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

Frequency of ocular manifestations of chronic graft versus host disease

With the advancement of techniques for haematopoietic cell transplantation, the number of transplant survivors is increasing rapidly and so are the chances of chronic graft versus host disease [cGVHD]. The ocular manifestations of this disease have not been explored in our local population. This study was conducted to determine the frequency of ocular complications in cases of cGVHD following successful bone marrow transplantation. Twelve diagnosed cases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestations were noted especially the ocular surface disorders, using double staining method with fluorescein and rose-bengal. Nine patients [75%] were having dry eyes, 7 [58.3%] with mebomian glands dysfunction, 4 [33%] with acute conjunctivitis, 2 [16.7%] with bilateral lacrimal canalicular occlusion, and 1 [8.3%] each of bilateral posterior subcapsular cataract, unilateral sterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema. The higher frequency of dry eyes along with other ocular manifestations in patients of cGVHD suggests the need of close ophthalmic monitoring in all such cases

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

Spontaneous resolution of direct carotid cavernous fistula

Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind

Bilateral lacrimal bicanalicular obstruction in chronic graft versus host disease

Bone Marrow transplantation has been increasingly used for the treatments of various blood cancers for last two decades. As a complication, a variable number of patients develop Chronic Graft Verses Host Disease [cGVHD] six to eight months later. Ocular involvement occurs in 60 to 80% of patients with cGVHD. Though dry eye sensation is the most common ocular symptom of cGVHD we report here a case of excessive watering due to bilateral lacrimal bicanalicular obstruction secondary to ocular involvement in cGVHD along with onset of dry eye features

Use of botulinum A toxin [BOTOX] in different types of facial dystonia

This study was carried out in the Eye Departments of Combined Military Hospital, Kharian and Military Hospital, Rawalpindi, from January 2007 to August 2008. To determine the effects of botulinum A toxin [Botox] injection in different types of facial dystonia. A total of 23 botulinum A toxin [Botox] injections were given in 13 patients including 7 males and 6 females. Patients were followed up at 1 week, 6 weeks and 6 months after the injection. The indications were essential blepharospasm in 4 [30.77%] cases and hemifacial spasms in 9 [69.23%] cases. Age ranged from 28 to 60 years [mean 41 +/- 12 years]. Four patients were given injections three times and 2 patients were injected twice. Onset of action of botulinum A toxin [Botox] was variable, starting on the same day in 3 patients while in the rest of patients it started on the next day. Mean duration of action was 12.77 weeks +/- 4.68 [range 6-23 weeks]. Dystonia improved in all the cases. Temporary slight facial paresis and lagophthalmos occurred in 3 [23%] cases while ptosis occurred in 2 [15.4%] cases. Two patients [15%] had mild ocular irritation and conjunctival congestion after injection, which settled with topical mild steroid [fluorometholone]. Botulinum A toxin [Botox] is useful treatment for different types of facial dystonia

Efficacy of pre-operative injection Mitomycin-C in prevention of pterygium recurrence

To determine the recurrence rate of pterygium with four weeks preoperative injection mitomycin-C using bare sclera technique. An interventional case series. This ongoing study was started in November 2005 at eye department of combined military hospital Kharian, Pakistan. Ninety one eyes of 87 patients have been so far enrolled in the study. Cases between 20 to 50 years of age, of either sex, with primary and recurrent pterygia were included. The subjects were first given 0.1 ml injection mitomycin-C 0.15 mg/ml into the body of pterygium. Four weeks later, pterygium surgery was performed using bare-sclera technique. The subjects are being followed up for at least one year to detect any recurrence. Out of 91 cases, 16 [17.58%] cases have been followed up for 12 months, 19 [20.87%] for 9 months, 21 [23.07%] for 6 months, 17 [18.68%] for 3 months and 18 [19.78%] for less than 3 months. Recurrence has not been encountered in any of these cases so far. Initial results show that pterygium surgery with pre-operative injection mitomycin-C appears to be an effective form of treatment for prevention of pterygium recurrence. Further follow up and multi-centric studies are required for final conclusion