Serum IgE levels: an effective diagnostic tool for evaluation and monitoring of orbital fungal granuloma

To determine the changes in IgE levels in diagnosis and postoperative monitoring of orbital fungal granuloma. Descriptive analytical study. Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from July 2012 to June 2013. Cases with clinically high index of suspicion for orbital fungal granuloma and 50 healthy volunteers were inducted as control subjects. Patients with recurrent cases of orbital fungal granuloma, previous orbital surgery, and those with very low clinical suspicion of fungal granuloma were excluded. Total serum IgE level [IU/ml], eosinophil counts and skin prick test were performed in all subjects. Independent t-test was used for comparison of healthy volunteers and patients with biopsy proven orbital fungal granuloma. Repeated measures ANOVA was used for comparing the preoperative and postoperative total serum IgE level of patients with biopsy proven fungal granuloma. The mean total serum IgE level for the healthy volunteers was 208.82 +/- 41.43 IU/ml. The mean pre-operative IgE value of histologically confirmed cases of fungal granuloma was 1613.72 +/- 282.83 IU/ml. The total serum IgE level gradually declined after surgery and anti-fungal treatment. The mean serum IgE level 3, 6 and 9 months postoperatively were 1039.48 +/- 308.40, 568.77 +/- 162.01 and 224.92 +/- 51.55 IU/ml respectively. These tests showed that the drop in IgE level in cases of fungal granuloma with treatment was statistically significant [p < 0.001]. Total serum IgE level can be used as a reliable diagnostic and postoperative monitoring tool in orbital fungal granuloma

Validity of frequency doubling technology to diagnose glaucoma

To determine the validity of frequency doubling technology [FDT] in identifying glaucoma subjects using Humphrey perimetry as gold standard. Cross-sectional validation study. The study was conducted at the Glaucoma clinic of Al-Shifa Trust Eye Hospital Rawalpindi from 16[th] Nov 2009 to 15[th] May 2010 on 84 eyes suspected to have glaucoma. After an informed consent, detailed history and complete ocular examination, patients were briefed about the two diagnostic tests. Each patient performed both perimetry tests, i.e. Standard Automated Perimetry [Humphrey 30-2] and FDT. At the end of each test, perimetry systems calculated mean deviation for the eye examined. Sensitivity and specificity of the procedures was calculated using formulae. Mean test duration for FDT perimetry was 4.44 min and for Humphrey perimetry duration was 9.10 min. The sensitivity and specificity calculated for FDT perimetry were 85.4% and 90.7% respectively. Area under the receiver operating curve for FDT perimetry was 0.880 [95%CI=0.799-0.961]. FDT perimetry has ability to discriminate between glaucomatous and healthy eyes, in less duration and can be effectively used as a screening tool to diagnose glaucoma

Prevalence of secondary complications and visual outcome in penetrating ocular injuries

To assess the prevalence of secondary complications and their effect on visual outcome in penetrating ocular injuries. A retrospective review. This study was carried out at Al Shifa Trust Eye Hospital Rawalpindi and consisted of a retrospective analysis of the data of patients presenting with penetrating ocular injuries from 1[st] January 2009 to 30[th] June 2011. At the time of presentation and after final treatment all patients underwent a complete ocular examination. In all cases primary globe repair was performed in the first stage. The percentage of secondary complications and related visual deficiency was calculated taking into consideration degree of penetration and the visual acuity at time of presentation. A proforma was prepared for documentation. A total of 93 eyes, with a male to female ratio of 3:1 and mean age of 20.5 years were enrolled. Overall incidence of post op complications was 55.91% [Cataract 42.3%, Phthisis 34.61%, retinal detachment 26.92%, vitreous haemorrhage 21.15%, endophthalmitis 11.5%, secondary glaucoma and APD 3.84%]. Best corrected final VA of up to or better than 6/12 was found in only 19.35% of patients. At the end of three months, the cases with normal vision were 16.3%, visual impairment 19.6%, severe visual impairment 04.1% and monocular blindness 60.8%. Penetrating ocular trauma in Pakistan has a high rate of secondary complications which carries a poor visual prognosis and leads to monocular blindness in signified number of cases

Mono therapy versus double therapy versus triple therapy in the treatment of diabetic macular edema

To compare the efficacy of macular laser photocoagulation [MPC] alone or MPC with intravitreal Bevacizumab or MPC with both intravitreal bevacizumab and intravitreal triamcinolone as primary treatment of Diabetic macular edema [DME]. A randomized clinical trial. Fifty eyes of 30 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three treatments groups. In Group-1, 20 eyes underwent focal or modified grid laser, In group-2, 15 eyes received 1.25 mg / 0.05ml of intravitreal bevacizumab [IVB] followed by MPC while in group-3, 15 eyes received 1.25 mg / 0.05ml of IVB and 2 mg / 0.05ml of intravitreal triamcinolone [IVT] followed by MPC. At 12 weeks after treatment, average improvement of visual acuity in group-1 was 1.0 line, in group-2 was 1.5 lines and in group-3 was 2.0 lines. Average central macular thickness reduction was significantly more [p=0.001] in group-3 [354 +/- 110 [micro]m] than in group- 1 [1 67 +/- 57 [micro]m] and group- 2 [278 +/- 76 [micro]m]. Up to 12 weeks triple therapy group showed better visual outcome than the other two groups where as the average reduction in central macular thickness was also more in triple therapy group. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after this treatment