Comparison of plasma homocysteine [HCY] levels in normal population and patients of pseudoexfoliation syndrome

Objective: To compare mean plasma homocysteine [HCY] levels [measured in umol/L] of normal population with patients having pseudoexfoliation syndrome [PXS]. Study Design: Cross sectional comparative study. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2016 to Apr 2017

Patients and Methods: In this study 60 patients of PXS and 60 healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included. All the participants were subjected to ophthalmic clinical examination including corrected distance visual acuity and slit lamp examination. Participants in both groups were evaluated for plasma homocysteine levels, by collection into a heparinized tube and later transferred in ice blocks. The samples were centrifuged at 4000 rpm for 5 minutes and stored at -20°C until the biochemical assay. HCY levels were determined by high performance liquid chromatography [HPLC]

Results: Total 120 participants of both groups were similar with respect to gender and age [p-value>0.05]. There were 36 [60%] males and 24 [40%] females in PXS group and in control group there were 29 [48.3%] males and 31 [51.7%] females. The mean age of PXS group was 44.68 +/- 3.234 years and for healthy control group it was 45.0 +/- 3.13 years. The comparison of homocysteine level between healthy controls and PXS patients showed a highly significant [p-value<0.01] difference between both groups. The mean homocysteine level was [32.14 +/- 14.33] in PXS group as compared to healthy controls [14.41 +/- 4.51]. The comparison of proportions of homocysteinemia showed that the rate of homocysteinemia was significantly [p-value<0.05] greater among patients of PXS. There were 24 [40%] participants in healthy control group who had homocysteinemia in comparison with 58 [96.67%] patients who had homocysteinemia among PXS group

Conclusion: Plasma HCY levels were raised in patients of pseudoexfoliation syndrome as compared to normal population, hence these patients may be considered for further systemic investigations by a medical specialist

Effect on Corneal Dioptric power in patients undergoing 23G Suture less plana vitrectomy

Objective: To determine the effect of 23-gauge pars plana vitrectomy on corneal dioptric power through a comparison of difference in pre- and post- surgery keratometry

Study Design: Prospective non-comparative interventional type

Place and Duration of Study: The study was conducted at the Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi from Dec 2016 to Jul 2017

Material and Methods: We studied 33 patients [33 eyes] who underwent 23-gauge vitrectomy with mean age of 46.4 +/- 12.8 years. Among them 13 were females and 20 were males. These patients were divided in four groups on the basis of pre-surgical diagnosis. 18 [55%] patients had rhegmatogenous retinal detachment, 9 [27%] had macular holes 3 [9%] with Vitreous hemorrhage and last 3 [9%] had dislocation of intraocular lens. Total vitrectomy was performed in all patients by standard 23G pars plana vitrectomy [PPV] procedure as used with three scleratomies and tunnel shaped incision. Keratometry readings before the surgery and at the end of 1st, 6th and 12th post procedural weeks were recorded in horizontal [K1] and vertical meridian [K2] by utilizing topcon auto kerato-refractometer

Results: The pre-operative dioptric power of cornea in horizontal and vertical meridian [K1 and K2 respectively] was statistically compared with post- operative dioptric power of cornea at the end of 1st, 6th and 12th postoperative weeks. At the end of first post- operative week there was significant difference between pre and post-operative corneal dioptric power with horizontal p-value<0.05 and vertical <0.04; leading to astigmatism. However, at the end of 6th and 12th post procedural weeks there was no significant difference between pre and post-operative corneal dioptric power which is evident with insignificant p-values. The p-value at the end of 6[th] post-operative week was 0.521 and 0.57 for K1 and K2 respectively. At the end of 12th post-procedural week these values are 0.854 and 0.941 for K1 and K2 respectively. Clinically these patients did not have any sign or symptoms of astigmatism

Conclusion: 23G was found safe procedure in vitreoretinal surgery with no insignificant change in corneal dioptric power except in cases in which silicone oil was used. However, due to small study group and short follow up further studies with longer follow-ups are required to establish the long-term changes in corneal dioptric power after 23G suture less vitrectomy

Effect of intralesional 5 fluorouracil injection in primary pterygium

Objective: To determine mean change in visual acuity, corneal astigmatism and clinical appearance of pterygium after intralesional injection of 5-Fluorouracil

Methods: This was a Quasi experimental study conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from June 2014 to May 2015. Total 68 eyes of 54 patients were included in the study. Patients were treated by injecting 0.1 ml of 5-FU [5mg] weekly injections for 04 weeks. All the patients underwent ophthalmic clinical examination that included Uncorrected distant visual acuity [UCVA], corrected distant visual acuity [CDVA], keratometery with Auto Ref-keratometer [RK-F1, Canon] and slit lamp examination before and 04 weeks after the last injection

Results: Total 68 eyes of 54 patients [18 females and 36 males] were treated with intralesional injection of 5 FU. Out of total, 30 were right eyes while 38 were left eyes. Age of patients ranged from 23 to 53 years with mean age of 39.2 +/- 4.90 years. Mean UCVA and corneal astigmatism before treatment were 0.162 +/- 0.167 and 2.12 +/- 1.53 respectively while the same parameters 04 weeks after last injection of 5 FU were 0.166 +/- 0.168 and 1.92 +/- 1.45 respectively. The magnitude of induced change in astigmatism was [0.235 +/- 1.35]. Ninety seven percent of the patients showed improvement in clinical appearance

Conclusion: Intralesional 5-FU injection results in significant clinical and cosmetic improvement of primary pterygium

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

Frequency of diabetes mellitus, viral hepatitis among cataract patients in a Saudi military hospital

To determine the frequency of diabetes mellitus and viral hepatitis B and C among cataract patients of Saudi origin. Record of ninety nine patients of Saudi origin who were operated for age related cataract was analyzed to note frequency of Diabetes mellitus and viral hepatitis B and C. This was besides the mandatory lab screening for HIV and sickle cell disease. Twenty nine percent patients were diabetics. Ten patients were reactive to viral hepatitis screening with six positive for hepatitis B surface antigen and four positive to anti Hepatitis C virus antibodies. Pre-op screening for common diseases should be mandatory for safety of patients and medical staff