Intravitreal bevacizumab in central serous chorioretinopathy

To evaluate the effect of intravitreal bevacizumab injection in patients with central serous chorioretinopathy [CSCR]. Quasi-experimental study. Layton Rehmatullah Benevolent Trust Eye and Cancer Hospital, Lahore, from July 2010 to April 2011. There were 43 eyes of 32 adult patients with CSCR. Patients with choroidal neovascularization, prior treatment for CSCR, history of thromboembolism, intraocular pressure more than 21 mmHg, history of retinal detachment, intraocular inflammation, and allergy to fluorescence were excluded from study. All patients had intravitreal injection of off label bevacizumab. At baseline and follow-up visits, patients had best corrected visual acuity [BCVA] and central macular thickness [CMT] measurement with optical coherence tomography. They were followed-up for 6 months. Outcome measures included BCVA and CMT. Wilcoxon Signed Ranks test was used for evaluation of BCVA and CMT. There were 26 [81.3%] males and 6 [18.7%] females with 21 [65.5%] cases of unilateral and 11 [34.5%] cases of bilateral involvement. Mean age was 39.09 +/- 8.49 years. Nineteen [59.4%] eyes showed less than 6 months involvement and 13 [40.6%] eyes showed more than 6 months involvement. Mean number of injections required was 2.37 +/- 1.24 in acute cases and 3.05 +/- 1.39 in chronic cases. Overall mean of required injections was 2.67 +/- 1.34. Median visual acuity at baseline was 0.25 and at 6 months was 0.7 [p < 0.001]. Median CMT at baseline was 557 micro and at 6 months was 286 micro [p < 0.001]. Intravitreal bevacizumab injection was associated with visual improvement and reduced neurosensory detachment

Bilateral loss of light reflex and accommodation following 360 peripheral retinal laser therapy

We report a case of bilateral loss of pupillary light reflex and accommodation following 360° peripheral retinal laser therapy. A 24 years old male underwent prophylactic laser barrage for peripheral retinal lattice degenerations. Soon after the procedure, he developed bilateral loss of pupillary light reflex and accommodation. The patient faced difficulty while doing near work. On instillation of 0.125% pilocarpine, both pupils demonstrated the phenomenon of denervation supersensitivity. Damage to the short ciliary nerves was the most likely mechanism responsible for this adverse outcome

Effect of phacoemulsification on intraocular pressure

To evaluate the effect of phacoemulsification on intraocular pressure in normal eyes and glaucomatous eyes. Quasi-experimental study. Layton Rehmatulla Benevolent Trust, Eye and Cancer Hospital, Lahore, from September 2009 to August 2010. The study subjects were adult patients with cataract and open or occludable angle, with or without raised intraocular pressure, who underwent phacoemulsification. Patients having any corneal pathology, synecheal angle closure more than 180 degrees, inflammatory eye disease, previous ocular surgery including YAG iridotomy and endothelial cell density less than 1500/mm[2] were excluded from the study. They were followed-up for one year. Outcome measures included intraocular pressure, angle width, visual acuity and number of antiglaucoma medicines. Results were compared using chi-square test for proportions and t-test for mean values. There were 50 [41%] males and 72 [59%] females with 80 [65.6%] right and 42 [34.4%] left eyes. Mean age was 56.4 +/- 8.57 years. Pre-operatively 52 patients had open angles while 70 patients had occludable angles. Postoperatively 96 patients had open angles and 26 patients had occludable angles. Mean pre-operative IOP was 25.70 +/- 7.79 mmHg, which was decreased to 17.44 +/- 2.8 mmHg [p <0.001] at final follow-up visit. Number of mean antiglaucoma agents decreased from 1.12 +/- 1.30 pre-operatively to 0.62 +/- 0.92 at final follow-up visit. Mean pre-operative visual acuity was 0.4 +/- 0.19 that increased to 0.86 +/- 0.15. Phacoemulsification resulted in reduction in intraocular pressure in normal as well as glaucomatous eyes and it significantly reduced the need for anti-glaucoma medicines

Visual results following intravitreal bevacizumab in neovascular age-related macular degeneration

To determine the visual and anatomic outcome of intravitreal Bevacizumab injection in the treatment of neovascular age-related macular degeneration [AMD]. Quasi-experimental study. Layton Rahmatulla Benevolent Trust Eye Hospital [LRBT], Lahore, from January to July 2010. Patients who received, one or more intravitreal Bevacizumab injections [1.25 mg per 0.05 ml] for exudative AMD were included in the study. Outcome measures included standardized visual acuity, optical coherence tomography [OCT], macular thickness, intraocular pressure, and blood pressure at 24 or more weeks follow-up. Descriptive statistics were obtained. Fifty eyes with exudative AMD were observed for six months. The mean VA improved from 0.21 +/- 0.11 before injections to 0.43 +/- 0.11 after injections at six months. Overall, mean OCT macular thickness decreased by 99 micron at last follow-up. At last follow-up, all eyes received an average of 3.28 +/- 0.85 injections. There was no incidence of severe vision loss or adverse effects like endophthalmitis or retinal detachment. Intravitreal Bevacizumab has the potential for improvement of vision in exudative AMD for at least 6 months

Use of internet by medical students in their basic and clinical skills

The potential of using internet for medical education is widely accepted in enhancing their knowledge, skill and attitude. To assess the ability, accessibility and attitudes of medical students about use of information technology for e-learning in improving their basic and clinical skills. A qualitative descriptive study carried out at Gynae Unit II and ENT Unit I, Allama Iqbal Medical College/Jinnah Hospital, Lahore from January 2007 to April 2007. One hundred and fifty medical students each from last three years of MBBS were included in the study. A self-administered questionnaire was applied to them which included their demographic details and perceived level of IT [information technology] ability and accessibility. Four hundred fifty undergraduate students participated in the survey. There were 49% females and 51% males with similar average age. Among students 88.5% were using internet for educational purposes either at home or in college computer lab. However, the average use per week was 3.4 hours. Google, Yahoo and Ask were three most commonly used search engines. Majority [90%] of the students said that they are not getting input from their teachers on e-medicine should be the part of education from first year onwards. Undergraduate medical students have a reasonable access and perception for internet based learning and this should become a part of medical curriculum from the first year of MBBS. Medical teachers should facilitate the use of internet as an important tool of learning. Internet facilities should made widely available in the medical colleges to help them in enhancing their skills

CSOM; ossicular damage in atticoantral variant

The current study aims to find the extent of ossicular chain damage in patients with chronic suppurative otitis media, associated with cholesteotoma and/or granulation tissue formation. Descriptive study. The study was conducted at the department of ENT unit 1, Jinnah hospital/ Allama Iqbal Medical College Lahore from March, 2007 to March, 2008. A total of fifty consecutive patients presenting with atticoantral disease of different age groups were included in the study. All patients were examined clinically and under microscope. X- rays mastoids and pure tone audiometry was done in all patients. Mastoid exploration was done in all the patients and ossicullar status was assessed peroperatively. Canal wall down procedure was adopted in all the patients. Among different age groups included, majority [more than 70%] of them, were below 30 years of age, showing that atticoantral variant of CSOM is a disease of the young people. Males were more in number [70%]. Duration of the symptoms was usually prolonged. On radiological examination, 39 cases [78%] had sclerotic mastoid. Audiological records of patients showed the air bone gap of more than 40 dB in most of [78%] of patients. Perforation was marginal in most of the patients [64%]. In gross pathologic findings, cholesteotoma only, was seen in 21 cases [42%], granulations seen in 13[26%] cases, while cholesteotoma and granulations seen in 16 cases [32%]. All cases showed erosion of the ossicles, complete or partial. Incus was a most commonly involved ossicle. Chronic suppurative otitis media, atticoantral variant do commonly damage the ossicles and routinely it is multiossicular damage. Incus, is damaged most with involvement of its long process

Pregnancy induced rhinitis

Objective of this prospective study was to evaluate the occurrence of nasal congestion during pregnancy. Nasal congestion during pregnancy in 54 patients was evaluated at 12, 20, 28 and 36 weeks and was correlated to age, parity and body mass index. Results were recorded on the basis of subjective experience of patients. The prevalence of nasal congestion increased during pregnancy and occurred in 16% of women at 12 weeks of gestation, in 25% at 20 weeks, in 29% at 28 weeks and in 30% at 36 weeks. It was more common in multiparous women. Age and body mass index were not associated with nasal stuffiness. More than half of the patients reported nasal congestion for more than two weeks during pregnancy. Nasal congestion should be recognized and referred for treatment to improve the quality of pregnancy