Transient corneal edema after phacoemulsification

To determine the association between pre-operative and intra-operative factors leading to transient corneal edema after phacoemulsification. Cohort study. Department of Ophthalmology, Shifa Foundation Community Health Centre, Islamabad, from October 2011 to September 2012. Patients undergoing phacoemulsification and Intraocular Lens [IOL] implantation were enrolled in the study using consecutive non-probability sampling. Pre-operative risk factors including peripheral corneal degenerations, the type and density of cataract were documented. Surgical risk factors included the incision site, the type of intraocular lens, the phacotechnique and the phacopower time. Postoperatively the patients were assessed for corneal clarity and the degree of striate keratopathy. Statistical analysis was done using SPSS version 17. There were 43% male and 57% female patients [n = 182]. Mean age was 58.92 +/- 13.00 years [median and mode-60 years]. Factors which increased the risk of transient corneal edema after phacoemulsification included hypertension [p = 0.022], dense nuclear cataracts [p=0.006], divide and conquer technique [p = 0.008], duration of phacopower use [p < 0.001] and peripheral corneal degenerations [p < 0.001]. Patients with peripheral corneal degenerations and dense nuclear cataracts had significantly higher rates of postoperative corneal edema. Use of phaco-chop technique and less phaco-power time helps in decreasing corneal edema

Reducing postoperative pterygium recurrence: comparison of free conjunctival auto-graft and conjunctival rotation flap techniques

To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Quasi-experimental study. Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of >/= 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group [n=26] cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group [n=31] cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences [SPSS] version 20. The median [and inter-quartile range] age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 [51.50 - 63.00] and 57 [45.00 - 60.00] years, 28.50 [27.00 - 30.50] and 16.00 [15.00 - 17.00] minutes respectively. Recurrence was seen in 2 [7.96%] and 3 [9.76%] cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups [p=0.60]. The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and complications are comparable

Percutaneous radiologic gastrostomy: results and complications

Percutaneous endoscopic gastrostomy is usually difficult in patients with malignant involvement of oral cavity, pharynx and esophagus. Flouroscopic guided insertion of Gastrostomy catheter with Gastropexy have gained acceptance because it is easy and less time consuming as well as less invasive as compare to surgical procedure[5]. This study was done to evaluate the safety and efficacy of percutaneous placement of gastrostomy with gastropexy using imaging guidance in patients with oropharyngeal and esophageal cancers. Over five years, 105 patients were referred to our department for percutaneous radiologic gastrostomy. In five patients the procedure was not performed because of overlying viscera and high position of stomach. We performed 100 gastrostomies with gastropexy procedures using seldinger technique. Success rate for percutaneous radiologic gastrostomy was 100%. No major complication had occurred. There were 11 minor complications occurred including 4 stomal infection, 3 catheter obstruction, one peritonism and three were extensive pneumoperitoneum. Stomal infection and catheter obstruction were not related to procedure. So, our true minor complications were only 4 [4%] which is comparable to literature. Percutaneous radiologic gastrostomy is an effective and safe procedure for enteric access of nutrition in patients with oral, pharyngeal and esophageal cancer where percutaneous endoscopic gastrostomy is difficult