Ocular features, clinical profile and results of surgical intervention in a series of patients with Port Wine Stain and neurofibromatosis

To describe the ocular features, clinical profile and results of surgical intervention in a series of patients with facial port-wine stain [PWS] and neurofibromatosis [NF] in the pediatric age group. All consecutive patients having PWS and NF presenting between January 2011 and April 2012 were included. Their systemic and ocular features were recorded. Imaging study of brain and orbits was carried out where required. Appropriate surgical interventions were carried out as indicated. These included trabeculectomy, cycloablation, excision of episcleral haemangioma and vitreo-retinal surgery. Patients were followed up for complications and control of intra ocular pressure [IOP]. A total of 9 eyes of 8 patients were included. At presentation IOP in the involved eye ranged from 6 to 42 mmHg [mean 25.00 +/- 12.23]. Glaucoma was present in 6 eyes. Episcleral haemangioma was noticed in one patient, retinal detachment [RD] was seen in 2 patients. Diffuse choroidal thickening on B scan was noted in 5 eyes of patients with PWS. After applying the appropriate management option, IOP on last follow up ranged from 6 to 24mmHg [mean 13.44 +/- 5.43] in the involved eye the last follow up ranged from 6 to 24mmHg [mean 13.44 +/- 5.43] in the involved eye. The difference between IOP of the involved eyes at initial presentation and that recorded at the last follow-up was significant [p=0.005]. Patients with SWS and NF present with varied clinico-ocular profiles and therapeutic interventions are individualized according to the ocular involvement. Post operative complications after treatment of glaucoma in such patients can largely be prevented with special measures taken per-operatively

Distribution of corneal haze after Photorefractive Keratectomy in myopic eyes

Objective: To assess the incidence and distribution of corneal haze after photorefractive keratectomy [PRK] in low, moderate and high myopia in Pakistani population

Study Design: A prospective interventional study conducted during one year at Al-Shifa Trust Eye Hospital, Rawalpindi

Participants and Methods: Excimer laser PRK was performed on 118 eyes of sixty patients. 84 corneas were treated with multizone PRK in a single step, using three zones. Standard PRK was performed on 34 corneas. Cases were followed up to three to six months. Haze was graded subjectively on a scale of 1 to 4

Results: At the end of six months after PRK, one [8.34%] eye from low myopia group, 2 [5.71%] eyes from moderate myopia group and 6 [13.96 %] eyes from high myopia group had grade 1 corneal haze. Grade 2 corneal haze was found in 5 [14.30%] eyes from moderate myopia group and 6 [13.96%] eyes from high myopia group. Similarly 4 [11.42%] eyes and 10 [23.25%] eyes had grade 3 corneal haze from moderate and high myopia groups respectively. Grade 4 corneal haze developed in 21 [48.83%] eyes in high myopia group. The eyes undergone single zone PRK required deeper ablations with relatively denser postoperative corneal haze as compared to the eyes treated with multiple zone PRK

Conclusion: It is concluded that deeper the ablation required to correct myopia higher the incidence of corneal haze. Haze can be reduced by using such techniques which would correct more degrees of myopia with less depth of ablation

Excimer laser; photorefractive keratectomy for 1.50 to 3.50 diopters of myopia [six months follow up]

To evaluate the efficacy and safety of excimer laser photorefractive keratectomy for myopia in Pakistani people. Prospective study. At Al-Shifa Trust Eye Hospital Rawalpindi. October, 1995 and Febrauray, 1996. The study group of thirteen patients, comprises of 25 eyes, with refractive error ranging from -1.50 to -3.50 D.S [diopters sphere] and less than -1.50 D.C [diopters cylinder]. Thirteen eyes [52%] lost to follow up after three months. Only twelve eyes [48%] could be reviewed at six months after photorefractive keratectomy. At one month, eleven eyes [44%] and at three months, eight eyes [32%] were hypermetropic within +0.25 to+1.00 diopters of spherical equivalent .At six months only three eyes [25%] had hypermetropia within +0.25 to +1.00 diopters spherical equivalent. None of the eyes had any kind of astigmatism more than 1.00 diopter. No over correction of more than +1.00 diopter of spherical equivalent was observed in any case. At one month, three months and six months after photo-refractive keratectomy, 88%, 80% and 100% eyes had 6/6 visual acuity respectively, without any optical aid. Hundred percent of the eyes showed complete healing of the epithelium on third post operative day. Moderate to severe postoperative pain was experienced by every one for three days with gradual reduction in intensity. Only one eye [8.33%] had grade 1 haze at six months. Rests of the eyes were clear .No vision threatening complications occurred. Despite the short term follow up, photorefractive keratectomy appears to be an effective and safe procedure with good predictability for the correction of low myopia. Despite relatively short term follow up of the study; photo refractive keratectomy [PRK] appears to be safe and quite predictable procedure for correction of low myopia

Experience of amniotic membrane transplant in corneal diseases at al-shifa trust eye Hospital, Rawalpindi, Pakistan

To assess the quality of human amniotic membrane [HAM] processing at Al-Shifa HAM bank and to analyze the outcome of amniotic membrane transplant in different corneal pathologies at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Prospective Interventional Case Series .Consecutive 102 eyes of as many patients [72 males and 30 females] from July 2006 to August 2007 presented at Corneal Clinic were included in the study. Average age of patients was 38 years [4.5-90 years]. Frozen human amniotic membrane [HAM] from a seronegative donor stored at -80°C in Dulbecco's Modified Eagle Medium [DMEM] and glycerol was used for transplant in different corneal diseases after thawing at room temperature for half an hour. HAM was applied epithelial side up. It was spread over the whole cornea beyond limbus and anchored through continuous/interrupted 10/0 monofilament nylon sutures on the corneal side and 7/0 vicryl on the conjunctival side. Over lay [patch] and in lay [graft] technique was used in most of the cases while multilayered technique was used in case of deep ulcer and corneal perforation. Bandage contact lens [BCL] was applied and discontinued after epithelialization in all the cases. The follow up visits were on post operative day one, one week, one month, three months and then after every six months. In clinical examination luster and lubrication of the eye and stability of corneal surface was noted. In subjective examination, a performa was designed to assess reduction in pain, watering, irritation and status of overall comfort of the patient. Average follow up period was 132 days. Overall 85.3% patients had subjective improvement while 74.5% showed clinical improvement; Visual acuity improved in 49% patients. AMT was repeated in 8 patients. No intraocular infection was reported in study cases. The study concludes that AMT is a useful treatment option in a variety of ocular surface pathologies. However, its efficacy varies in different diseases. The study also proved reliability of processing technique at Al-Shifa Human Amniotic Membrane Bank

Excimer laser photorefractive keratectomy for 3.75 to 6.00 diopters of myopia-six months follow up

To assess the efficacy and safety of excimer laser photorefractive keratectomy for myopia in Pakistani population. Prospective interventional case series. This study group included 44 eyes within range of-3.75 to 6.00 diopters sphere [DS]. Range of the astigmatism was 0.50 to 1.50 diopters cylinder [DC], with an average of 0.93. Nine eyes [20.45%] were lost to follow up after three months. Therefore 35 eyes [79.45%] were examined at final visit scheduled at six months postoperatively. All patients presenting at the cornea clinic with moderate myopia and eligible and willing for PRK underwent laser surgery by the same surgeon. The patients were examined at one, three and six months for outcome measures which included visual acuity, incidence of complications, and patient satisfaction. At one month, three months, and six months after PRK 45.45%, 63.63%, and 74.31% eyes respectively achieved 6/6 visual acuity without glasses. It was found that 23 eyes [52.27%], 24 eyes [54.54%] and 17 eyes [48.57%] had hypermetropia of+1.00 diopters spherical equivalent [DSE] after one month, three months and six months respectively. None of the eyes had astigmatism more than+1.0 diopters, whereas 02 eyes [05.71%] had -1.0 diopter astigmatism at the end of six months. After six months, eleven eyes [31.33%] still had postoperative corneal haze varying between grades 1 to 3. No vision threatening complication occurred. PRK appeared to be an effective and safe procedure with good predictability for the correction of moderate myopia

Patients' satisfaction after photorefractive keratectomy

To evaluate the subjective response of patients after PRK [Photorefractive keratectomy] and report overall satisfaction of the patients with the procedure. Qualitative Survey. Thirty four [34] patients with preoperative myopia ranging from 1.50 to 20 diopters, who underwent PRK in their both eyes, six months previously. All participants filled a specially designed questionnaire for this purpose and the response was analyzed. Twenty six [76.47 %] patients were happy with the overall result at completion of six months, whereas, eight [23.52%] were not comfortable with the overall out come. Keeping in view the range of myopia treated, the satisfaction with the procedure is encouraging and quite high