Bowman's layer transplantation in advanced keratoconus; 18-months outcomes.

PURPOSE: To assess the outcome of isolated Bowman's layer transplantation (BLT) in advanced keratoconus in the patients not suitable for ultra violet cross-linking and intra stromal corneal ring segments. STUDY DESIGN: Nonrandomized Quasi-Experimental. MATERIALS AND METHODS: Mid corneal stromal dissection followed by implantation of manually isolated bowman layer from a donor into the recipient stromal pocket was performed in the Department of Ophthalmology Khyber Teaching Hospital Peshawar from September 2018 to October 2018 and followed up over 18 months. RESULTS: Eleven eyes of 11 patients, 8 male and 3 female within the age range of 7-28 years with progressive keratoconus went under BLT All keratometry values decreased after surgery. Mean anterior pre-operative SimK changed from 69.05 ± 10.85 D to 61.14 ± 6.23 D at 18 months post-operatively (P = 0.005). Means pre-operative Kmax value decreased from 77.24 ± 7.58 D to 71.07 ± 5.37 D at 18 months post-operatively (p = 0.060). The mean pre-operative posterior keratometry value changed from - 10.03 ± 0.88 to - 8.96 ± 1.06 D at 18 months post-operatively (P = 0.002). Mean pre-operative thinnest corneal thickness increased from 281.64 ± 196.86 um to 355.27 ± 19.17 um at 18th months post-operatively (P = 0.001). Pachymetry p-value pre-operative to 18 months (P = 0.001) was statistically significant. Mean anterior SimK at 6 months post-operatively, 60.55 ± 5.56D changed to 61.14 ± 6.23D at 18 months post-operatively (P = 0.000), Kmax at 6 months postoperative 71.60 ± 5.01 D changed to 71.07 ± 5.37 D at 18 months post-operatively (P = 0.008). Both anterior K values at 6 months and 18 months post-operatively showed less significant change, and the same was true for Kmax data at 6 months and 18 months post-operatively. P-values at 6 months to 18 months post-operatively for cornea back data remained (P = 0.001) unchanged. No complications were observed intra-operatively or post-operatively. CONCLUSION: Bowman layer transplantation is a unique surgical treatment for advanced keratoconus to stabilize progressive ectasia with fewer complications avoiding the need for penetrating or deep anterior lamellar keratoplasty.

Ocular Surface Squamous Neoplasia: Clinicopathological Analysis and Treatment Outcome of 65 Cases.

OBJECTIVES: To find out the demography, clinical behaviour and outcome of ocular surface squamous neoplasia (OSSN) in North-west Pakistan. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from March 2011 to December 2017. METHODOLOGY: All patients with OSSN consulting this department were registered. A special proforma was designed to document demography, clinical features, management, and follow-up of all cases. At the end of study, the data was analysed using SPSS version 25 and the result compiled. RESULTS: Sixty-five eyes with OSSN were included in the study, in which 40 (61.5%) were males and 25 (38.5%) were females. Mean age of the patients was 61.68 +12.76 years. Twenty-six (40%) patients were farmers and exposed to ultraviolet light for prolong period. Fifty-nine (90.8%) presented with a painless, reddish mass on ocular surface. Average size of neoplasm at presentation was 18.60 + 11.30 mm in large dimension. Histopathologically, 23 (35.4%) were carcinoma in situ and 41(63%) invasive squamous cell carcinoma. During the period of follow-up 41 (63.1%) cured, 21 (32.2%) developed recurrence, and 3 (4.6%) patients passed away. CONCLUSION: OSSN is common in North-west Pakistan. The presentation is late due to certain socio-economic factors; but overall behaviour of the neoplasm is almost the same as mentioned in other studies from different parts of the world. Key Words: Ocular surface squamous neoplasia (OSSN), conjunctival squamous cell carcinoma, Carcinoma in situ.

Vogt Koyanagi Harada disease: treatment and visual prognosis.

Vogt Koyanagi Harada (VKH) disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases (100%). One patient developed bilateral cataract, glaucoma and subretinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is generally favourable if the disease is identified early and adequately treated and the associated complications are addressed properly.

Clinicopathological analysis of malignant eyelid tumours in north-west Pakistan.

OBJECTIVE: To analyse the demography, mode of presentation, gross morphology, histopathological diagnosis and subsequent course of malignant eyelid tumours in north-west Pakistan. METHODS: The retrospective observational study was performed at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, from January 2007 to July 2010, and comprised data related to 222 patients. Charts of patients with malignant eyelid tumours admitted to the department during study period were reviewed. Patients' demographic data, gross and microscopic features of the tumours and their subsequent course of treatments were recorded. SPSS 14 was used for statistical analysis. RESULTS: Of the total, 122 (54.1%) patients were male and 102 (45.9%) were female. Mean age of all patients was 59.3 +/- 14.2 years. Among the patients, 73 (32.9%) had the involvement of the lower lid; 57 (25.7%) the upper lid; 18 (8.11%) the medial canthus; 2 (0.9%) the lateral canthus; and 72 (32.4%) had more than one region involved. On histopathology, basal cell carcinoma was the most common (n= 131; 59%), followed by squamous cell carcinoma in 70 (31.5%), sebaceous gland carcinoma in 15 (6.8%), malignant melanoma in 3 (1.3%) and undifferentiated carcinoma in 3 (1.3%) cases. Of the total tumours, 164 (73.87%) did not spread, and 58 (26.13%) spread either locally or distantly. CONCLUSION: Basal cell carcinoma was is the most common malignant eyelid tumour in the study. Squamous cell carcinoma, which was second, was found to be more common in north-west Pakistan than in any other part of Asia, while the sebaceous gland carcinoma was relatively less common.

Non-viral microbial keratitis: etiology, clinical features and visual outcome.

OBJECTIVE: To determine the etiology, clinical features and visual outcome in non-viral microbial keratitis. STUDY DESIGN: An observational study (case series). PLACE AND DURATION OF STUDY: Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from January 2007 to December 2009. METHODOLOGY: Charts of all patients with infective keratitis treated at the department were reviewed. The data collected and recorded on a standardized form included age, gender, predisposing factors, microbiology results of culture and sensitivity, clinical features, treatment given, complications and visual acuity at last follow-up (at least 2 months). RESULTS: Among a total of 228 cases, 148 were male (64.9%) and 80 were female (35.1%). Mean age of the patients was 42.8 ± 21.9 years. Trauma was the most common (31.5%) predisposing factor followed by previous ocular surgery (8.8%) and use of topical steroids (6.6%). The most common isolate among positive cultures was Staphylococcus aureus isolated in 31.4% (11/35) eyes followed by fungal hyphae in 25.7% (9/35) and Gram negative bacilli in 17.1% (6/35) eyes. Visual outcome was good (> 6/18) in 19.6 %, moderate (< 6/18 to ³ 6/60) in 22% and poor (< 6/60) in 58.4%. CONCLUSION: The main predisposing factors in the studied group of patients with non-viral keratitis were ocular trauma and injudicious use of topical steroids. The most common microorganism involved was Staphylococcus aureus. Visual outcome was moderate to poor even after successful treatment.