Anterior lamellar marginal z-plasty with transverse tarsotomy for management of trichiasis with cicatricial entropion--a new surgical approach.

BACKGROUND: Trichiasis is the main risk factor for corneal opacification. The primary treatment of trichiasis is surgical. Successful surgery is likely to halt the progression of corneal opacity. The aim of the study is to report the efficacy of the anterior lamellar marginal z-plasty combined with transverse tarsotomy in the management of severe trichiasis andcicatricial entropion of upper eyelid. METHODS: A prospective study was carried out from January 2009 to June 2012, on 54 eyelids (44 patients) who underwent anterior lamellar marginal z-plasty with transverse tarsotomy for correction of trichiasis and cicatricial entropion involving upper eyelid with a minimum of 6 months' follow-up. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Failure was defined as recurrent trichiasis with one or more lashes touching any part of cornea in primary position. Secondary outcomes were visual acuity and corneal opacification. RESULTS: At the end of six month period, none of patients had any trichiatic eye lash touching the cornea in primary position (100% success). Forty-eight (88.9%) of the operated eyelids were free of trichiasis, while residual trichiasis was noticed only in 6 (11.1%) operated lids. At the end of six months, there was a significant reduction of lash burden from median of 12 trichiatic lashes from the base line to the median of 2. All the patients reported significant reduction in symptoms of irritation. Significant improvement in visual acuity (p < 0.000) and reduction in the density of corneal opacity (p < 0.000) was notified from the base line. CONCLUSION: Anterior lamellar marginal z-plasty combined with transverse tarsotomy seems to have promising surgical outcome for the correction oftrichiasis and cicatricial entropion secondary to cicatricial trachoma.

Silicon tube frontalis suspension in simple congenital blepharoptosis.

BACKGROUND: Ptosis is an abnormally low position of the upper eyelid. Congenital ptosis should be corrected in early years of childhood. The aim of this study was to assess the efficacy and complications of frontalis suspension using silicon tube for simple congenital blepharoptosis with poor levator function. METHODS: A prospective study was performed on 33 children who underwent frontalis suspension using silicon tube from Jan 2008 to Jun 2011 with a minimum of 6 month follow-up. Functional success was defined when 3 criteria were met: (a) satisfactory lid height defined as margin-to-reflex distance > or = 3.5 mm with minimal frontalis action (brow up); (b) satisfactory lid symmetry (< or = 2 mm asymmetry in margin-to-reflex distance) between two lids; and (c) satisfactory cosmesis, i.e., normal lid contours. RESULTS: The mean follow-up duration was 9 months (range 6.5-27 months). The functional success rate was 91.4% (32/35 eyes). Three eyes had complications. In one eye (2.8%), recurrence of ptosis due to slippage of knot was seen, one eye developed infection of tract, and one with bilateral ptosis developed abnormal tenting of one of the lid. CONCLUSION: In simple congenital ptosis with poor levator function, frontalis suspension using silicon tube has good efficacy and an excellent safety profile. The results of frontalis suspension using silicon tube are comparable to fascia lata and superior to other non-autogenous materials.

Outcome of sutureless manual extra capsular cataract extraction.

BACKGROUND: Cataract surgery is constantly evolving. Purpose of this study was two folds: to estimate visual outcome and evaluate safety and efficacy of sutureless manual extra-capsular cataract extraction. METHODS: This was a prospective, interventional case series, using sutureless manual extra capsular cataract surgery technique from June 2004 to January 2007 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex Peshawar. Patients included in the study were those having operable cataracts. All those having corneal co-morbidities extensive enough to block visualisation of posterior segment details, chronic adenexal diseases, long standing glaucoma, advanced diabetic eye disease and retinal detachment evident on B-Scan ultrasonography were excluded from the study. After thorough examination and investigation all the patients were operated upon by a single experienced surgeon using the same technique. Their visual outcome was analysed. The patients were followed for a period of six weeks. RESULTS: A total of 1500 cataract surgeries were carried out, of which 1211 (80.74%) patients completed six weeks of follow up. Seven hundred and fifty seven (62.51%) had an uncorrected good visual acuity (6/6-6/18) on 1st post-op day, 1131 patients (93.40%) had an uncorrected visual acuity of 6/6-6/18 on 6th week follow up. Mean surgically induced astigmatism at 6 weeks was 0.3 dioptres. CONCLUSION: Sutureless manual extra capsular cataract surgery is a safe and effective technique. It offers faster wound healing and quick rehabilitation of cataract patients at any level of community eye care setting.

Status of children in blind schools in the northern areas of Pakistan.

BACKGROUND: Prevalence of blindness in Pakistan is estimated to be 0.9%, which comes to about 1.25 million persons. A significant number of these are persons under 20 years of age. To make these children useful citizens in future, special facilities are to be provided to these children for their education and training. A study was done to find out the visual status of the students studying in a blind school in Abbottabad, Pakistan, the only such facility in the region. METHOD: A total of 50 patients were examined during our visit to the blind school in Abbottabad. Age of the patients ranged from 6 to 27 years (mean: 12.32 years). All the students, who were otherwise healthy, were included in the study. RESULT: The most common disorder identified was malformed globe or traumatic eyes (16 cases, 32%), in most of the cases, leading to phthisis bulbi. Other conditions noticed were Retinitis Pigmentosa (10 cases, 20%), Keratoconus, Optic atrophy, Buphthalmos (6 cases each, 12%), corneal opacity (4 cases, 8%) and retinal detachment (2 cases 4%). CONCLUSION: We should work towards betterment of these schools by providing them with more funds, equipment and manpower. Regular visits of Ophthalmologists to these schools may be helpful. Genetic counselling should be arranged for the families.

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73 per cent of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11 per cent) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73 per cent) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.