Various Manifestations Of Trachoma In Internally Displaced Rural Population - A Free Eye Camp Based Survey.

BACKGROUND: The objective of the study is to observe frequency of various clinical manifestations of trachoma in rural population. This observational study was conducted at Khalifa Gul Nawaz Teaching Hospital (KGNTH), Bannu, Pakistan from April 2016 to Jan 2017. METHODS: Patients visiting for ocular complaints underwent initial screening that included demographic details and documentation of unaided as well as best corrected visual acuity (BCVA) which was followed by detailed slit lamp examination of anterior segment including eversion of upper lid for assessment of changes in upper tarsal conjunctivas by consultant ophthalmologist. A total of 648 patients who had clinical presentation of trachoma were included in the study. Patients who had other forms of conjunctivitis, trichiasis, entropion, corneal opacification and vascularization due to causes other than trachoma were excluded. Patients were categorized according to age in three groups (Group 1-3) and according to stages of trachoma in five groups (TF, TI, TS, TT and TO). RESULTS: Six hundred and forty-eight (648) were examined in this cross-sectional survey with a mean age of 14.3+14.2 years. Mean unaided visual acuity and BCVA of the patients was 0.12+.24 and 0.07+0.18 respectively. Groups-1 comprised of 86.7% of the patients and stage TF of trachoma was the most prevalent stage accounting for 70.06% of the patients. CONCLUSIONS: Trachoma is a serious community health problem with various clinical manifestations in different age groups. Awareness and educational programs are required to be conducted in schools and vocational training centres regarding its mode of transmission and control..

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.

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% versus ketorolac 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 & 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.

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.

Visual outcome of retinal vein occlusion in patients residing at high altitude.

OBJECTIVE: To study visual outcome in patients of high altitude retinopathy presenting with retinal venous occlusion. METHODS: The randomised clinical trial study was conducted at the Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from January 2013 to December 2015, and comprised eyes of lowlanders. Patients staying at high altitude (>8,000 feet above sea level) as part of their service duty and presented with retinal venous occlusive disease were included. Patients with history of diabetes, hypertension, glaucoma, any pre-existing retinal disease or age-related conditions responsible for decreased vision were excluded. Detailed ocular as well as systemic examination was carried out to establish the diagnosis of retinal venous occlusion. Patients were divided into two groups. First group was observed over a period of 6 months and labelled as control group, whereas the second group was treated with intravitrealbevacizumab and labelled as intervention group. Complete ocular examination was carried out in all patients at 4 weeks, 3 months and 6 months. SPSS 21 was used for data analysis. RESULTS: A series of 32 eyes of 28 male patients were included. The overall mean age was 31.40±3.40 years. The mean altitude of their temporary stay was 4,120±941 metres above sea level and the mean duration of stay was 6.80±4.13months. Besides, 21(75%) subjects were smokers. Moreover, 26(81.25%) eyes had central retinal vein occlusion while branch retinal vein occlusion was seen in 6(18.75%) eyes. The mean visual acuity in the control group was 0.70±0.56 on Logarithm of the Minimum Angle of Resolution chart at the presentation while it was 0.26±0.87, 0.20±0.32 and 0.15±0.23 after 4 weeks, 3 months and 6 months, respectively. The mean best corrected visual acuity in intervention group was 0.68 ± 0.46 before treatment and 0.15±0.11, 0.12±0.11 and 0.10±0.08 at 4 weeks, 3 months and 6 months, respectively. Significant post-intervention change was observed in best corrected visual acuity at 6 months (p<0.05) in patients who presented with severe visual loss. CONCLUSIONS: Treatment with intravitrealbevacizumab may be considered in patients with severe visual loss at presentation.

Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis.

OBJECTIVE: To assess the mean change in interpalpebral fissure height and marginal reflex distance after brow suspension with autogenous fascia lata sling in patients of ptosis. METHODS: This was a Quasi experimental study conducted at Department of Ophthalmology, Mayo Hospital, King Edwards Medical University Lahore, from Jan 2013 to June 2016. Included were the patients who had unilateral or bilateral ptosis with poor levator function (< 5 mm). Informed consent was obtained from all patients after explaining about the research project. Patients were admitted in ward and all of them underwent surgery by a single surgical team. The surgical procedure was performed in supine position under general anesthesia in children and uncooperative patients. Patients were followed at week 4, 8, 12 and 24 to observe vertical interpalpebral fissure height and marginal reflex distance. RESULTS: The mean age of the patients was 9.03 ± 5.26 years. The mean Inter palpebral fissure height (IPFH) was 4.40±0.91 mm and mean MRD was 0.50 ± 1.00 mm before surgery while after surgery it was 7.41±0.76 mm and 3.10 ± 1.50 mm respectively at 04 weeks. The mean IPFH and MRD at 24 weeks postoperatively were 8.43±0.98 mm and 3.60 + 1.50 mm respectively. The mean change in IPFH and MRD at 24th week, were 3.90 ± 0.34 mm and 3.50 ± 1.00 mm. CONCLUSION: Brow suspension with fascia lata sling is safe and effective technique for correction of ptosis with poor levator function.

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.

Ocular Features in a Case of Nevus of Ota.

Oculodermal melanocytosis, also known as Nevus of Ota, is a hamartomatous melanocytic nevus of dermal melanocytes. It presents as a bluish grey patch on the face, which may be congenital or acquired involving the area of distribution of the ophthalmic and maxillary branches of the trigeminal nerve. The nevus can be unilateral or bilateral, and, in addition to skin, it may involve ocular and oral mucosal surfaces. It is a rare disorder and the ocular complications, such as glaucoma and melanoma, may be vision or life-threatening. Here, we report a 26-year male who presented with decreased vision in his left eye. On detailed examination, he turned out to be a case of nevus of Ota.

Effect of half adult dose of oral Rifampicin (300mg) in patients with idiopathic central serous chorioretinopathy.

OBJECTIVES: To evaluate the effect of half adult dose of oral Rifampicin on mean change in best corrected visual acuity and central macular thickness in patients with central serous chorioretinopathy. METHODS: Thirty-eight eyes of 31 patients with idiopathic central serous chorioretinopathy (CSCR) were registered. Unaided Visual acuity, best corrected visual acuity was documented and detailed slit lamp examination along with dilated ophthalmoscopy was performed. All subjects were treated with oral Rifampicin 300 mg (half adult dose) daily for 03 months. Patients underwent a complete ocular and systemic examination as well as central macular thickness (CMT) measurement by optical coherence tomography (OCT) every month after starting treatment until four months. Fundus fluorescein angiography (FFA) was performed in recurrent cases. Liver function tests were carried out prior to the treatment and during follow up period. RESULTS: A total of 38 eyes of 31 patients (24 males, 07 females) were included in the study. Mean age of patients was 36.16±3.19 years (range 30-44). Mean best corrected visual acuity (BCVA) before treatment was 0.56±0.11 and improved to 0.47±0.14 at 04 weeks (P<0.001) of treatment. The mean CMT at the time of presentation was 494.39±96.29 um and was decreased to 306.90±50.71 um after 04 weeks of treatment (P<0.001). The mean induced reduction in CMT was 187.48±122 um (P<0.001) while that in BCVA 0.41±0.16 at 04 weeks of treatment (P<0.001). Liver function tests were within normal range before and after the treatment. CONCLUSION: Half adult dose rifampicin (300mg) is effective and safe in treatment of central serous chorioretinopathy without causing any systemic imbalance.

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. Atotal 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).

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.

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. A24-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.

Comparison of primary versus recurrent pterygium after intralesional 5-Fluorouracil.

OBJECTIVE: To compare the mean change in corneal astigmatism and clinical appearance after intralesional injection of 5-Fluorouracil in primary and recurrent pterygia. METHODS: The quasi-experimental study was conducted at the Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from June 2014 to April 2015. The patients were categorised into two groups. Group1 named GP comprised primary pterygia patients, while those of recurrent pterygia were in Group 2 named GR. All the patients were treated with 0.1ml intralesional 5-Fluorouracil 5mg weekly injections for 04 weeks. Ophthalmic clinical evaluation included uncorrected distant visual acuity, keratometery and slit lamp examination was performed before and 04 weeks after the treatment. RESULTS: There were 86 eyes of 64 patients in the study. Mean uncorrected distant visual acuity of patients was 0.12±0.13 in GP and 0.26±0.17 in GR. Mean astigmatism before treatment was 1.75±1.08 in GP and 2.92±2.28 in GR. Same parameters 04 weeks after last injection were 1.66±1.17 and 2.64±1.78 in GP and GR respectively. All eyes had a statistically significant change in clinical appearance. CONCLUSIONS: Intralesional 5-Fluorouracil injection improved cosmesis of primary as well as recurrent pterygia, but did not have statistically significant effect on corneal astigmatism.

Effect of intralesional 5 fluorouracil injection in primary pterygium.

OBJECTIVE: To determine mean change in visual acuity, corneal astigmatism and clinical appearance of pterygium after intralesional injection of 5-Fluorouracil. METHODS: This was a Quasi experimental study conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from June 2014 to May 2015. Total 68 eyes of 54 patients were included in the study. Patients were treated by injecting 0.1 ml of 5-FU (5mg) weekly injections for 04 weeks. All the patients underwent ophthalmic clinical examination that included Uncorrected distant visual acuity (UCVA), corrected distant visual acuity (CDVA), keratometery with Auto Ref-keratometer (RK-F1, Canon) and slit lamp examination before and 04 weeks after the last injection. RESULTS: Total 68 eyes of 54 patients (18 females and 36 males) were treated with intralesional injection of 5 FU. Out of total, 30 were right eyes while 38 were left eyes. Age of patients ranged from 23 to 53 years with mean age of 39.2 ± 4.90 years. Mean UCVA and corneal astigmatism before treatment were 0.162 ± 0.167 and 2.12 ± 1.53 respectively while the same parameters 04 weeks after last injection of 5 FU were 0.166 ± 0.168 and 1.92±1.45 respectively. The magnitude of induced change in astigmatism was (0.235 ± 1.35). Ninety seven percent of the patients showed improvement in clinical appearance. CONCLUSION: Intralesional 5-FU injection results in significant clinical and cosmetic improvement of primary pterygium.

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.

Homocystinuria (HC) and Neurofibromatosis Type-1 (NF-1): An Unusual Presentation in a Child.

Homocystinuria (HC) and neurofibromatosis type-1 (NF-1) are two genetically determined conditions with variable clinical manifestations. HC is a neurocutaneous autosomal recessive condition while NF-1 is an autosomal dominant phacomatosis. Both HC and NF-1 present with distinct systemic as well as ocular manifestations; however, vascular complications can occur in both the conditions. A9-year boy diagnosed case of HC along with other two siblings is reported here. He was referred by his paediatrician with decreased vision secondary to ectopia lentis. When examined in detail, he turned out to be suffering from both HC and NF-1, based on raised serum homocysteine levels, biopsy report of NF-1 and presence of café au laitspots and ectopia lentisclinically. Lens anomaly was corrected surgically while he was given oral vitamin B6 for HC to which he responded well.

Unilateral-external Ophthalmoplegia: ARare Presentation of Myasthenia Gravis.

Myasthenia gravis (MG) is a disease of autoimmunity with variable and diverse clinical presentations. The target tissue is neuromuscular junction of skeletal muscles, where efficient nerve impulse transmission is hampered leading to less effective muscle contraction. Patients of MG usually present with bilateral ptosis, diplopia and fatigability, which may or may not coexist with generalised weakness, dysphagia and dysarthria. A46-year male presented with unilateral ptosis and diplopia. Except for unilateral moderate ptosis and restriction of extraocular movements, ocular and systemic examination was normal. Both ice pack and tensilon tests revealed improvement in ptosis. Patient was advised tablet pyridostigmine and prednisolone; and a remarkable improvement was noticed within a week.

Effect of wavefront optimized LASIK on higher order aberrations in myopic patients.

OBJECTIVE: To determine mean change induced in root mean square value of higher order aberrations in myopic patients undergoing wavefront optimized laser assisted in situ keratomileusis. METHODS: This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Sixty eyes of 35 myopic patients were included in the study. All patients underwent wavefront optimized (WFO) laser assisted in situ keratomileusis (LASIK) using femtosecond laser (FM 200Wavelight technologies) and excimer laser (Ew 500Wavelight technologies). Higher order aberrations (HOAs) were measured with aberrometer (Wavelight allegro analyzer version 1073) during preoperative assessment and one month after surgery. RESULTS: All 35 patients ranged from 20 to 32 years with a mean age of 24 ± 3.41 years. Refractive error ranged from -1.00 to -9.50 DS with a mean spherical equivalent (SE) of -3.73 ± 1.95 before surgery and - 0.36 ± 1.50DS one month after LASIK. Uncorrected visual acuity (UCVA) was improved to 0.00 or better in all 60 eyes. An increase of 1.56 fold was observed in RMS of total HOAs. Among the HOAs, a statistically significant positive correlation was observed between spherical aberrations (4(th) order aberration) and preoperative spherical equivalent. CONCLUSION: In spite of excellent improvement in refractive error, significant amount of higher order aberrations were induced after WFO LASIK.

Comparison of higher order aberrations in patients with various refractive errors.

OBJECTIVE: To compare the mean root mean square (RMS) of total higher order aberrations (HOAs), coma and spherical aberrations in individuals with myopia, hypermetropia and myopic astigmatism. METHODS: This prospective analytical study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Two hundred eyes of 121 patients with age ranging from 18-40 years were included in the study. Patients were divided into 4 group namely Low myopia, High myopia, Astigmatism and Hypermetropia on the basis of refractive error. Included were the patients who had refractive error more than ± 0.5D and best corrected visual acuity (BCVA) of 0.00 or better. Patients who had history of surgery and / or eye disease were excluded from the study. Visual acuity (VA), Spherical equivalent (SE) of refractive error, RMS value of total HOAs, coma and spherical aberrations were evaluated. HOAs were measured with aberrometer (Wavelight analyzer version 1073) at 6 mm pupil size. RESULTS: Age of the patients ranged from 18 years to 40 years with mean age of 29.10±10.6 years. Seventy one (35.5%) were males and 129 (64.5%) were female. Mean RMS value of HOAs, coma and spherical aberrations was calculated in all four groups. RMS of total HOAs and spherical aberrations in hypermetropia was 0.96±0.96 and 0.30±0.42 respectively and it was higher than other three groups. CONCLUSIONS: In overall comparison the mean RMS of total HOAs and spherical aberrations was significantly increased in hypermetropia group and there was a statistically significant negative correlation of SE of hypermetropia with RMS of total HOAs and spherical aberration.

Partial Oculocutaneous Albinism: Two Siblings with Features of both Hermansky Pudlak and Waardenburg's Syndrome.

Albinism is an inherited abnormality of melanin synthesis with incidence of one per 20,000 births. Its clinical manifestations are related to the reduction or absence of pigmentation in the visual system and/or the skin and teguments. The clinical spectrum of Oculocutaneous Albinism (OCA) has four types ranging from OCA 1 - 4, of which OCA 1, A-1 is the most severe form. Partial cutaneous albinism which is a subtype of OCA is associated with systemic immunodeficiency disorders like Chediak Higashi (CHS), Griscelli (GS) and Hermansky-Pudlak (HPS) syndromes. A7 years boy was labeled initially as a case of Hermansky Pudlak syndrome at the age of 01 year. He as well as his 4 years old younger brother when examined in detail along with audiological investigations were diagnosed as a rare presentation of both Hermansky Pudlak and Waardenburg's syndrome.