Effects of anterior chamber depth and axial length on corneal endothelial cell density after phacoemulsification

Objective: To evaluate mean decrease in Corneal Endothelial cell Density [CED] after phacoemulsification in patients with different Anterior Chamber Depths [ACDs] and Axial Lengths [ALs]

Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. One hundred eyes of 90 patients, scheduled to undergo phacoemulsification surgery, were included. AL and ACD of each patient were calculated preoperatively using IOL Master. Cataracts were classified according toLens Opacities Classification System III [LOCS III] giving nuclear opalescence [NO] grades on slit lamp examination and only patients with grades NO2 and NO3 were included.Eyes were divided into two groups according to ACD and AL: Group-I: ACD 2.0mm - 3 mm and AL 22mm - 23.5mm; Group-II: ACD 3.1 mm -4.0 mm and AL 23.6mm - 25mm. CED measurements were done preoperatively and 2 month postoperatively using specular microscopy. The difference in CED change [Endothelial Cell Loss] between the two groups after surgery was analyzed using SPSS, v 22; IBM Corporation, Armonk, NY

Results: Differences in gender, laterality, age and preoperative CED between two groups were not significant. Difference in postoperative CED was also not significant, however difference in mean change and mean frequency change in CED between two groups was found to be statistically significant

Conclusion: ACD and AL affect the CED during phacoemulsification and Intraocular Lens[IOL] implantation and can be considered as risk factors of peroperative endothelial cell loss

Frontalis brow suspension for congenital ptosis using silicon dacrocystorhinostomy tube with three months follow up

Primary congenital ptosis usually presents at the time of birth and is due to poor development of levator muscles.The frontalis brow suspension technique is being used for patients with severe congenital ptosis and a levator function of 4 mm or less. Oculoplastic surgeons have been using different artificial materials not only to avoid an accessory wound and bleeding, but also to shorten the surgical time. Several artificial materials [e.g., nylon suture, silicone rods] have been used for congenital ptosis surgery. In this case report we have used silicon dacrocystorhinostomy [DCR] tube for frontalis brow suspension. This synthetic tube is readily available as well as cost effective with promising results post operatively for congenital ptosis correction with Frontalis Brow Suspension Technique

Comparison of intraocular pressure measurement by goldmann applanation tonometry and pneumotonometry in healthy subjects and patients with primary open angle glaucoma

Objective:To evaluate the role of non-contact Pneumo-tonometry [PT] by comparing intraocular pressure [IOP] measurements with Goldmann Applanation Tonometry [GAT] and PT in healthy subjects, and patients with Primary Open Angle Glaucoma [POAG]

Materials and Methods: This prospective comparative study was conducted at PNS Shifa Naval Hospital, Karachi from January 2016 to June 2016. A total of 360 eyes of 180 patients were included, and IOP measurement was done using GAT and PT methods. The difference in readings between the two methods was calculated and analysed using SPSS version 17

Results: A total of 360 eyes were analysed. 90 healthy subjects [180 eyes] and 90 patients with diagnosed POAG [180 eyes] were included. Mean IOP measured in all eyes using GAT and PT was 16.32 +/- 5.31 mm of Hg and 18.16 +/- 6.76 mm of Hg respectively. Mean difference in IOP was 2.31 +/- 1.89 mmHg between two methods, with 278 [77.22%] eyes showing higher IOP reading than those measured using GAT. The difference of readings between two methods was statistically significant. The patients with POAG were divided into three groups. Group 1 had IOP less than 15 mm Hg, Group 2 had IOP between 15-25 mm Hg and Group 3 had IOP greater than 25 mm Hg. Mean difference in IOP between two methods was 1.38 +/- 1.85, 2.29 +/- 2.72 and 3.05 +/- 2.68 mm Hg in Group 1,2 and 3 respectively. The mean difference of IOP measurement using GAT and PT in these groups was statistically significant [P<0.001]

Conclusion: IOP measurement using PT overestimates the recorded IOP as compared to GAT, and the difference is more pronounced in eyes with higher than normal IOP

frequency of preclinical nephropathy in patients of type II diabetes mellitus with diabetic retinopathy

Objective: To determine the frequency of preclinical nephropathy in patients with diabetic retinopathy and its correlation to the severity of retinopathy

Study Design: Prospective case study

Place and Duration of Study: Department of Ophthalmology, Military Hospital [MH], Rawalpindi for six months

Methods: Ninety [90] diabetic patients [thirty in each grade of retinopathy i.e. background, preproliferative and proliferative] with no known renal dysfunction were included in the study. They were investigated for albumin/creatinine ratio a sport urine sample. The outcome of renal function was described as either positive or negative. The cutoff value for albumin creatinine ratio was 200 mg/g. The various grades of retinopathy were compared to the values of urine albumin creatinine ratio, to find the correlation

Results: Five [17%] patients with background diabetic retinopathy had preclinical nephropathy. Seventeen [60%] patients with preproliferative diabetic retinopathy and 27 [90%] of patients with proliferative diabetic retinopathy had preclinical nephropathy. The frequency of nephropathy correlated to the severity of retinopathy [correlation co efficient, r value: 0.630] and p value of <0.001

Conclusion: it is important for ophthalmologists to carefully consider the renal status of any patient with retinopathy as this can influence the progression of retinopathy and its response to treatment