Screening thresholds for the corneal tomography in a myopic Pakistani population

Objective: To evaluate key corneal tomography parameters for screening refractive surgery patients in Pakistani population

Study Design: Cross-sectional, observation study

Place and Duration of Study: Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to December 2016

Methodology: Myopic patients were evaluated by two separate observers on Allegro OculyzerII [Wavelight] for normal ocular examination. A total of 20 tomographic parameters, used for pre-refractive surgical evaluation, were included. Normality of data was evaluated using Kolmogorov-Smirnov test. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles

Results: The sample of 451 patients [895 eyes], comprised of 61% [n=277] females and 39% [n=174] males [39%]. The mean age was 26 +6.4 years [range of 18-62 years, M=F]. Normal mean anterior segment values included; flat simulated keratometry [K1] 42.9 +/-1.44 diopters [D], steep K2 43.9 +/-1.52 D, K mean 43.4 +/-1.43 D, K maximum 44.6 +/-1.56 D, astigmatism -0.96 +/-0.97 D, anterior chamber depth [ACD] 3.19 +/-0.28 mm, front elevation at the thinnest point 4.11 +/-2.44 um, and that at the back was 7.56 +/-4.52 um progression index [PI] maximum 1.14 +/-0.17, Ambrosio relational thickness maximum [ART max] 487.5 +/-89.0 and pachymetry at thinnest point 542.2 +/- 31.1 um

Conclusion: The study demonstrates key corneal tomography parameters, which can be useful for screening refractive surgery patients in Pakistani population

Effect on Corneal Dioptric power in patients undergoing 23G Suture less plana vitrectomy

Objective: To determine the effect of 23-gauge pars plana vitrectomy on corneal dioptric power through a comparison of difference in pre- and post- surgery keratometry

Study Design: Prospective non-comparative interventional type

Place and Duration of Study: The study was conducted at the Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi from Dec 2016 to Jul 2017

Material and Methods: We studied 33 patients [33 eyes] who underwent 23-gauge vitrectomy with mean age of 46.4 +/- 12.8 years. Among them 13 were females and 20 were males. These patients were divided in four groups on the basis of pre-surgical diagnosis. 18 [55%] patients had rhegmatogenous retinal detachment, 9 [27%] had macular holes 3 [9%] with Vitreous hemorrhage and last 3 [9%] had dislocation of intraocular lens. Total vitrectomy was performed in all patients by standard 23G pars plana vitrectomy [PPV] procedure as used with three scleratomies and tunnel shaped incision. Keratometry readings before the surgery and at the end of 1st, 6th and 12th post procedural weeks were recorded in horizontal [K1] and vertical meridian [K2] by utilizing topcon auto kerato-refractometer

Results: The pre-operative dioptric power of cornea in horizontal and vertical meridian [K1 and K2 respectively] was statistically compared with post- operative dioptric power of cornea at the end of 1st, 6th and 12th postoperative weeks. At the end of first post- operative week there was significant difference between pre and post-operative corneal dioptric power with horizontal p-value<0.05 and vertical <0.04; leading to astigmatism. However, at the end of 6th and 12th post procedural weeks there was no significant difference between pre and post-operative corneal dioptric power which is evident with insignificant p-values. The p-value at the end of 6[th] post-operative week was 0.521 and 0.57 for K1 and K2 respectively. At the end of 12th post-procedural week these values are 0.854 and 0.941 for K1 and K2 respectively. Clinically these patients did not have any sign or symptoms of astigmatism

Conclusion: 23G was found safe procedure in vitreoretinal surgery with no insignificant change in corneal dioptric power except in cases in which silicone oil was used. However, due to small study group and short follow up further studies with longer follow-ups are required to establish the long-term changes in corneal dioptric power after 23G suture less vitrectomy

Effect of using version image guided system on surgically induced Astigmatism [Sia] in patients undergoing cataract surgery

Objective: To analyze the effect of use of VERION image guided system on surgically induced astigmatism [SIA] in patients undergoing cataract surgery

Study Design: Randomized controlled trial

Place and Duration of Study: The study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Aug 2016 to Dec 2016

Material and Methods: Sixty eyes undergoing cataract surgery with already existing corneal astigmatism of at least 0.5 diopter [D] were included in the study. Cases with already existing ocular pathology or any per operative complication were excluded. Non-probability [purposive] sampling technique was used. Patients were randomly grouped into two groups 1 and 2. Group-1 underwent normal conventional phacoemulsification with no specific predetermined incision site. Group-2 underwent keratometric assessment using VERION image guided system and data was transferred to operating microscope. Steep and flat meridian were displayed on screen and incision were made on steep axis. Pre and 2 week post op keratometric readings were noted on a workup performa for both the groups and compared. All the surgeries were done by the same surgeon. Statistical program for social sciences [SPSS] version 23.0 was used for statistical analysis

Results: Sixty eyes [29 male, 31 female] with mean age of 57.65 +/- 7.41 years were studied. Group-1 included 30 eyes with mean age of 56.73 +/- 9.16 years. Group-2 also included 30 eyes with mean age of 58.56 +/- 5.10 years. Mean pre op astigmatism was 0.93 +/- 0.45D and 0.88 +/- 0.47 D in group 1 and 2 respectively. Mean residual astigmatism -0.016 +/- 0.43 and 0.37 +/- 0.24 D in groups 1 and 2 respectively showing a 42 percent reduction in astigmatism in group 2 as compared with 1.7 percent increase in group 1

Conclusion: There is no significant difference between the SIA between two groups however there was a significantly less residual astigmatism in VERION group [group 2]. Verion assisted incision along the steep axis is helpful in achieving a better refractive outcome in patients undergoing cataract surgery

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

Correlation of intraocular pressure with ocular axial length after intravitreal injection of bevacizumab in diabetic macular edema

Objective: To determine the effect of Intravitreal injection of Bevacizumab on IOP in eyes of different axial lengths. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at AFIO Rawalpindi, from Sep 2013 to Jan 2014

Material and Methods: In this study 55 patients scheduled for intravitreal injection of bevacizumab for the treatment of diabetic macular edema were enrolled. An informed written consent was taken from all the patients. All patients underwent clinical ophthalmic examination including uncorrected distance visual acuity, corrected distance visual acuity, slit lamp bio-microscopy and fundus examination with 90 diopter lens. Axial length was measured before IVB using IOL master. Intra Ocular Pressure [IOP] was measured before and after 1 minute of administration of Intravitreal Bevacizumab [IVB] using Tono-Pen

Result: The mean age of patients was 54.51 +/- 7.53 years with minimum age of 43 years and maximum age of 70 years. There were 26 [47.3%] male and 29 [52.7%] female patients. The mean axial length of the examined eyes was 21.12 +/- 1.80 with range of 6 mm. Mean IOP before IVB was 13.09 +/- 1.62 mmHg. After 1 minute of IVB, mean IOP was 32.8 +/- 6.19 mmHg. A good correlation was observed between the axial length and intraocular pressure rise after 1 min i.e. Pearson correlation [r.] = -0.914 [p-value <0.001] with R2 = 0.835

Conclusion: There is significant rise in IOP after intravitreal injection of bevacizumab in patients with short axial length as compared to long axial length

Efficacy of intravitreal bevacizumab combined with pan retinal photocoagulation versus panretinal photocoagulation alone in treatment of proliferative diabetic retinopathy

Objective: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy

Methods: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], slit lamp examination of anterior and posterior segments. Optical coherence tomography [OCT] and fundus fluorescein angiography [FFA] were carried out and patients were divided in two groups [GP and GI]. Three monthly sessions of Pan retinal photocoagulation [PRP] using Pattern Scan Laser [PASCAL] alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab [IVB] was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups

Results: Seventy six eyes of 50 patients [38 in each group] were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47 +/- 6.08 years while that in group GI was 55.69 +/- 6.58. The magnitude of induced change in BCVA was 0.09 +/- 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 +/- 92.30 um and 117.50 +/- 93.82 um in group GP and GI

Conclusion: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME

Association of inflammatory markers with physical activity, family history and other diabetic complications in patients of diabetic retinopathy

Objective: To study the association of inflammatory markers with physical activity, family history and other complications among patients of diabetic retinopathy

Study Design: Cross sectional comparative study

Place and Duration of Study: Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi in collaboration with Armed Forces Institute of Ophthalmology [AFIO] and Military Hospital Laboratories, Rawalpindi from Jan 2016 to Jun 2016

Material and Methods: A total of 90 diagnosed patients of diabetic retinopathy of ages 40-70 years were enrolled from Armed Forces Institute of Ophthalmology, Rawalpindi. Their inflammatory markers [ESR and CRP] were assessed and their levels were compared with their physical activity, family history and other complications of diabetes already developed in them. These were then compared with those of 90 normal healthy controls enrolled from general population using independent student's t test and one way Anova test for scale variables and Chi square test for nominal variables

Results: Both patients and controls were age and gender matched with mean age of 60 +/- 8.9 years in patients and 59 +/- 13.02 years in controls. Among 90 patients enrolled 51[56.7%] were males and 39 [43.3] were females. And among 90 controls 49 [54.4%] were males and 41[45.6%] were females. An inverse association was observed between inflammatory markers and physical activity with ap-value of 0.001. On the contrary a strong positive association was observed between inflammatory markers and family history and complications of diabetes with a p-value 0.001

Conclusion: There is an inverse association of inflammatory markers with physical activity and a direct association of these with family history and complications of diabetes among patients of diabetic retinopathy

Effectiveness of preoperative subconjunctival injection of mitomycin-C in primary pterygium surgery

Objective: To compare the effectiveness of preoperative subconjunctival injection of Mitomycin-C at 24-hour and at one month before primary pterygium excision

Study Design: Randomised controlled trial

Place and Duration of Study: Eye Department, Combined Military Hospital, Sargodha, from January to December 2014

Methodology: Eyes of 60 patients were randomly allocated into two equal groups [A and B] of 30 each. In group A Mitomycin-C was injected into the pterygium one month before, and in group B Mitomycin-C was injected 24 hours before excision. All pterygia received 0.1 ml of Mitomycin-C in a concentration of 0.15 mg/ml. Primary pterygia greater or equal to 2.5 mm were selected and excised as a bare sclera technique. Postoperatively, all patients were followed-up for 06 months. The recurrence and corneoscleral complications were recorded. Pearson chi-square test was used to compare the recurrence between group A and group B

Results: The recurrence of pterygium in group A was 3.3%; and in group B, it was 6.7%. Comparison of the recurrences between both the groups was statistically insignificant, [p=0.554].Postoperatively, no serious corneoscleral complications occurred in either group

Conclusion: The preoperative subconjunctival injection of Mitomycin-C in a dose of 0.15 mg/ml given 24 hours prior to excision is as effective as 01 month preoperative injection for primary pterygium surgery with bare sclera technique

Comparison of the long-term and short-term fluctuations of frequency-doubling technology perimetry between peripheral and paracentral zones of visual field

Objective: To compare the long- and short-term fluctuations of frequency doubling technology perimetry between peripheral and paracentral zone and determine the relationship between threshold sensitivity and long- and short-term fluctuation within peripheral and paracentral zone of visual field

Study Design: Descriptive study

Place and Duration of Study: Eye Department, United Nations, Pakistan Field Hospital Level-3 Darfur, Sudan, from February to July 2015

Methodology: Normal eyes of 30 volunteers were recruited. Frequency doubling technology perimetry, program N-30, full threshold was employed. Each subject was tested at weekly intervals, once in the 1st, 3rd and 4th sessions and three times in the 2nd session. Visual field was divided into paracentral, superior, and inferior zones. Short-term and long-term fluctuation as well as threshold sensitivity were calculated for each patient as the mean fluctuation and mean sensitivity value. Mann-Whitney U-test was used to compare each zone in terms of their short- and long-term fluctuations and Spearman's rho correlation test for determining the relationship of threshold sensitivity with short- and long-term fluctuations

Results: Long-term fluctuation values differences were insignificant between superior and paracentral zones. Short-term fluctuation values were statistically insignificant between all three zones. Short-term fluctuation and threshold sensitivity in each zone did not correlate. Long-term fluctuation and threshold sensitivity had a very weak negative, statistically insignificant correlation in superior and paracentral zones

Conclusion: Frequency doubling perimetry exhibits uniform short- and long-term fluctuations in peripheral and paracentral zones of visual field in normal subjects. Threshold sensitivity and long- and short-term fluctuations are independent of each other in peripheral and paracentral zones of visual field

Determining the efficacy of corneal crosslinking in progressive Keratoconus

Objective: To determine the Efficacy of Corneal Crosslinkage [CXL], using Corneal Topography, in eyes with progressive Keratoconus

Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from October 2013 to April 2014. A total of 60 eyes of 30 patients were included who presented with bilateral progressive Keratoconus. Each eye of the patient was randomized either to a treatment group [Group-A] or control untreated group [GroupB] of 30 eyes each. A written informed consent was obtained from each patient, following which corneal crosslinkage [CXL] with topical riboflavin eye drops was performed. Follow up visit was done at three months post operatively, Corneal topography was repeated and recorded

Results: The mean age of the patients was 23.13+/-7.62 years [range 13 to 39 years]. There were 26 males and 34 females patients. The mean simK value at the start of study was 50.94+/-4.84 diopters in Group-A and 49.73+/-5.24 diopters in Group-B. At three months follow-up, the mean simK value was significantly lower in Group-A [48.28+/-4.47] as compared to Group-B [51.11+/-4.85]. Keratoconus improved/ remained stable in 34 [56.7%] eyes while progressive disease was noted in 26 [43.3%] eyes. When compared between the groups, the frequency of efficacy was significantly higher in Group-A [86.7% vs. 26.7%; p=.000] as compared to Group-B

Conclusion: Corneal Crosslinking was found effective in causing regression or halting the progression of disease in patients with progressive Keratoconus at three months follow-up, however, the efficacy of corneal crosslinking was unaffected by patient's age and gender

Comparison of clinical characteristics of rhegmatogenous retinal detachment in pseudophakic and phakic eyes

Objective: To compare the clinical profile, systemic risk factors, and characteristics of rhegmatogenous retinal detachment [RRD] in pseudophakic and phakic eyes

Study Design: Cross-sectional comparative study

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from August 2013 to August 2015

Methodology: A total of 164 eyes [96 pseudophakic patients and 68 phakic patients] with RRD were analyzed. Demographic data and associated known risk factors of study population were acquired. Retinal examination was done by single experienced retinal surgeon using indirect ophthalmoscopy for type of retinal break, location and number of retinal breaks, status of macula, morphological extent of RRD and retinal degenerations. All the findings were endorsed on a pre-devised proforma

Results: Mean age of patients in pseudophakic and phakic groups was 61.18 +/- 10.39 and 59.27 +/- 9.57 years, respectively. Frequency of male patients in pseudophakic and phakic groups was 74% and 57.4%, respectively. Mean axial length in pseudophakic and phakic groups was 23.13 +/- 2.18 mm and 21.9 +/- 2.01 mm, respectively. Difference in axial length and gender distribution between two groups was statistically significant [p < 0.05]. Difference in frequency of patients with history of hypertension and myopia between two groups was statistically significant [p < 0.05]. Characteristics of RRD [type, location and number of retinal breaks, macula status, and extent of RRD] between groups were not statistically significant

Conclusion: RRD is more common in pseudophakic patients with male gender, increased axial length, myopia, and hypertension

Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results

Objective: The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking [TE-CXL] with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking[CXL] in adult Pakistani population with progressive keratoconus

Methods: This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel [[riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose] and vibeX Xtra [riboflavin 0.25%] [Avedro, USA]] were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities [UDVA, CDVA], spherical equivalent [SE], astigmatism, pachymetry at thinnest point [Pachy thin], apex keratometry [Kmax], simulated and steep keratometry [Sim K, steep K] were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm[2] for 10 min [total dose 30 mW/cm[2]]

Results: The mean age of the patient was 24.54 +/- 5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points [p=0.000, 0.004, 0.000, 0.004 respectively]. Kmax and pachy thin were significantly reduced over baseline at 1 year [p=0.000, 0.004 respectively]. Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported

Conclusion: Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus

Change in central corneal thickness, corneal endothelial cell density, anterior chamber depth and axial length after repair of rhegmatogenous retinal detachment

Objective: To compare the effects of Pars Plana Vitrectomy [PPV] and Scleral Buckling [SB] with reference to Central Corneal Thickness [CCT], Corneal Endothelial-Cell Density [CED], Anterior Chamber Depth [ACD] and Axial Length [AL] in repair of Rhegmatogenous Retinal Detachment[RRD]

Methods: This comparative cross sectional analytical study was conducted at Armed Forces Institute of Ophthalmology [AFIO], Rawalpindi from July 2013 to July 2015. A total of 69 eyes of 69 patients which underwent repair of RRD by either PPV or SB were analyzed to compare mean change in CCT, CED, ACD and AL between two groups

Results: Mean age of patients was 56.23+/-5.22 years. Mean pre-operative CCT, CED, ACD and AL in PPV group was 533.06+/-13.28micro m, 2231.67+/-164.57Cells/mm[2], 3.37+/-0.18mm and 23.66+/-0.76mm respectively. Mean post-operative CCT, CED, ACD and AL in PPV group was 534.81+/-11.83micro m, 2037.19+/-167.83 Cells/ mm[2], 3.24+/-0.13mm and 23.88+/-0.80mm respectively. Change in CED, ACD and AL from pre-operative value after PPV was statistically significant [p<0.001]. Mean pre-operative CCT, CED, ACD and AL in SB group was 530.73+/-12.59 micro m, 2161.79+/-161.96 Cells/mm[2], 3.343+/-0.14mm and 23.67+/-0.82mm respectively. Mean post-operative CCT, CED, ACD and AL in SB group was 532.76+/-7.74 micro m, 2158.27+/-156.58 Cells/mm[2], 3.24+/-0.10mmand 25.71+/-0.86mm respectively. Change in ACD and AL from pre-operative value after SB was statistically significant [p<0.001]. Mean change of CED, ACD and AL between two groups was also statistically significant [p<0.001]

Conclusion: Rhegmatogenous retinal detachment repair causes ocular changes, with significantly more decrease in corneal endothelial cell density after pars plana vitrectomy, and more increase in anterior chamber depth and axial length after scleral buckling

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 effect of silicon oil on central corneal thickness and corneal endothelial-cell density

Objective: To compare the mean changes in central corneal thickness [CCT] and corneal endothelial-cell density [CED] after removal of silicon oil [ROSO] using anterior [limbal] versus posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Study Design: Randomized controlled trial

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Sixty eyes of 60 aphakic patients who underwent removal of silicon oil from December 2014 to August 2015 in AFIO after successful retinal re-attachment surgery were analysed. Thirty eyes underwent removal of silicon oil through anterior [limbal] approach [groupl] and 30 eyes through posterior [pars plana] approach [group-2]. Pre-operative central corneal thickness and corneal endothelial-cell density was measured and compared with central corneal thickness and corneal endothelial-cell density measurements 3 months after removal of silicon oil

Results: Mean age of study population was 49.93 +/- 5.18 years. Both groups were age and sex matched [p=0.694 and p=0.80 respectively]. In group 1, mean change in CCT was 1.80 +/- 6.58 micro meters [jum] and mean change in CED was 196.30 +/- 33.78 cells per millimetres square [mm[2]], while in group 2, mean change in CCT was 1.63 +/- 8.96 microm and mean change in CED was 60.20 +/- 39.75 cells/mm2 after 3 months of ROSO. Mean change in CCT between two groups was not statistically significant [p=0.935], however, mean change in CED between two groups was statistically significant [p<0.001]

Conclusion: Removal of silicon oil through anterior [limbal] approach causes significant reduction in CED, as compared to posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Effect of pan retinal photocoagulation on central macular thickness and visual acuity in proliferative diabetic retinopathy

Objective: To evaluate the effect of pan-retinal photocoagulation with Pattern Scan Laser [pascal] on best corrected visual acuity and central macular thickness in patients having proliferative diabetic retinopathy [PDR]

Methods: This study was conducted at AFIO, Rawalpindi, Pakistan from Oct 2014 to Jul 2015. Sixty seven eyes of 46 patients having proliferative diabetic retinopathy were included in the study. All patients underwent ophthalmic clinical examination including uncorrected distant visual acuity [UCVA], best corrected visual acuity [BCVA], fundus examination with slit lamp and optical coherence tomography to document the pretreatment central macular thickness [CMT]. Two sessions of PRP using Pattern Scan Laser were performed 04 weeks apart and OCT was repeated 04 weeks after the 2[nd] session. Central macular thickness and BCVA were documented

Results: Sixty seven eyes of 46 patients [29 females and 17 males] with mean age of 57.45 +/- 5.78 years underwent treatment with two sessions of laser PRP. Mean pretreatment BCVA was 0.67 +/- 0.43 and mean post-treatment BCVA was 0.57 +/- 0.3. Mean central macular thickness [CMT] as measured by OCT was 391.93 +/- 170.43 before treatment and 316.91 +/- 90.42 um after treatment. The magnitude of induced change in CMT after treatment was 75.01 +/- 90.75 and BCVA was 0.09 +/- 0.14

Conclusion: Laser PRP with Pattern scan laser alone in patients with combined presentation of PDR and DME is safe and effective

Spectrum of combat ocular injuries in Pakistani troops

Objective: To analyze the demography, characteristics, visual and anatomical outcomes of combat ocular injuries sustained by Pakistani troops

Study Design: Case series

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from January 2010 to June 2014

Material and Methods: Data of 156 eyes of 120 war wounded patients treated at AFIO from 2010 - 2014 was retrieved and analysed. Record of each patient was evaluated and demographic data, mode and type of injury, initial and final visual acuity [VA], associated globe injuries, concomitant non-ocular injuries, type of surgical procedures and complications were endorsed on a pre-devised proforma. Injuries were classified according to the Birmingham Eye Trauma Terminology [BETT]. Statistical analysis of the data was done using SPSS version 13.0

Results: Mean age of study population was 28.33 +/- 7.70 years. Improvised explosive device [IED] blast was the most common mode injury occurring in 51 [42.5%] of casualties. Forty eight [30.76%] eyes sustained closed globe injuries while 108 [69.23%] eyes had open globe injuries. Thirty one [19.87%] eyes were initially managed conservatively, while primary corneo scleral repairs were done in 77 [49.35%] eyes. Overall, final visual outcome was significantly better in closed globe injuries as compared to open globe injuries with 26 [54.16%] eyes with closed globe injury achieving final VA of >/= 6/12 as compared to 10 [9.25%] eyes with open globe injuries

Conclusion: Closed globe combat ocular injuries have better visual outcome as compared to open globe injuries

Nd YAG laser embolysis in a young woman with hemiretinal artery occlusion

Retinal artery occlusion is an uncommon condition but can lead to grave consequences if not managed in time

Elderly population with other comorbid conditions like hypertension, ischemic heart disease, hyperlipidemia and stroke are commonly affected. However, this condition may affect younger population with entirely different systemic associations

Thromboembolism, which usually takes place secondary to cardiac emboli or hypercoagulable states cause retinal artery occlusion in young population

A 24-year lady presented with a short history of unilateral altitudinal visual loss

On examination, she was found to have hemiretinal artery occlusion. Ocular massage, anterior chamber paracentesis was performed initially, followed by Nd YAG laser embolysis, which led to successful restoration of retinal circulation and significant improvement in visual field loss

Detailed evaluation and systemic investigations were carried out to identify the underlying cause, but no systemic association could be found

Corneal Collagen Cross Linking [CXL] in treatment of Pseudophakic Bullous Keratopathy

Objective: To determine mean change in visual acuity, central corneal thickness and symptoms in patients with pseudophakic bullous keratopathy after treatment with corneal collagen crosslinking

Methods: This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from April 2015 to Nov 2015. A total of 24 eyes of 24 patients were included in the study. Visual symptoms were graded in five grades [Grade 1-5], Grade-1 being very mild with decreased vision only while patients with all five symptoms [decreased vision, foreign body sensations, pain, watering and photophobia] were graded as Grade-5. Corneal collagen cross linking using topical isotonic riboflavin followed by UVA radiations [3mW/cm[2] for 10 minutes] was performed in all the patients

Visual acuity [VA], visual symptoms and central corneal thickness [CCT] were recorded before and 04 weeks after the treatment

Results: A total of 24 eyes of 24 patients [18 male and 6 females] underwent surgery

Age of the patients ranged from 55 to 75 years with mean age 65.83 + 3.89 years. Mean visual acuity was 2.09 + 0.23 before treatment while after treatment it was 2.13 + 0.22. Mean CCT as measured by optical pachymetry [Galilae G6] was 753.96 + 55.16 and 641+ 29.25 before and after surgery respectively. Improvement of clinical symptoms was seen in all the patients

Conclusion: Corneal collagen cross linking is a temporary but effective symptomatic treatment of pseudophakic bullous keratopathy

Intravitreal triamcinolone alone versus combined intravitreal triamcinolone and bevacizumab on central macular thickness in diabetic macular edema

Objective: To compare the effect of intravitreal triamcinolone [IVT] alone with combined intravitreal triamcinolone [IVT] and intravitreal bevacizumab [IVB] on central macular thickness [CMT] in patients of diabetic macular edema [DME]

Study Design: Randomized control trial

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Jun 2013 to Dec 2013

Material and Methods: Eighty patients were included in the study through non probability consecutive sampling and were randomized to IVT alone or IVT + IVB group using random number table. Pre and post injection [12 weeks] CMT were recorded and intra and inter group comparison was performed

Results: Both groups showed statistically significant reduction in mean CMT at 12 weeks [p<0.05]. In Group A, mean CMT reduction at 12 weeks was 64.33 microns [SD=15.17] while in Group B it was 75.18 [SD=20.82]. On comparison, IVT + IVB group was more effective in reducing CMT with statistically significant difference [p=0.009]

Conclusion: Intravitreal triamcinolone used in combination with IVB is more effective in reducing central macular thickness in diabetic macular edema [DME] than intravitreal triamcinolone alone