Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan

Objective: This study was conducted to quantify the normal indices of anthropometric measures related to ophthalmology including Interpupillary distance [IPD], Inner canthal distance [ICD], Outer canthal distance [OCD] in a normal, healthy Pakistani population

Methods: This is a cross sectional study. Total 500 patients were chosen randomly but 499 were included in this study. Patients were selected randomly in an outpatient department of Jinnah Post Graduate Medical Centre Karachi, over the period of five months. IPD, ICD and OCD all measurements were taken with the help of plastic rule by only one researcher to minimize chances of error as much as possible. IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by occluding one eye of researcher to reduce error. Participants were divided into four categories on basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and greater

Results: Our study comprised a total of 499 patents of which 272[54.5%] were males, and 227[45.5%] were females. The mean age of the participants was 39.3 +/- 14.5 years. The mean values for the IPD, ICD and OCD in mm were 61.8 +/- 6.2, 30.9 +/- 2.9 and 85.2 +/- 6.6 respectively. A statistically significant difference was observed between IPD, ICD and OCD Indices among male and female study participants [p<0.001, p=0.043, p<0.001]. While comparing the IPD, ICD and OCD indices amongst the different ethnic groups, we found no statistically significant difference [p=0.09. p=0.28, p=0.06]. Overall, there was no correlation between the age and other variables i.e. IPD, ICD, OCD, [r = 0.07, p = 0.085], [r = 0.005, p = 0.906], [r = -0.08, p = 0.058]

Conclusion: This work has recommended normative values of IPD, ICD and OCD in Pakistani population on the basis different variables including gender, age, and ethnicity

Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab: a comparative overview

Objective: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab

Methods: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab [Avastin] 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab [Avastin]. Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17

Results: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab [Avastin] before surgery, intraoperative bleeding monitored was ,no bleeding in 17 cases [60.7%], mild was observed in 6 cases [21.4%] and severe bleeding requiring diathermy to stop was observed in only 5 cases [17.9%]. 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases [7.1%], mild in 6 cases [21.4%] and severe in 20 cases [71.4%]

Conclusions: Intravitreal injection of Bevacizumab [Avastin] was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease

Frequency of hepatitis-B and C in patients undergoing cataract surgery in a tertiary care centre

To analyze the frequency of hepatitis B and C in patients undergoing cataract surgery. This descriptive study was conducted at department of Ophthalmology Jinnah Post Graduate Medical Centre. The duration of study was seven months from May 2013 to November 2013. After taking informed consent from the patient and hospital ethical committee all patients presenting with cataract and undergoing cataract surgery were evaluated for the existence of hepatitis C and B. Diagnosis of hepatitis C or B was made on the criteria that a patient must be positive for either Anti-HCV or HBsAg or both. Proformas were filled and data was collected and analysis was done. Pearson's correlation coefficients were calculated to calculate the occurrence of hepatitis C and B in general population undergoing cataract surgery. Six hundred and forty-eight patients were operated on for cataract surgery at Jinnah Post Graduate Medical Centre during the study period. Mean age of patients was 63 years, 300 [46.29%] were male and 348 [53.70%] female. Out of them 57 [8.79%] patients were carriers of either Hepatitis C or B. Hepatitis B accounted for 17 cases [2.62%] however Hepatitis C positive were 40 cases [6.17%]. Nobody was simultaneously affected by both hepatitis C and B. Significant number of asymptomatic carriers of hepatitis C and B were found in preoperative cataract patients. It is recommended that preoperative screening of all cataract patients should be done so that asymptomatic carriers might not become a threat for spread of disease

Intravitreal injection of bevacizumab in diabetic macular edema

To assess the effectiveness of intravitreal injection of Bevacizumab in the treatment of diabetic macular edema. This case series was conducted at Department of Ophthalmology, Jinnah Post Graduate Medical Centre [JPMC], Karachi. The duration of study was six months from May 26, 2011 to November 25, 2011. The study group comprised of 54 patients of the Diabetic Macular Edema [DME]. Intravitreal injection of 1.25 mg of bevacizumab [Avastin] was injected 3.5 mm from the limbus under topical anaesthetic drops. Post procedure follow up was scheduled on 1[st] post procedure day and after one month. Post procedure Optical Coherence tomography [OCT] was performed in all patients 1 week before and 1[st] month after 1[st] injection. The results were statistically analyzed through SPSS 17. Out of the 54 Eyes of 54 Patients who were given the Intravitreal injection of Avastin [Bevacizumab], 43 Eyes [79.6%] showed more than ten percent decrease in macular thickness from pre-injection thickness, 10 Eyes [18.5%] showed less than ten percent decrease and 1 Eye [1.9%] showed increase in macular thickness post operatively after one month. Intravitreal injection of Bevacizumab [Avastin] is effective in the treatment of diabetic macular edema

Visual outcome and complications after removal of posterior segment intraocular foreign bodies through pars plana approach

To assess the visual outcome and complications after removal of posterior segment retained intraocular foreign bodies through pars plana approach. Case series. Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi, from May 2005 to May 2006. Fifty patients with history of ocular foreign body were admitted through outpatient department and emergency. History, visual acuity, ocular and general examination was done. The foreign body was localized with the radiograph of the skull and ultrasonography. Primary repair was done in patients with open wounds. Pars plana vitrectomy, magnetic or forceps extraction of foreign body was done as required visual outcomes and complications were noted. Among the 50 patients, there were 45 [90%] males and 5 [10%] females. Average age of the patients was 31.52 +/- 9.52 [ranging from 20 to 50] years. The pre-operatively visual acuity finger counting to perception of light was 78% cases. The best corrected final visual acuity was 6/6 in 1 [2%] patient, 6/9 in 5 [10%] patients, 6/12 in 5 [10%] patients, 6/18 in 3 [6%] patients, 6/24 and 6/36 in 4 [8%] patients each, 6/60 in 4 [8%] patients, finger counting in 8 [16%] patients, hand movement in 4 [8%] patients, projection of light in 9 [18%] patients and no projection of light in 3 [6%] patients. The postoperative complications were corneal opacity in 8 [16%] patients, anterior chamber inflammatory reaction in 6 [12%] patients, increased intraocular pressure in 1 [2%] patient, silicone oil in anterior chamber in 1 [2%] patient, macular scar in 7 [14%] patients, cystoid macular edema in 1 [2%] patient, endophthalmitis in 4 [8%] patients, retinal detachment in 11 [22%] patients and phthisis bulbi in 3 [6%] patients. Acceptable visual results were achieved after the removal of posterior segment intraocular foreign bodies by vitrectomy. However, multiple complications can be encountered which require meticulate postoperative care