Squint publication in ophithalmic journals from Pakistan: a10 years of literature

Objective: to analyze the publication rate of squint, the most frequent study design used, nature of published articles and yearly breakdown of articles in two ophthalmic journals of Pakistan from 2006-2015

Methods: all editorial, original articles, review articles, case reports published and available on the website of Pakistan Journal of Ophthalmology, Al-Shifa journal of Ophthalmology from 2006 to 2015 was analyzed to determine the publication rate of squint and study design used in different articles

Results: overwhelmingly four hundred and twenty seven [427] original articles published. Eighty six [86] case reports, fifty five [55] editorials, and no review article published on squint. Nine original articles [n= 9] 2.1 %, one case report [n=1]1.2%, one editorial [n=1] 1.8% published on squint. In five different studies prospective study design was used, cross sectional, retrospective, case and control used in three different studies

Conclusion: these findings revealed that publications on squint are less prevalent. Most frequent study design used in published articles on squint was prospective and the nature of articles mostly described the surgical aspects of squint

Visual outcome and complications in intra ocular foreign bodies

To evaluate visual outcome and complications in intraocular foreign bodies. Descriptive case series. This prospective study was carried out in the department of Ophthalmology, Services Hospital Lahore, over a period of one year from July 2008 to July 2009. Eighteen patients having magnetic or non-magnetic intraocular foreign bodies [IOFBs] were included. The location of foreign body was determined with the help of slit lamp, direct and indirect ophthalmoscope, orbital radiogram, B-scan and CT scan. Patients with open entry wound underwent primary repair. Vitrectomy for intraocular foreign body was performed within to weeks of primary repair. Eighteen eyes of 18 patients were analyzed. There were 17 [94.44%] males and 1 [5.66%] female. Pre-operative visual acuity was perception of light in 9 [50%], hand movement in 5 [27.77%], finger counting in 2 [11.11%] and 6/60 in 2 [11.11%] patients. Post operative visual acuity was 6/18 or better in 6 [33.33%] and 6/60 in 4 [22.22%], hand movements in 6[33.33%], perception of light in 2 [11.11%] patients. Lens touch occurred in 1 [5.55%] patient and endophthalmitis developed in 1 [5.55%] patient. Giant retinal tear and total retinal detachment [RD] in 1 [5.55%] and phthisis bulbi in 1 [5.55%] patient. Intra ocular foreign bodies contribute a significant component of ocular morbidity associated with open globe injury. However with prompt treatment a useful vision can be restored

Macular epiretinal membranes and their association with sighting dominance laterality and visual performance

Objective: the purpose of this study was to investigate for associations between sighting dominance, laterality and handicap in visual performance in patients presenting with unilateral Macular Epiretinal membranes [ERM]

Material and Methods: consecutive patients with unilateral macular epiretinal membranes and no other ocular pathology were included in this study. A questionnaire and case note review were performed to determine the patient's mode of presentation, presence of symptomatic binocular interference, historically dominant eye and whether they choose to undergo surgery

Results: 44 eyes of 44 patients fulfilled the inclusion criteria. 21 affected eyes were right sided and 25 eyes [56%] were considered historically dominant. None of the included patients considered themselves as historically co-dominant. 25 [56%] patients had initially presented symptomatically. In 19 patients the macular Epiretinal membrane was detected as an asymptomatic finding during a routine ocular examination. 22 patients [50%] were aware of binocular interference [that is that the affect d eye interred with its normal fellow in day to day binocular viewing]. 23 [52%] patients elected to undergo surgery

Conclusions: this study suggests that sighting dominance may be an important determinant of the visual handicap suffered by patients with unilateral Epiretinal membranes

Prevalence of posterior capsular opacification after intravitreal dexamethasone and subconjunctival mydricaine injections in paediatric cataract surgery

Objective: to determine the prevalence of posterior capsular opacification in congenital cataract surgery after intravitreal dexamethasone and subconjunctival mydricaine injections

Material and Methods: this prospective study was conducted in Eye unit 1, Services Hospital, SIMS, Lahore from 21/7/2008 to 26/6/2013. During this period we evaluated 30 eyes in 30 children aged 4 months to 2 years with congenital cataract with no other associated anterior or posterior segment pathology after intravitreal dexamethasone and subconjunctival mydricaine injection. A comprehensive detailed history, demographic data, surgical techniques and the prevalence of delayed post-operative co plication like posterior capsular opacification was noted

Results: the incidence of posterior capsular opacification was observed in 64% of the congenital cataracts after surgical intervention with intravitreal dexamethasone and subconjunctival mydricaine injections

Conclusion: the present study revealed that use of intravitreal dexamethasone and subconjunctival mydricaine injections during paediatric cataract surgery provides better surgical outcome in terms of clearer visual axis due to less inflammation and synechiael formation which decreases the incidence of posterior capsular opacification in these cases of congenital cataracts

Role of fiberoptic bronechoscopy in the diagnosis of lung diseases: an experience with 164 cases

The aim of this cross sectional study is to determine the role of fiberoptic bronchoscopy in the diagnosis of lung diseases and observe the clinical presentation, diagnosis, complications and demographic characteristics of the patient in Jinnah Hospital Lahore. The study was performed in the Department of Pulmonology, Jinnah Hospital/Allama Iqbal Medical College Lahore from January 2007 to June 2008. This study was completed on 164 patients who underwent bronchoscopy for various reasons. The data was analysed on the basis of demography, clinical symptoms, radiological and bronchoscopic findings, type of specimen taken, and their microbiological and histopathological reports for definite diagnosis. A total of 164 patients underwent bronchoscopy during this period. Among these 99 [60%] were males and 65 [40%] were females. Age of the females ranged from 16-70 years with mean 48.5 +/- 13.2 and the males were from 14-85 years with mean age 57.8 +/- 18.1. Fifty eight [35.4%] were non smokers whereas 106 [64.6%] were smokers. Among them 63 [38.4%] presented with cough while 37 [22.5%] with cough and fever and 23 [14.0%] with chest pain. Hoarseness of voice was present in 6 [3.7%] and 35 [21.3%] presented with haemoptysis. Right lung involvement was observed in 74 [45.2%] and left lung in 52 [31.7%], whereas bilateral involvement was observed in 30 [18.3]. On bronchoscopy in 84 subjects, fungating mass was present in 30 [18.2%], infiltrative lesion was observed in 10 [6.8%], nodular mass was seen in 8 [4.7%], thick pussy secretion was obtained in 25 [15.1%], external compression was found in 05 [3.0%] subjects and vocal cord paralysis was present in 06 [3.6%]. Among 164 patients we were able to reach a definite diagnosis in 109 [66.4%]. There was no complication in 140 [85.4%] patients, while mild haemoptysis was present in 7 [4.3%], 13 [8%] had low grade fever and 4 [2.4%] developed bronchospasm. Bronchoscopy is a safe procedure for the diagnosis of bronchogenic carcinoma and also for smear negative pulmonary tuberculosis. The incidence of complication is also very low in experienced hands

Role of ultrasound in vitreous hemorrhage-a prospective study in a teaching hospital

Objective: to detect and assess posterior segment pathology in cases of vitreous hemorrhage by ultrasound examination in patients presenting to ophthalmology department of Services Institute of Medical Sciences, Lahore

Material and Methads: this study included 179 patients [200 eyes] with vitreous hemorrhage who underwent A and B scan ultrasound by one examiner at Eye unit I in Services Hospital, affiliated to Services Institute of Medical Sciences, Lahore, for the duration of four years from January 2003 to January 2007. 114 were male and 65 were females. All patients had dense vitreous hemorrhage prevented visualization of the retina. Age range was between 10 to 67 years. Before ultrasound, all the patients were completely examined in OPD including a comprehensive history, record of visual acuity and intraocular pressure, Detailed fundus examination was carried out after dilatation of pupils with mydriacyl [tropicamide] eye drops with 78 D lens and Indirect ophthalmoscope

Results: unilateral cases were 60 and bilateral cases 70. Proliferative diabetic retinopathy with vitreous hemorrhage was observed in 90 eyes, [tractional retinal detachment was present in 38 eyes, both tent like and table top configuration were observed on B scan white vitreous hemorrhage with proliferative diabetic retinopathy was observed in 52 eyes]. Rhegmatogenous retinal detachment was observed in 10 eyes. Vitreous: hemorrhage due to penetrating injuries occurred in 55 eyes and out of these 55, rnetallic intra-ocular foreign body was present in 05 eyes. Eales disease with vitreous hemorrhage was present in 25 eyes. Posterior vitreous detachment was noted in 20 eyes with vitreous haemorrhage

Conclusion: ultra-sound surgeons A-and B-ultrasound the most important examination tool. It should be typically performed early and frequently after presentation of patient with vitreous hemorrhage

Intravitreal triamcinolone for refractory diabetic clinically significant macular oedema

Objective: to determine long term effects on final visual outcome, macular fluorescein leakage and intraocular pressure after intravitreal injection of triamcinolone for treating refractory diabetic clinically significant macular oedema [CSMO]

Material and Methods: patients with CSMO of more than 12 months duration, diagnosed according to ETDRS criteria were recruited. All patients had at least two or more macular grid laser treatment with the more recent laser at least 3 months prior to the injection. Patients with CSMO and active proliferative disease, vein occlusions and macular ischemia were excluded. Patients with pre-existing significant cataract or glaucoma were also not considered. Triamcinolone, 4mg was injected through the pars-plana, infrotemporally using a 27 guage needle. The response to the treatment was monitored at 1 month, 3 months and 6 months. Visual acuity was assessed by Log MAR units, Fluorescein leakage by measuring the area of late phase of digital fluorescein angiogram and intraocular pressure by Goldman's applanation tonometry

Results: fourteen eyes of 13 patients were included in the study. The mean age was 68 years. All patients had an average of 2.4 previous sessions of grid laser treatment for CSMO. The mean visual acuity improved from 0.54 Log MAR units prior to the injection to 0.43, 0.40 and 0.37 Log MAR units at 1, 3 and 6 months post-injection. This showed statistically significant p-values of 0.042, 0.013 and 0.002 respectively. The mean intraocular pressure [IOP] increased from a pre-injection value of 16.57 to 19.42, 22.07 and 21.50 at 1, 3 and 6 months post injection respectively. The p-value for this rise in IOP was also statistically significant at 0.035, 0.005 and 0.000 respectively. Evaluated subjectively in a masked fashion, macular post injection fluorescein angiograms of all 14 eyes [100%] were graded to show less leakage than on the pre-injection angiograms in at 1, 3 and 6 months visits. No injection site related complications were noted. No patient had a repeat injection

Conclusion: intravitreal triamcinolone has shown visually and anatomically encouraging results for the treatment of diabetic macular oedema that fails to respond to conventional laser photocoagulation. Raised intraocular pressure is a concern but longer follow up is needed to assess the efficacy and safety as well as need for re-treatment

Anatomical and functional results in macular hole surgery

Objective: to assess the anatomical and functional results in macular hole surgery

Material and Methods: this study was conducted in the department of ophthalmology, SIMS/ Services Hospital Lahore over a period of one year between July 2008 to July 2009. Eighteen eyes of eighteen patients were included in this study. Pars plana vitrectomy was done in all cases. Internal limiting membrane [ILM] staining with trypan blue or brilliant Perfluoropropane [C3F8] 14% was used in 17 cases and silicone oil was used in one case for internal tamponade. Patients were advised to posture in face down position for one week. All patients were followed-up for at least six months

Results: 18 eyes of 18 patients were operated. 15 [83.33%] patients had idiopathic while 3 [16.66%] had secondary macular holes. There were 17 [94.44%] phakic and 1 [5.55%] pseudophackic patients. In 5 [27.77%] ILM staining was done with brilliant peel while in 13 [72.22%] patients Trypan blue was used. For internal tamponade C3F8 was used in 17[94.44%] patients and in 1 [5.55%] silicone oil was used. Postoperatively, 100% macular hole closure was achieved in all cases with at least 6 month follow-up

Conclusion: pars plana vitrectomy with ILM peeling is a very effective technique for the surgical closure of full thickness macular holes. This technique should be combined with post-operative head posturing for at least one week to expedite hole closure