Intravitreal bevacizumab [IVB] for macular edema secondary to branch retinal vein occlusion [BRVO]

Objective: To evaluate the effectiveness of intravitreal Bevacizumab in decreasing central macular thickness in branch retinal vein occlusion [BRVO] related macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi, Pakistan, from March to August 2017

Methodology: Intravitreal Bevacizumab [1.25 mg/0.05 ml] was given in inferotemporal quadrant under aseptic conditions on monthly basis for consective three months. Post-injection, all the patients were followed up on monthly basis for consecutive three months. CMT [in microm] was measured by using OCT at baseline and after intravitreal Bevacizumab injections at one month, two months, and finally at three months

Results: Forty eyes of forty patients were included in the study. There were 25 [62.5%] male patients and 15 [37.5%] female patients. Baseline mean CMT +/-SD was 358 +/-36 microm before IVB injection. Mean CMT was 252 +/-12 microm at 3 months [after three IVB injections]. At three months, mean percentage decrease in CMT was 29.60%

Conclusion: Intravitreal Bevacizumab is effective and results in decrease in central macular thickness to normal or nearnormal levels in branch retinal vein occlusion [BRVO] related macular edema

Combined intravitreal triamcenolone acetonide and bevacizumab for refractory diabetic macular edema

Objective: To evaluate the effectiveness of combined Intravitreal triamcinolone acetonide [IVTA] and Intravitreal Bevacizumab [IVB] for treatment of refractory diabetic macular edema

Study Design: Quasi-experimental study

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi, from January to December 2017

Methodology: Pseudophakic diabetic patients with macular edema refractory to prior treatment were included. Patients having best corrected visual acuity [BCVA] better than 20/40 [6/12] or worse than 20/200[6/60] or the central subfield thickness [CSFT] less than 300 um on spectral domain optical coherence tomography [OCT] were excluded. Effectiveness of treatment was compared in terms of change in BCVA and CSFT on OCT. Intravitreal injection of 2 mg IVTA and 1.25 mg of IVB was given. IVB was repeated on monthly basis in next two months. Follow-up was done after one week of first injection and then monthly for next three months

Results: Fifty eyes of 42 patients were studied. Mean age of the patients was 62.4 years +/- 7.13. Male to female ratio was 2:1. Mean pre op LogMAR visual acuity was 0.708 +/- 0.12 and CSFT was 439.10 +/- 54.64 um. Mean postoperative LogMAR visual acuity was 0.586 +/- 0.13 um and mean post op CSFT was 382.80 +/- 56.12. There is statistically significant difference in improvement of LogMAR BCVA and decrease in CSFT after treatment. [p<0.001, paired t-test]

Conclusion: Eyes with refractory macular edema showed improvement of visual acuity and reduction of CSFT at three months when treated with combined IVTA and IVB

Intravitreal bevacizumab [ivb] for macular edema secondary to branch retinal vein occlusion [brvo]

Objective: To evaluate the effectiveness of intravitreal Bevacizumab in decreasing central macular thickness in branch retinal vein occlusion [BRVO] related macular edema

Study Design: Quasi experimental study

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi, Pakistan, from March to August 2017

Methodology: Intravitreal Bevacizumab [1.25 mg/0.05 ml] was given in inferotemporal quadrant under aseptic conditions on monthly basis for consective three months. Post-injection, all the patients were followed up on monthly basis for consecutive three months. CMT [in ìm] was measured by using OCT at baseline and after intravitreal Bevacizumab injections at one month, two months, and finally at three months

Results: Forty eyes of forty patients were included in the study. There were 25 [62.5%] male patients and 15 [37.5%] female patients. Baseline mean CMT +/-SD was 358 +/-36 Mum before IVB injection. Mean CMT was 252 +/-12 Mum at 3 months [after three IVB injections]. At three months, mean percentage decrease in CMT was 29.60%

Conclusion: Intravitreal Bevacizumab is effective and results in decrease in central macular thickness to normal or nearnormal levels in branch retinal vein occlusion [BRVO] related macular edema

Comparison of levobunolol and brimonidine in prophylaxis of intraocular pressure [IOP] rise following ndryag laser capsulotomy

To compare the efficacy of topical 0.5% Levobunolol and 0.2% Brimonidine in preventing intraocular pressure rise after Nd: YAG laser posterior capsulotomy. Randomized controlled trial [RCT]. Ophthalmology Department Combined Military Hospital Multan, from September 2010 to March 2011. A total of 82 patients fulfilling the inclusion criteria were selected from out-patient department and randomly divided into two equal groups. Topical 0.5% levobunolol was instilled in group A while 0.2% brimonidine was instilled in group B one hour before and immediately after doing Nd:YAG laser capsulotomy. The intraocular pressure [IOP] was measured using Goldmann applanation tonometer 1, 3 and 24 hours later. Data was analyzed using SPSS version 15.0. There was no statistically significant difference in mean IOP between 0.5% Levobunolol group [Group A] and 0.2% Brimonidine group [Group B] at 1 hour, 3 hours and 24 hours after Nd:YAG laser capsulotomy. The mean intraocular pressure [IOP] one hour after Nd:YAG laser and topical treatment in group A was 16.10 +/- 1.60 mmHg while in group B was 15.65 +/- 3.01 mmHg [P=0.401]. Mean IOP after three hours in group A was 15.80 +/- 1.35 mm Hg and in group B was 15.05 +/- 2.15 mmHg [p=0.062]. Mean IOP after 24 hours in group A was 15.13 +/- 2.05 mmHg while in group B was 14.32 +/- 1.62 mmHg [p=0.058]. Both 0.5% Levobunolol and 0.2% Brimonidine are equally effective in controlling the IOP spike after Nd: yAG laser capsulotomy. Either of these medicines can be used as a prophylaxis to prevent rise in IOP after NdrYAG laser capsulotomy

comparison of safety and efficacy between sodium cromoglycate 2% and fluorometholone 0.1% in management of vernal keratoconjunctivitis

To compare the safety and efficacy of sodium cromoglycate 2% eye drops with fluorometholone 0.1% eye drops in patients with bilateral vernal keratoconjunctivitis [limbal and conjunctival palpebral or mixed]. Quasi Experimental Study This study was carried out in Department of Ophthalmology, Combined Military Hospital, Multan from 20[th] May 2009 to 20[th] June 2009. This was hospital based study conducted on 60 diagnosed cases of vernal keratoconjunctivitis attending the OPD of Eye Department Combined Military Hospital, Multan in year 2009. Cases were divided in to two groups of 30 patients each. Group 2 was treated with sodium Cromoglycate while Group 1 was given Fluoro metholone 0.1%. Ocular complaints were noted and graded. Slit lamp examination was done at the start of treatment and at the end of the treatment. After first week of treatment in group 2 [sodium cromoglycate 2%] 22 patients had mucoidal discharge with photophobia, redness and itching while in group 1 [Fluorometholone 0.1%] none of the patient had mucoidal discharge. At the end of study 24 patients had itching, redness and photophobia in group 2 but in group 1 only 16 patients had these symptoms. It was also revealed that 6 patients in group 2 had watering and mucoid discharge but none of the patient in group 1 had watering and mucoid discharge at the end of study. [p < 0.001]. Patients treated with fluorometholone 0.1% got better results than patients treated with sodium cromoglycate 2% in the management of vernal Keratoconjunctivitis

Modified suture anchors for open Bankart repair

To evaluate the efficacy of cancellous screws as suture anchors, in open Bankart repair. Case series. Department of Orthopaedics, Combined Military Hospital, Rawalpindi, from March 2009 to October 2010. Fourteen patients with recurrent anterior dislocation were included in the study. Through anterior approach three 4 mm partially threaded cancellous screws were placed at the anterior Glenoid rim. Prolene-1 suture was tied around these screws which acted as anterior anchors and was used to re-attach the capsule and labrum back to bone. The mean duration of follow-up was 8 months. The patients were evaluated at 3 monthly intervals with a physical examination, radiographs, the modified shoulder rating scale of Rowe and Zarins and American Shoulder and Elbow Surgeons score. The mean operating time was 58 minutes. There was no immediate/early postoperative complication. At the last follow-up none of the patients had recurrence or radiological evidence of hardware failure/complication. Eleven patients [79%] had a score of 90 points on the scale of Rowe and Zarins and 12 patients [85.7%] had a score of at least 90 points on the scale of the American Shoulder and Elbow Surgeons scale. Ten patients [71%] had full range of motion in all planes. Use of cancellous screws as a suture anchor is a safe and cost-effective substitute of commercially available suture anchors in open Bankart repair

Comparison of post-operative astigmatism following phacoemulsification with sutured versus un-sutured wound closure

To compare corneal astigmatism induced by sutured and sutureless wound closure of the main incision, after phacoemulsification, in patients attending the Eye department, Military Hospital, Rawalpindi. Quasi experimental study. Armed Forces Institute of Ophthalmology, Rawalpindi, from 20th May, 2006 to 19th May, 2007. Sixty patients were included in this study divided in two equal groups. Phacoemulsification with foldable IOL was done in all patients by the same surgeon with same surgical technique. Main incision was closed with a single suture in group A and left sutureless with stromal hydration in group B. Keratometry was performed preoperatively, at day one and 4 weeks post operatively. Postoperative astigmatism in sutured and sutureless groups at the end of first week was [1.00 D +/- 0.38] and [0.88 D +/- 0.35] respectively. At one month postoperatively astigmatism was [0.76 +/- 0.43] and [0.66 +/- 0.32] respectively in the two groups. There was statistically no significant difference between the postoperative astigmatism at one month between the two groups [p> 0.05]. There is statistically no significant difference between post-operative astigmatism after phacoemulsification between a 3.2 mm self-sealing incision whether closed without suture or secured by a single suture

role of umbilical artery doppler in detection and management of fetal growth retardation

The objective of this study was to evaluate the efficacy of Doppler flow study in the umbilical artery in the diagnosis and management of FGR [foetal growth retardation] in small for gestational age [SGA] fetuses. This descriptive study was carried out in the Department of Obstetrics of Military Hospital Rawalpindi, in collaboration with the Radiology department. The data was collected from Jan 2000 to Dec 2001. Seventy subjects with SGA pregnancies on clinical examination were evaluated for foetal growth retardation. On the basis of umbilical artery doppler flow study the subjects were categorized into normal and abnormal umbilical artery doppler groups. Perinatal outcome of these groups were compared. Out of all SGA foetuses 28 [40%] were found to have abnormal umbilical artery doppler. They were more likely to be delivered by caesarean section [82.1%] and were born more than two weeks earlier. They had poorer Apgar score, higher rate of birth asphyxia [10.7%], hypoglycemia [46%], were twice as likely to be admitted to the newborn nursery [75%] and spent longer in the hospital [68% > 48 hrs] and were smaller in all body proportions than those with normal umbilical artery doppler. There were five perinatal deaths [17.8%], all in babies with abnormal umbilical artery doppler. It is thus concluded that the doppler study allows a noninvasive assessment of uteroplacental insufficiency, and is an accurate method for diagnosis and management of foetal growth retardation

Recurrent inguinal hernia repair by open preperitoneal approach

To evaluate the open preperitoneal hernia repair for safety, testicular complications and recurrence rate. Prospective cohort study. Combined Military Hospital, Muzaffarabad AJ and K from March 1997 to April 2001. Sixty-five consecutive male patients above the age of 25 years, with unilateral recurrent inguinal hernia underwent open preperitoneal hernia repair using polypropylene mesh. Scrotal or irreducible/obstructed hernias were also included in the study. Patients with primary inguinal hernia were excluded from the study. Patients with class 11/111 obesity [BMI > 35] and patients with ASA grade 3 and beyond were also excluded. Preperitoneal space was entered through a transverse lower abdominal incision placed 3cm above the inguinal ligament. Mesh was anchored using 2/0 polypropylene interrupted sutures. Forty-two patients were operated under spinal while 23 patients had general anaesthesia. Patients were examined on 7th and 12th postoperative day for early complications. Subsequently they were examined at third month, six-month and then yearly for three years. Main outcome measures considered were intra-operative complications, postoperative testicular complications and re-recurrence. Mean age in our study was 51 years. Fifty-one [78.4%] patients had direct while fourteen [21.6%] patients had indirect recurrence. There were two [3%] wound infections. One [1.5%] patient had hematoma formation. Three [4.6%] patients went into urinary retention postoperatively. There was no seroma formation, no case of bladder or intestinal injury. None of the patients developed any testicular complication or chronic residual neuralgia. There was only one [1.5%] case of re-recurrence during second year of repair. Open preperitoneal repair for recurrent inguinal hernia is safe procedure. It effectively eliminates testicular complications and has a very low recurrence rate

Prolene darn: safe and effective method for primary inguinal hernia repair

The purpose of the study was to evaluate darn repair in terms of morbidity and recurrence rate. Descriptive study. Combined Military Hospital, Muzaffarabad from February 1997 to April 2001. Four hundred and sixty-five consecutive patients above the age of 20 years, with primary inguinal hernia underwent darn repair using polypropylene suture. Two hundred and forty-two patients were operated under spinal anaesthesia, 100 under local anaesthesia while 123 patients had general anaesthesia. Patients were examined on 7th and 12th postoperative day for early complications. Subsequently, they were examined at third month, six-month and then yearly for three years. Mean age in our study was 52 years [range 20-75]. Indirect hernia was present in 305 [65.5%] patients while 160[34.5%] patients had direct hernia. There were 11 [2.4%] postoperative wound infections. Three [0.6%] patients had hematoma formation. Twenty-one [4.5%] patients went into postoperative urinary retention. Three [0.6%] patients developed recurrence; all these patients were among those who had postoperative wound infection. There was no seroma formation. None of the patients developed any testicular complication or postoperative hydrocele. There was no case of dysejaculation or chronic residual neuralgia. It can be concluded from our results that darn repair using non-absorbable suture is safe procedure. It is easily performed and has a very low recurrence rate which is comparable to any other procedure for primary inguinal hernia