Efficacy of intravitreal bevacizumab combined with pan retinal photocoagulation versus panretinal photocoagulation alone in treatment of proliferative diabetic retinopathy

Objective: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy

Methods: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], slit lamp examination of anterior and posterior segments. Optical coherence tomography [OCT] and fundus fluorescein angiography [FFA] were carried out and patients were divided in two groups [GP and GI]. Three monthly sessions of Pan retinal photocoagulation [PRP] using Pattern Scan Laser [PASCAL] alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab [IVB] was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups

Results: Seventy six eyes of 50 patients [38 in each group] were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47 +/- 6.08 years while that in group GI was 55.69 +/- 6.58. The magnitude of induced change in BCVA was 0.09 +/- 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 +/- 92.30 um and 117.50 +/- 93.82 um in group GP and GI

Conclusion: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME

Effect of axial length on peripapillary retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography

Objective: To determine the relationship between mean axial length and mean peripapillary retinal nerve fibre layer [RNFL] thickness using spectral domain optical coherence tomography [SD OCT] in healthy subjects

Study Design: Cross sectional study

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Data of 300 eyes of 300 healthy volunteers were collected at AFIO from December 2014 to August 2015 and analysed. Axial length and RNFL thickness of each volunteer was calculated using laser interferometer [IOL master] and SD OCT respectively. Eyes were divided in three groups based on axial length. Statistical analysis of the data were done using SPSS version 17.0

Results: Mean age of study population was 23.16 +/- 3.73 years. Mean axial length was 24.40 +/- 1.50 millimetres [mm]. Mean of average peripapillary RNFL thickness was 128.87 +/- 9.94 micrometres [micro m]. Mean peripapillary RNFL thickness of superior, inferior, nasal and temporal quadrant was 158.27 +/- 11.04 micro m, 152.92 +/- 14.54 micro m, 103.85 +/- 5.01 micro m and 100.45 +/- 11.59 micro m respectively. Mean RNFL thickness, as well as RNFL thicknesses of each quadrant was also significantly different between hypermetropic, emmetropic and myopic eyes [p-value<0.001]. There was also a strong negative correlation between axial length and peripapillary retinal nerve fibre layer thickness [r= -0.964, p-value<0.001]

Conclusion: Variation in axial length significantly affects the measurement of RNFL thickness and must be counted for, while diagnosing glaucoma on basis of thinning of RNFL

Comparison of the long-term and short-term fluctuations of frequency-doubling technology perimetry between peripheral and paracentral zones of visual field

Objective: To compare the long- and short-term fluctuations of frequency doubling technology perimetry between peripheral and paracentral zone and determine the relationship between threshold sensitivity and long- and short-term fluctuation within peripheral and paracentral zone of visual field

Study Design: Descriptive study

Place and Duration of Study: Eye Department, United Nations, Pakistan Field Hospital Level-3 Darfur, Sudan, from February to July 2015

Methodology: Normal eyes of 30 volunteers were recruited. Frequency doubling technology perimetry, program N-30, full threshold was employed. Each subject was tested at weekly intervals, once in the 1st, 3rd and 4th sessions and three times in the 2nd session. Visual field was divided into paracentral, superior, and inferior zones. Short-term and long-term fluctuation as well as threshold sensitivity were calculated for each patient as the mean fluctuation and mean sensitivity value. Mann-Whitney U-test was used to compare each zone in terms of their short- and long-term fluctuations and Spearman's rho correlation test for determining the relationship of threshold sensitivity with short- and long-term fluctuations

Results: Long-term fluctuation values differences were insignificant between superior and paracentral zones. Short-term fluctuation values were statistically insignificant between all three zones. Short-term fluctuation and threshold sensitivity in each zone did not correlate. Long-term fluctuation and threshold sensitivity had a very weak negative, statistically insignificant correlation in superior and paracentral zones

Conclusion: Frequency doubling perimetry exhibits uniform short- and long-term fluctuations in peripheral and paracentral zones of visual field in normal subjects. Threshold sensitivity and long- and short-term fluctuations are independent of each other in peripheral and paracentral zones of visual field

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure

Objective: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration [ONSF] in patients with raised intracranial pressure [ICP]

Methods: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015.Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure

Results: Thirteen [72.22%] patients underwent ONSF bilaterally, while five [27.78%] underwent unilateral ONSF. Best corrected visual acuity [BCVA] improved in 24 [77.4%], remained stable in four [12.9%] and deteriorated in three [9.7%] patients. Papilledema improved in 27 [87.1%] while remained stable in four [12.9%] according to Frisenscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant [p<0.001]. There was significant negative correlation [r= -0.434, p=.017] between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia

Conclusion: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema

Corneal Collagen Cross Linking [CXL] in treatment of Pseudophakic Bullous Keratopathy

Objective: To determine mean change in visual acuity, central corneal thickness and symptoms in patients with pseudophakic bullous keratopathy after treatment with corneal collagen crosslinking

Methods: This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from April 2015 to Nov 2015. A total of 24 eyes of 24 patients were included in the study. Visual symptoms were graded in five grades [Grade 1-5], Grade-1 being very mild with decreased vision only while patients with all five symptoms [decreased vision, foreign body sensations, pain, watering and photophobia] were graded as Grade-5. Corneal collagen cross linking using topical isotonic riboflavin followed by UVA radiations [3mW/cm[2] for 10 minutes] was performed in all the patients

Visual acuity [VA], visual symptoms and central corneal thickness [CCT] were recorded before and 04 weeks after the treatment

Results: A total of 24 eyes of 24 patients [18 male and 6 females] underwent surgery

Age of the patients ranged from 55 to 75 years with mean age 65.83 + 3.89 years. Mean visual acuity was 2.09 + 0.23 before treatment while after treatment it was 2.13 + 0.22. Mean CCT as measured by optical pachymetry [Galilae G6] was 753.96 + 55.16 and 641+ 29.25 before and after surgery respectively. Improvement of clinical symptoms was seen in all the patients

Conclusion: Corneal collagen cross linking is a temporary but effective symptomatic treatment of pseudophakic bullous keratopathy

Amniotic membrane transplantation in primary pterygium compared with bare sclera technique

To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation [AMT]. An experimental study. Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. A pilot study of 70 patients was conducted. Patients were divided in two groups. In group I, pterygium excision was done by bare sclera technique while in group II, AMT was done after excision. Patients were followed for 6 months. Proportion of recurrence of pterygium was noted in each group and compared with chi-square test with significance at p < 0.05. Number of patients who presented with recurrence of pterygium in group-I were 12 [37.5%] and in group-II were 4 [12.9%]. Chi-square tests showed that there was a statistically significant difference in frequency of recurrence between the two groups [p = 0.025]. AMT after excision of pterygium appeared to be safe and effective way of treating primary pterygium as compared to bare sclera technique due to lesser recurrence at 6 months

Comparison of post-operative astigmatism following phacoemulsification with sutured versus un-sutured wound closure

To compare corneal astigmatism induced by sutured and sutureless wound closure of the main incision, after phacoemulsification, in patients attending the Eye department, Military Hospital, Rawalpindi. Quasi experimental study. Armed Forces Institute of Ophthalmology, Rawalpindi, from 20th May, 2006 to 19th May, 2007. Sixty patients were included in this study divided in two equal groups. Phacoemulsification with foldable IOL was done in all patients by the same surgeon with same surgical technique. Main incision was closed with a single suture in group A and left sutureless with stromal hydration in group B. Keratometry was performed preoperatively, at day one and 4 weeks post operatively. Postoperative astigmatism in sutured and sutureless groups at the end of first week was [1.00 D +/- 0.38] and [0.88 D +/- 0.35] respectively. At one month postoperatively astigmatism was [0.76 +/- 0.43] and [0.66 +/- 0.32] respectively in the two groups. There was statistically no significant difference between the postoperative astigmatism at one month between the two groups [p> 0.05]. There is statistically no significant difference between post-operative astigmatism after phacoemulsification between a 3.2 mm self-sealing incision whether closed without suture or secured by a single suture

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness

Intralenticular foreign body with a clear lens

Intraocular foreign bodies [IOFBs] are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normally within 2 months

Frequency of pseudoexfoliation syndrome in patients undergoing cataract surgery in eye department Military Hospital Rawalpindi

To determine the frequency of Pseudoexfoliation syndrome [PXS] in patients greater than 40 years of age, undergoing cataract surgery in Eye department Military Hospital Rawalpindi.Quasi experimental Study. Eye Department Military Hospital Rawalpindi, for 06 months duration, from March 2005 to August 2005. A total of 1008 patients, greater than 40 years of age, admitted in Eye department Military Hospital Rawalpindi for cataract surgery were included. Patients were examined on slit lamp for evidence of PXS and those with the disease were subjected to further thorough examination including Visual acuity, Goldmann applanation tonometry, gonioscopy, slit lamp examination before and after dilation of the pupil and fundus examination. Out of 1008 patients 36 [3.57%] were found to be having PXS, out of which 29 patients were male and 7 females. Male to female ratio was 4:1 appx. The disease was bilateral in 66.7% [24 cases] and unilateral in 33.3% [12 cases]. The frequency increased with advancing age. Frequency of PXS increases with the advancing age with associatation but associated with grade in insignificant