determine whether adequate post-operative control of IOP and a lower incidence of post operative complications can be achieved by using mitomycin-C for a shorter period of time during trabeculectomy, performed in high risk glaucoma patients. Twenty eyes of patients of glaucoma, who were considered to be at high risk for failure because of their young age, previous ocular surgery like cataract extraction and trabeculectomy, inflammatory glaucoma, high myopia and prolonged anti-glaucoma medication, underwent trabeculectomy with topical application of 0.2 mg/ml concentration of mitomycin C for three minutes. They were case matched with a group of same number of eyes of high risk glaucoma patients who received same concentration of drug for 5 minutes. Twelve months after surg ery, the mean pre-operative IOP decreased from 29.9 mmHg to a post-operative level of 16.05 mmHg in 3 minutes group, with a success rate of 85%, and from 29.35 mmHg to 16.55 mmHg in 5 minutes group, with the same success rate of 85%. The incidence of complications was higher in 5 minutes group, when total number of complications was compared. [p value< 0.05] Ocular hypotony developed in 3 [15%] eyes in 5 minutes group, and none in 3 minutes group. No patient developed hypotony related maculopathy in either group. Other complications like hyphema, post-operative uveitis, and conjunctival wound leakage were managed conservatively. The present study supports the conclusion of previous studies that mitomycin C is highly effective drug when used in association with trabeculectomy, and when used in concentration of 0.2 mg/ml for three minutes is as effective in controlling post-operative IOP as is five minutes exposure time of the same concentration. Further, emphasizing that the shorter exposure of the drug is associated with lesser incidence of vision threatening complications

Pattern of somatization in depression

A study has been done to find out the relative frequency of somatic symptoms in depressive illness. 50 cases were studied from April 1993 to October 1993, which consisted of 38 male and 12 female patients. 80% of the patients in this study were between the ages of 25-50 years. 96% of the patient belonged to social class III, IV and V. 76% of the recorded cases were having educational standard of below matriculation. Twelve most common somatic symptoms complained by the patients in this study were insomnia, loss of appetite, fatigability, physical weakness, flatulence, pressure over head, giddiness, palpitations, dryness of mouth, pain neck, consitpation and burning sensations in feet. Contribution of cultural factors in somatization of depression in our country is discussed

Restructuring undergraduate Tea Chang and training programme in ophthalmology to meet visual health challenges of 21st century

In Pakistan we lack not only statistics about health problems but also effective health delivery system. Presently available data about causes of blindness though extremely limited indicates that most of this tragic outcome is preventable provided primary eye care is delivered in time. In our community general practitioners [GP] and Medical Officers working at Basic Health Units, Rural Health Centres and Tehsil Headquarter Hospital, have an important role in providing primary eye care in addition to general health care. Many eye conditions can be treated by them; however there are many conditions which may be puzzling and raise the question of whether to treat or refer, when to refer and to whom? A survey of the present system indicated that it is not geared towards this objective of identifying treatable from referable eye disease including the degree of urgency involved. No significant eye care is provided at BHU, RHC, THQ levels and very minimal at GP level. To enable primary health care team to provide eye care and play a prophylactic role against potentially blinding eye diseases, definite course objectives, strategies of teaching and training for undergraduates are recommended