Validation of postnatal growth and retinopathy of prematurity (G-ROP) screening guidelines in a tertiary care hospital of Pakistan: A report from low-middle income country.

Retinopathy of Prematurity (ROP) significantly contributes to childhood blindness globally, with a disproportionately high burden in low- and middle-income countries (LMICs) due to improved neonatal care alongside inadequate ROP screening and treatment facilities. This study aims to validate the performance of Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria in a cohort of premature infants presenting at a tertiary care setting in Pakistan. This cross-sectional study utilized retrospective chart review of neonates admitted to the neonatal intensive care unit (NICU) at The Aga Khan University Hospital, Pakistan from January 2018 to February 2022. The complete G-ROP criteria were applied as prediction tool for infants with type 1 ROP, type 2 ROP, and no ROP outcomes. Out of the 166 cases, 125 cases were included in the final analysis, and remaining cases were excluded due to incomplete data. ROP of any stage developed in 83 infants (66.4%), of whom 55 (44%) developed type 1 ROP, 28 (22.4%) developed type 2 ROP, and 19 (15.2%) were treated for ROP. The median BW was 1060 gm (IQR = 910 to 1240 gm) and the median gestational age was 29 wk (IQR = 27 to 30 wk). The G-ROP criteria demonstrated a sensitivity of 98.18% (95% CI: 90.28-99.95%) for triggering an alarm for type 1 ROP. The G-ROP criteria achieved 100% sensitivity (95% CI: 87.66 to 100%) for type 2 ROP. The overall sensitivity of G-ROP criteria to trigger an alarm for any type of ROP was 98.8% (95% CI: 93.47 to 99.97%). Thus, the G-ROP screening model is highly sensitive in detecting at-risk infants for ROP in a Pakistani tertiary care setting, supporting its use in LMICs where standard screening criteria may not suffice.

A Neuro-Ophthalmologist's Guide to Advances in Intracranial Pressure Measurements.

Cerebrospinal fluid disorders have a wide-ranging impact on vision, headache, cognition and a person's quality of life. Due to advances in technology and accessibility, intracranial pressure measurement and monitoring, usually managed by neurosurgeons, are being employed more widely in clinical practice. These developments are of direct importance for Ophthalmologists and Neurologists because the ability to readily measure intracranial pressure can aide management decisions. The aim of this review is to present the emerging evidence for intracranial pressure measurement methods and interpretation that is relevant to Neuro-ophthalmologists.

Post-operative visual outcomes based on morphological staging of idiopathic epiretinal membranes on OCT.

AIM: To evaluate the recently described optical coherence tomography (OCT) based classification of epiretinal membrane (ERM) and its usefulness in predicting the functional outcome. METHODS: A retrospective observational review of OCT scans of patients with the diagnosis of idiopathic ERM was carried out from January 2016 to June 2021. All consecutive images diagnosed with any stage of idiopathic ERM and fulfilled the eligibility criteria were included in the analysis. ERM was identified on OCT scans as a thin hyperreflective layer over the inner layers of retina. OCT scans of patients with ERM who underwent vitrectomy, were independently staged as per the new classification by two independent retinal surgeons to form a consensus on stage. Best corrected visual acuity (BCVA) in logMAR scale and central subfield thickness (CST) on pre- and post-operative spectral domain OCT scans were the variables noted for all patients at the time of diagnosis and at 6 and 12mo follow up visit after undergoing intervention. Partial correlation coefficient was computed between BCVA (logMAR) and CST by ERM stage adjusting by baseline measures. RESULTS: Clinical charts of 74 patients with idiopathic ERM were assessed. Clinically significant improvement in BCVA overtime was observed with significant difference in median visual acuity of patients with Stage II-IV ERM with P<0.001. The median CST of all patients with stage II-IV ERM showed similar consistent improvement with P<0.001 from baseline to 12th month. Our results showed not only gain in visual acuity but also shift from baseline to anatomical normalization of CST in stage II. We found a decrease in CST with difference of 166 µm and 151 µm in stage III and stage IV respectively. Our results remained consistent with the hypothesis of improved visual outcomes with all stages of ERM with adjusted moderate linear correlation between visual acuity and CST in stage II-IV (r>0.3). CONCLUSION: Equally significant visual outcomes of patients with ERM staged II-IV and therefore can be counselled for improved visual acuity after surgical removal of ERM with improvement up to 5 lines on Snellen's chart from the baseline.

Outcomes of Epi-On Collagen Cross-Linkage Procedure Assessed in Progressive Keratoconus Patients.

INTRODUCTION: Keratoconus is a corneal ectasia that causes astigmatism and reduced vision. Conventional treatment to stop the progression of ectasia involves debridement of corneal epithelium, followed by ultraviolet light and riboflavin drops to reinforce the collagen covalent bonds, called collagen cross-linkage (CXL). Epi-on (epithelium-on) is a modified technique without epithelial debridement and associated complications of pain, infection, and damage to the cornea. However, despite a good safety index and efficacy, Epi-on has not completely replaced the conventional Epi-off (epithelium-off) CXL. We aim to report our five-year experience and outcomes with Epi-on CXL Methods: In this five-year retrospective clinical audit, we included all patients who underwent Epi-on CXL from December 2014 to June 2020 at the Aga Khan University Hospital. Outcomes were based on best-corrected visual acuity (BCVA) and topographic indicators such as keratometry-max (K-max), keratometry mean (K-mean), pachymetry apex (Pachapex), and pachymetry thinnest (Pachthin) performed during pre-CXL clinical visit within one month of the procedure and were compared with the most remote follow up within three years post-CXL. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 223 eyes of 134 patients had undergone CXL of which 32 eyes of 18 patients were included in the study based on the inclusion criteria. The mean age was 26.8 (+/- 6.137) years; nine were males and 16 were right eyes. Mean BCVA was 0.383 logMAR (logarithm of the minimum angle of resolution) units which improved to 0.292 units post CXL (p=0.02) and K-max decreased from 57.4 to 56.60 diopters (p=0.048), both outcomes were statistically significant. Pachapex decreased slightly from 471 to 460 micrometers (p=0.099), K-mean was almost stable from 48.8 to 48.7 diopters (p=0.9), and Pachthin also decreased slightly from 455 to 445 micrometers (p=0.117), however, these outcomes were not statistically significant. Other studies reported similar improvements in K-max and visual acuity. CONCLUSION: Epi-on CXL is an effective treatment for halting the progression of keratoconus. Our results showed significant improvement in visual acuity and K-max readings indicating a halting of the progression of keratoconus in our patients. Long-term follow-up is required for all patients to assess detailed outcomes. Further studies comparing Epi-on CXL with other methods may be carried out.

Mask-associated dry-eye in COVID-19 pandemic: A case report and review of the literature.

Mask-Associated Dry Eye (MADE) has been showing a rising trend during COVID 19 pandemic. This phenomenon seems inevitable, as wearing a face mask is a requisite part of personal protective measures to suppress of the spread of virus. However, simple expeditious awareness among health care staff, including the general population, can decrease the incidence.

Surgical training in ophthalmology: Role of EyeSi in the era of simulation-based learning.

Recent advancements in surgical training methods have escalated the need for simulators. The EyeSi simulation has played a major role in Ophthalmology training by providing opportunity to the novice residents to grasp the surgical steps of the procedure and master the skill by repeated attempts. Participants were assessed on single level of cataract module and their consecutive scores were assessed with each attempt. It was found that repetitive practice on simulator can help develop proficiency in the desired steps that can ultimately prepare the surgical trainees for real life surgery.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

Abstract Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases.

Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Factors Associated with Drain Output in Patients Undergoing to Parotidectomy

Abstract Introduction Tumors of the parotid gland are heterogeneous. The purpose of the drain placement is to evacuate fluid that has a potential to accumulate in the dead space and cause infection after parotidectomy. Objectives To evaluate the factors associated with drain output among patients submitted to parotidectomy. Methods A retrospective cohort study was conducted in the Department of Otolaryngology/Head and Neck Surgery at the Aga Khan University Hospital, Karachi, from January 1994 to December 2014. Patients who underwent parotidectomy were included in the study. Linear regression analysis was used to determine the factors associated with drain output. Results A total of 193 patients were included in the study. The mean age of the patients was 46.3 years, and 57% of them were male. Length of surgery (β coefficient = 24.2; 95% confidence interval [95%CI]: 4.94-85.26), type of neck dissection (modified radical neck dissection: β = 93.9; 95% CI: 30.47-157.38; selective neck dissection: β = 79.9; 95%CI: 29.04-126.85), and type of parotidectomy (total β = 45.1; 95%CI: 4.94-85.26) were factors that significantly influenced drain output in patients submitted to parotidectomy with or without neck dissection. Conclusion Neck dissection, total parotidectomy and length of surgery were predictors of postoperative neck drainage in our cohort. These factors can help predict postoperative neck drain output and help in patient counselling.

Factors Associated with Drain Output in Patients Undergoing to Parotidectomy.

Introduction Tumors of the parotid gland are heterogeneous. The purpose of the drain placement is to evacuate fluid that has a potential to accumulate in the dead space and cause infection after parotidectomy. Objectives To evaluate the factors associated with drain output among patients submitted to parotidectomy. Methods A retrospective cohort study was conducted in the Department of Otolaryngology/Head and Neck Surgery at the Aga Khan University Hospital, Karachi, from January 1994 to December 2014. Patients who underwent parotidectomy were included in the study. Linear regression analysis was used to determine the factors associated with drain output. Results A total of 193 patients were included in the study. The mean age of the patients was 46.3 years, and 57% of them were male. Length of surgery (ß coefficient = 24.2; 95% confidence interval [95%CI]: 4.94-85.26), type of neck dissection (modified radical neck dissection: ß = 93.9; 95% CI: 30.47-157.38; selective neck dissection: ß = 79.9; 95%CI: 29.04-126.85), and type of parotidectomy (total ß = 45.1; 95%CI: 4.94-85.26) were factors that significantly influenced drain output in patients submitted to parotidectomy with or without neck dissection. Conclusion Neck dissection, total parotidectomy and length of surgery were predictors of postoperative neck drainage in our cohort. These factors can help predict postoperative neck drain output and help in patient counselling.

Resolution of symptomatic secondary empty sella syndrome following lumbar-peritoneal shunt.

BACKGROUND: Post-surgical empty sella is related to the removal of pituitary tumors either from the transcranial or transphenoidal route, rendering diaphragma sellae incompetent at the end of the procedure. This subsequently leads to herniation of the third ventricle and optic apparatus into the empty sella. Studies have shown that in 50% of the cases, individuals with primary and secondary empty sella syndrome have developed defects in the visual fields. Benign increased intracranial pressure, cerebrospinal rhinorrhea, papilledema, and abnormalities affecting visual acuity may also occur as a result of empty sella. CASE DESCRIPTION: This case report discusses a rare treatment option for the symptomatic secondary empty sella syndrome. Patient underwent lumbar drain placement and that resulted in astonishingly significant improvement in vision. Keeping in view the beneficial effect of lumbar drain, lumbar-peritoneal (LP) shunt was inserted which showed drastic improvement in vision. CONCLUSION: The surgical outcome of symptomatic cases of ESS is favorable. Various common surgical options were reported in literature; however, we have discussed an unconventional surgical option with an impressive outcome.

SODIUM AND WATER IMBALANCE AFTER SELLAR, SUPRASELLAR, AND PARASELLAR SURGERY.

OBJECTIVE: To report the frequency of sodium and water disturbances (SWDs) in patients undergoing sellar, suprasellar, and parasellar surgery (SSPS). METHODS: We conducted a cross-sectional, retrospective study on 115 patients in the Aga Khan University Hospital after ethical approval. Patients were 16 years old or older undergoing pituitary or sellar surgeries. We collected data on basic sociodemographic characteristics and clinical indication for surgery. We noted laboratory values for serum electrolytes, plasma and urine osmolality, urine sodium, and 24-hour fluid balance from the immediate postoperative day until discharge and follow-up. We recorded medical management plans. We also recorded diabetes insipidus (DI), syndrome of inappropriate antidiuretic hormone (SIADH), cerebral salt wasting (CSW), triphasic response, and hyponatremia, according to the diagnostic definitions. Finally, we performed data analysis using Statistical Package for the Social Sciences, version 19.0. RESULTS: Of 115 patients, there were 61.7% males, mean age 42.3 ± 13.86 years, 91.3% had pituitary adenoma (73.0% nonfunctioning), and 86.1% underwent transsphenoidal surgical approach. Transient DI occurred from days 1 to 6, peaking with 57.4% on day 2. Permanent DI and SIADH were rare. We did not note typical triphasic response or CSW in any of the patients. However, isolated hyponatremia occurred in 11%, and 20.9% had DI with hyponatremia. CONCLUSION: Transient DI is the most common postoperative SWD after SSPS. Hyponatremia occurred alone and following DI. This is the first study describing postoperative SWDs after different sellar surgeries in Pakistan. ABBREVIATIONS: ADH = antidiuretic hormone CSW = cerebral salt wasting DI = diabetes insipidus SIADH = syndrome of inappropriate antidiuretic hormone SSPS = sellar, suprasellar, and parasellar surgery SWD = sodium and water disturbance.