Bilateral atrophic maculopathy in two siblings of wolfram syndrom

Wolfram disease is a rare genetic disease which mainly presents as diabetes mellitus and optic atrophy. Presence of maculopathy in a case of wolfram disease is rarely reported in literature. We present here two cases/siblings with age of 12 and 14 years. They had diabetes mellitus, deafness and disc palor. Ocular examination also revealed atrophic maculopathy in both siblings, supported by depressed response on ERG. Assosiation of maculopathy with wolfram syndrome is rare and worth reporting

Agreement between keratometric readings by verion image guided system, Galilei G4 and pentacam

Objective: To study Agreement between Keratometric readings by VERION image guided System, Galilei G4 and Pentacam

Methods: The quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from August 2016 to December 2016. Twenty five patients fulfilling the inclusion criteria participated in the study. All Patients were subjected to Keratometric assessment using Galilei G4 Dual Scheimpflug analyzer [Ziemer, Switzerland], Wavelight Oculyzer II [Pentacam, Germany] and Verion image guided system [Alcon]. Steep and flat meridian and diopter of astigmatism by three systems were recorded and endorsed. All readings were taken by the same observer. Statistical Program for Social Sciences [SPSS] version 22.0 was used for statistical analysis. Results analyzed for significance by t-tests and Interclass correlation analysis. In t tests, P values of <0.05 was considered statistically significant while interclass coefficient of >0.7 was considered acceptable

Results: Fifty eyes of twenty-five patients [22 male, 28 female] with mean age of 29.50 +/- 3.46 years were studied. Flat K, steep K and dioptric power of astigmatism were measured with verion, pentacam and Galilei G4. Interclass correlation analysis showed agreement between individual variables measured by the three devices, while one sample t test showed no significant difference between dioptric power of astigmatism between Verion-Pentacam and Verion- Galilei group. [p 0.178 for former and 0.622 for later group]

Conclusion: Verion image guided system is comparable to other instruments used currently for keratometry. Verion can be interchangeably used with Pentacam and Galilee G4 in assessing corneal astigmatism

Effect of femtosecond laser-assisted cataract surgery [FLACS] on endothelial cell count

Objective: To compare the change in endothelial cell count after femtosecond laser-assisted cataract surgery [FLACS] versus conventional phacoemulsification

Study Design: Randomized controlled clinical trial

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from January 2016 to August 2017

Methodology: Patients with senile cataract and age ranging from 40 to 80 years were included in the study. Patients with any other cause of endothelial cell loss, history of trauma, documented diabetes millitis, hypertention and glaucoma were excluded. Preoperative detailed ocular examination, including both anterior and posterior examination, was carried out. Patients were distributed into two groups. Group GP were planned for conventional phacoemulsification, while group GF underwent FLACS. All the surgeries were performed under local anesthesia by same ophthalmic surgeon. Specular microscope [Topcon specular microscope sp-3000p] was utilized to measure the endothelial cell count [ECC] before and 4 weeks after the surgery

Results: Fifty eyes [25 in each group] of 48 patients underwent cataract surgery by phacoemulsification or FLACS. Twenty-five [52.08%] out of the total were females while 23 [47.91%] were males. Median age of the participants in phacoemulsification group was 55 years [IQR 20.50], while in FLACS group it was 54 years [IQR 8]. The median change in endothelial cell count was 228 [IQR 532] in Phaco group, while 23 [IQR 35] in FLACS group. [p<0.05 Mann Whitney U-test]

Conclusion: FLACS is a safe and effective modality for cataract treatment and it induces significantly less endothelial cell loss than conventional phacoemulsification

Comparison of analgesic effect of preoperative topical diclofenac versus ketorolac on postoperative pain after corneal collagen cross linkage

Objective: To compare post-operative pain relieving effect of topical diclofenac 0.1 0,5% in Corneal Collagen Cross Linking [CXL] for patients diagnosed with keratoconus

Methods: This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to [Group-A] and ketorolac 0.5% to [Group-B] 30 minutes in advance of the corneal collagen cross linking [CXL] procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale [VAS] numbers from zero to five where 0 designated no pain 6 5 symbolized worst pain

Results: The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 +/- 2.93 years [range 20 to 29 years]. In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A [diclofenac 0.1%] was 2.57 +/- 0.67 while in Group-B [ketorolac 0.4% treated arm] was 3.20 +/-0.61

Conclusion: Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation

Optic nerve sheath diameter on sonography in idiopathic intracranial hypertension versus normal

Objective: To compare the mean optic nerve sheath diameter [ONSD] in patients with idiopathic intracranial hypertension [IIH] versus normal healthy individuals using B-scan ultrasonography as diagnostic tool

Study Design: Cross-sectional analytical study

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, Pakistan, from June to December 2015

Methodology: Participants aged 30 - 50 years were divided into two groups. Group A [GP] comprised of patients who were diagnosed cases of idiopathic intracranial hypertension while normal healthy adults who volunteered to participate in the study were included in Group B [GC]. Ocular B mode ultrasound scan was performed on all the participants and each eye was considered separately. The optic nerve head was visualized as a linear hypoechoic structure, and ONSD was measured 3 mm behind the retina. A total of three readings were taken by the same radiologist and the average of three was recorded. Mean values of both groups were compared by t-test with significance at p < 0.05

Results: Fifty-two eyes of 26 patients [26 eyes in each group] were included in the study. Twenty-four out of 26 in Group A [GP] and 23 out of 26 in Group B [GC] were females. Mean age of the patients was 33.92 +/-4.89 years in group A [GP] while it was 34.69 +/-4.79 years in group B [GC]. Mean ONSD was 6.61 +/-0.39 mm in group A [GP] and 4.33 +/-0.38 mm in group B[GC] which was significantly different [p < 0.001]

Conclusion: Ultrasound can provide a reliable, non-invasive tool to measure optic nerve sheath diameter in monitoring the patients with benign intracranial hypertension [BIH]