Cephalometric analysis of patients with beta thalassemia receiving fetal hemoglobin induction therapy.

Objective: We aimed to determine the effects of fetal hemoglobin induction therapy in restricting or even reversing the cephalometric changes associated with beta thalassemia. Materials and methods: In this comparative observational study, 90 participants were equally divided into three groups: a control group; patients with thalassemia major receiving blood transfusion (BT group); and patients receiving induction therapy (i.e., hydroxyl urea (5-10 mg/kg/day) or as much as 20 mg/kg/day) and thalidomide (2-10 mg/kg/day) along with blood transfusion (IT group). All patients underwent history taking and examination, photographic assessment, and radiographic evaluation with a lateral cephalogram. One-way ANOVA followed by post-hoc Tukey test was used to determine differences among groups. Results: The IT group differed significantly from the BT group in all photographic and skull table parameters, and most cephalometric parameters, such as facial angle (p ≤ 0.001), middle and lower facial heights (p ≤ 0.001), and inter-incisal angle (p = 0.036); the mean values in the IT group were similar to those in the control group. In-addition, dental and soft tissue measurements significantly differed among groups. For most parameters, the mean difference indicated higher values in the BT group. Conclusion: Induction therapy appeared to improve the facial angles, heights, and inter-incisal angles, whereas a class II skeletal pattern was observed in the transfusion only group. These findings suggest that fetal hemoglobin induction therapy might have restricted some of the cephalometric changes in patients with beta thalassemia.

Retinal Ganglion Cell Complex Changes after Intravitreal Bevacizumab for Diabetic Macular Edema.

OBJECTIVE: To measure the changes in ganglion cell complex as measured on optical coherence tomography (OCT) after intravitreal injection of bevacizumab (Avastin). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Lahore General Hospital, Lahore, from March 2017 to April 2018. METHODOLOGY: Patients presenting to the Eye OPD were assessed for diabetic macula edema requiring intravitreal injection of anti-VEGF. Patients having any coexisting ocular pathology hindering the OCT measurement, i.e. corneal opacity, vitreous hemorrhage, retinal detachment or having macular edema secondary to other cases were excluded. Retinal ganglion cell complex thickness and signal strength was measured in superior, inferior, supero-nasal, superotemporal, infero-nasal and infero-temporal quadrants on OCT. Pre-injection, visual acuity was measured, OCT performed and the findings were recorded on a designed proforma. Post-injection, the patients were called for follow-up after one month at which time same measurements were evaluated. All the injections were administered by a single surgeon. RESULTS: The thickness of ganglion cell complex increased significantly (p <0.001) one month after Intravitreal injection of bevacizumab. CONCLUSION: Intravitreal administration of bevacizumab in diabetic macular edema affects the measurement of retinal ganglion cell complex thickness on OCT.

Retinal Nerve Fiber Layer Thickness Changes after Phacoemulsification with Intraocular Lens Implantation.

OBJECTIVE: To determine the changes in the retinal nerve fiber layer as measured on optical coherence tomography (OCT) after phacoemulsification with intraocular lens implantation. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Lahore General Hospital, Lahore, from March 2017 to April 2018. METHODOLOGY: All patients (n=64) diagnosed with cataract and requiring surgery were included in study. Patients having any coexisting ocular pathology hindering the OCT measurement, i.e. corneal opacity, vitreous hemorrhage, retinal detachment etc. were excluded from study. Retinal nerve fiber layer thickness was measured in four quadrants. Signal strength on OCT was also documented. Preoperatively, visual acuity was measured, OCT performed, and the findings were recorded on a designed proforma. Postoperatively, the patients followed up after one month for visual acuity and OCT measurement. RESULTS: Retinal nerve fiber layer thickness was increased postoperatively as measured on OCT as did the signal strength. The increase was statistically significant (p <0.001). CONCLUSION: Removal of cataract by surgery enhances the OCT measurement of retinal nerve fiber layer, resulting in increased thickness.

Comparison of Mean Corneal Endothelial Cell Loss after Trabeculectomy with and without Mitomycin C.

OBJECTIVE: To compare mean endothelial cell loss in patients of primary open angle glaucoma undergoing trabeculectomy with and without mitomycin C. STUDY DESIGN: Randomised control study. PLACE AND DURATION OF STUDY: Institute of Ophthalmology, Mayo Hospital, Lahore, from May 2016 to April 2017. METHODOLOGY: Patients with primary open angle glaucoma, not controlled with medication, were selected from the outpatient department. Patients with secondary glaucomas and concomitant ocular disease were excluded. Selected patients were divided into two groups of 30 each. Group A patients underwent trabeculectomy with adjunctive mitomycin C while group B patients underwent trabeculectomy alone. Pre- and post-trabeculectomy endothelial cell counts were recorded with the help of specular microsope and entered on proforma. RESULTS: Median cell loss was 283 (66.50) when trabeculectomy was done with the use of adjunctive mitomycin C in group A while median endothelial cell loss was 72.50 (19.25) when the trabeculectomy was done without the use of adjunctive mitomycin C in group B. CONCLUSION: Use of mitomycin C causes more endothelial cell loss during trabeculectomy as compared to when done without it.