Treatment Of Senile Entropion: A Comparison Of Standard And Modified Surgical Technique.

Background: The aim of this study is to compare the postoperative functional outcomes of two different surgical techniques for the correction of senile lower lid entropion. It was a Quasi experimental study, carried out at BHY Hospital, Karachi, Pakistan from January to December 2018. Methods: This study recruited fifty patients belonging to either gender with an age range of 60-70 years having unilateral lower lid senile entropion. All the patients were briefed about the study dynamics and divided into two groups with twenty-five patients in each group via convenience-based sampling technique. Those with a prior history of lid surgery or bleeding diathesis were excluded from the study. Patients of group A underwent the standard Weis surgical procedure whereas Group B patients underwent a modified surgical approach using an external tamponade. Main outcome measure was the rectification of abnormal lid position to the normal level. All the patients were followed for a period of six months postoperatively. Study approval was obtained from the institutional ethical review board. Results: This study included a total of fifty patients with twenty-five patients in each group. Mean age was 64.5±3.23 years. Recurrence was observed in 32% patients of group A and 4% patients of group B. Conclusion: The modified surgical technique for entropion repair using an external tamponade has a favourable outcome with minimal recurrence and symptomatic relief.

Modified Treatment Of Shallow Fornix For Better Retention Of Ocular Prosthesis.

Background: The purpose of this study is to share the experience of a modified surgical technique for treating shallow inferior fornix to enhance the retention of cosmetic ocular prosthesis in a tertiary care hospital. It was a Quasi experimental study, carried out at Khalid Eye Hospital, Karachi, Pakistan from January to December 2018. Methods: This study included twenty-five patients between the ages of 20-40 years belonging to either gender having an anophthalmic socket with shallow inferior fornices unable to retain cosmetic ocular prosthesis. Three pieces of Silicone tube were placed deep within the inferior fornix with the help of 2-0 Vicryl suture, taking bite of the inferior orbital rim periosteum. Main outcome measure was deepening of the inferior fornix with better retention of the ocular prosthesis. All the patients were followed up for a period of one year after the surgery. Study dynamics were briefed to all the patients and study approval obtained from the hospital ethical review committee. Results: This study included a total of twenty-five patients of both genders. Mean age was 29.6±6.53 years. By the end of the follow up period, twenty-four (96%) out of the twenty-five patients were satisfied with a proper retention of ocular prosthesis within the fornix along with complete lid closure. One (4%) patient required revision surgery because of extrusion of the silicone tube piece after one month. Mean follow up period was 358.5±16.76 days. Conclusion: This modified technique does not require expensive consumables and proved to be effective in terms of cosmetic and functional outcome.

Upper Eyelid Reconstruction Surgeries; Comparison Of Outcomes Between Reverse Tenzel Flap Versus Cutler Beard Flap Procedure.

BACKGROUND: Objective of this study was to compare Reverse Tenzel flap and Cutler Beard flap for upper eyelid defects. METHODS: This interventional study was carried out at occuloplasty department of LRBT (Layton Rahamatullah Benevoloent Trust), Karachi. Patients diagnosed with upper eye lid defect between 50 and 75 years were included after ethical approval from institutional ethical review committee and briefing patients about study dynamics. The patients were randomly divided in two groups, group A in whom reverse tanzel flap was done, while in group B Cutler beard procedure was done. Main outcome measure was eyelid contour, complete lid closure and surgical procedure time. SPSS version 25.0 was used for data analysis. RESULTS: Reverse Tenzel flap mean age 64.00±6.17 years, mean duration of surgery 33±5.78 minutes, and mean healing time 2.2±0.41 weeks. Cutler Beard flap mean age 59.60±6.26 years, mean duration of surgery 32±5.78 minutes, and mean healing time 5.7±0.8 in 3 weeks. 60% of patients were female. 30 (50%) patients each underwent Reverse Tenzel flap and Cutler Beard flap. In Reverse Tenzel flap, no complications were observed. In Cutler Beard flap, 06 (20%) patients reported mild entropion, 04 (13.3%) retraction of flap and 02 (6.7%) were found to have mild incomplete lid closure. CONCLUSIONS: Reverse Tenzel flap was superior to Cutler Beard flap as it reported no complications, being single stage surgery with early healing. Cutler-Beard flap reported mild entropion and retraction of flaps which required second surgery and delayed healing.

Cosmetic Outcome Of Autogenous Dermis Fat Graft As An Orbital Implant After Enucleation.

BACKGROUND: The surgical method of removing the complete intact globe while leaving the extraocular muscles and orbital fat behind is called as enucleation. The intention behind this study is to share the experience of autogenous dermis fat graft as an orbital implant following enucleation and its cosmetic outcome. It was a prospective study conducted at the Orbit and Oculoplastic department of LRBT Tertiary Teaching Eye hospital from July 2018 to June 2019. Methods: Eighty-five patients were recruited for this study belonging to either gender with ages ranging from 20 to 50 years. None of the recruited patients had undergone prior enucleation or evisceration. All the patients were informed and counseled about the surgical modus operandi and the expected outcomes and verbal consent was taken from each patient along with approval from the hospital's ethical review committee before proceeding with the surgery. Every participant underwent primary enucleation followed by autogenous dermis fat graft orbital implant and followed up for duration of up to 3 months after the surgical procedure. Results: At ninety days after the procedure, 78.2% of patients had a very good cosmetic result. Conclusion: The placement of autogenous dermis fat graft as an orbital implant following primary enucleation has a good accomplishment rate with excellent cosmetic outcome.

Ocular manifestations in a patient with Dandy-Walker malformation: A case report.

We present a unique case of a ten-month-old boy with a protruding left globe and vitreous haemorrhaging, and later being diagnosed as a case of a dandy-walker syndrome (DWS) with buphthalmos and vitreous haemorrhage. Treatment is depending on the symptoms reported, thus close monitoring and a multidisciplinary approach are essential. We would like to recommend that even if there are no cardinal symptoms of DWS, paediatric patients with ocular signs should have Dandy walker Malformation (DWM) considered as a differential diagnosis.

Added Advantage Of Injecting Subtarsal Steroid Injection After Incision And Curettage Of Multiple Chalazion.

BACKGROUND: Being one of the most common eye lid inflammatory lesions, there is an abundance of ways its treatment can be approached; however, the dearth of consensus on its management guidelines still remains a point of interest in peer reviewed literature. PURPOSE: To evaluate the additional advantage of injecting subtarsal steroid injection simultaneously with incision and curettage of multiple eye lid chalazion. METHODS: This intervention study was carried out in the Ophthalmology unit of Khalid Eye Clinic, Karachi from February to July 2019 and included fifty patients of both male and female with age ranging between 15-45 years. The patients were distributed into two groups with twenty-five patients in each group. Group A included patients undergoing incision and curettage only for eye lid multiple chalazion, whereas, Group B included patients undergoing incision and curettage with simultaneous subtarsal steroid injection. Post operatively patients were advised to do hot compresses for at least five days and observe the resolution of swelling and recurrence of chalazion for up to six months. RESULTS: The average time for resolution of the swelling in group A patients was 4.4±1.45 days, but eleven out of the twentyfive patients developed chalazion on the same eye lid again within the follow up period. Although group B patients took 6.0±2.7 days for the resolution of swelling but none of them developed recurrent chalazion within the follow up period. CONCLUSIONS: Patients undergoing incision and curettage with simultaneous steroid injection proved to have an additional benefit in terms of reduction in recurrence of chalazion.

The Experience Of Intralesional Bleomycin For Orbital Vascular Anomalies.

BACKGROUND: Orbital vascular anomalies are congenital and pose a challenge. They require various treatment modalities which are often unsuccessful. The use of intralesional Bleomycin has gained popularity in recent times as a scar less procedure when other treatment modalities are not effective. PURPOSE: To share the experience of using intra lesional Bleomycin in orbital vascular anomalies in a Tertiary care hospital. METHODS: This quasi-experimental study was carried out at Layton Rahmatullah Benevolent Trust (LRBT) Teaching Tertiary care hospital, Karachi from 1st June to 31st December 2018. It included fifteen patients of various orbital vascular anomalies treated with injection of intra lesional sclerosing (Bleomycin) agent. Patients were given multiple injections and the effects of sclerosing agent on orbital vascular anomalies were observed. RESULTS: Results were excellent in terms of regression of vascular anomalies. CONCLUSIONS: Intralesional sclerosing agent (Bleomycin) has an outstanding role in vascular tumour.

23-gauge sutureless vitreo-retinal surgery for superior rhegmatogenous retinal detachment.

OBJECTIVE: To determine the results of 23-gauge sutureless vitreo-retinal surgery for superior/supero-temporal rhegmatogenous retinal detachment (RRD). STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: LRBT, Free Base Eye Hospital, Karachi, from January 2010 to December 2011. METHODOLOGY: Adult patients who underwent 23-gauge sutureless vitreo-retinal surgery along with use of Perfluoropropane (C3F8) gas as internal tamponading agent for fresh (upto 3 weeks) superior/supero-temporal RRD was reviewed. Major outcome measures were anatomical success, best corrected visual acuity (BCVA) with Log Mar and complications during and after surgery. Postoperative follow-up was done on 1st day and at 1st, 4th, 8th and finally at 12th week. RESULTS: Sixty eyes of 60 patients, age between 30 - 60 years including 37 (61.67%) males and 23 (38.33%) females having superior or superatemporal RRD underwent 23-guage sutureless vitreo-retinal surgery with the use of perfluoropropane (C3 F8) gas as internal temponade at the end of procedure. Anatomical success rate was 81.66% (49 out of 60 eyes) with first surgery and raised to 90% (54 cases) with second surgery. Log Mar BCVA significantly improved from mean baseline 0.93 to 0.49 with mean difference of 0.43 (p < 0.001), 95% confidence interval. Postoperative complications were sub-conjunctival haemorrhage in 11 eyes (18.33%), wound leak in 7 eyes (11.66%), anterior chamber became shallow in 6 eyes (10%), cataract developed in 5 eyes (8.33%), re-retinal detachment in 4 eyes (6.66%), ocular hypotony and sterile inflammatory reaction in 3 eyes (5%) each, while iatrogenic breaks developed in 2 eyes (3.33%). CONCLUSION: The 23-gauge sutureless vitreo-retinal surgery for superior rhegmatogenous retinal detachment achieved high anatomical success and significant visual improvement. Sub-conjunctival haemorrhage was the most frequent procedural complication.

Management of Macular Pre-Retinal Subhyaloid hemorrhage by Nd:Yag laser hyaloidotomy.

OBJECTIVE: To evaluate the efficacy, visual outcome and complication following Nd:Yag laser hyaloidtomy for subhyaloid hemorrhage. METHODS: This interventional case series was managed at LRBT, Free Base Eye Hospital Karachi from January 2010 to December 2010. It included 30 eyes of 30 patients with subhyaloid hemorrhage due to different causes which underwent Nd: Yag laser sublyaloidotomy Results: Out of thirty patients, eighteen (60%) were male and twelve (40%) were females. Mean age was 32.57 years. Males pre-dominated the study. Pre laser visual acuity was between counting finger at one meter in 22 patients (73.33%) and between counting finger one meter to hand movement in 8 patients (26.66%). Vision improved to 6/6 in 10 patients (33%), 6/9 - 6/12 in 17 patients (56.66%) and between 6/24 - 6/60 in 3 patients (9.99%) at the end of follow up. Complications were persistent vitreous hemorrhage in one (3.33%) patient, failed drainage in one (3.33%) patient and metamorphopsia in one (3.33%) patient. CONCLUSION: Nd: Yag laser hyloidotomy is an excellent technique for management of Subhyaloid hemorrhage with early visual recovery provided there is no macular pathology.

Outcomes of silicone oil removal.

OBJECTIVE: To evaluate the outcome and complications of removal of silicone oil after pars plana vitrectomy. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rahmatullah Benevolent Trust (L.R.B.T), Free Base Eye Hospital, Karachi, from February 2008 to January 2011. METHODOLOGY: Ninety five eyes of 95 patients with a history of undergoing three-port pars plana vitrectomy were included in this study that subsequently underwent removal of silicone oil. Silicone oil was removed after ophthalmoscopically determining retina attachment or when the duration of silicone oil tamponade was atleast of 6 months. Patients were followed for a period of 12 months. RESULTS: Retinal re-detachment was seen in 19 (20%) out of 95 eyes, vitreous haemorrhage in 2 (2.1%) out of 95 eyes, corneal decompensation in 6 (6.3%) out of 95 eyes, hypotony in 7 (7.3%) out of 95 eyes, phthisis bulbi in 2 (2.1%) out of 95 eyes and lens opacification in 9 (9.4%) out of 95 eyes. CONCLUSION: In this study, silicone oil removal resulted in various complications among which retinal re-detachment was the most frequent.

Combined trabeculotomy and augmented trabeculectomy in primary congenital glaucoma.

OBJECTIVE: To evaluate the results of combined trabeculotomy and augmented trabeculectomy as a primary procedure on intraocular pressure and corneal clarity in uncomplicated congenital glaucoma. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: L.R.B.T Free Base Eye Hospital, Karachi, from January 2007 to December 2010. METHODOLOGY: Twenty eyes of 14 consecutive children with primary congenital glaucoma who had primary trabeculotomy and augmented trabeculectomy were observed from January 2007 to December 2010 at LRBT Free Base Eye Hospital, Karachi. Main outcome measures were pre-operative and postoperative intraocular pressure, corneal clarity and complications. RESULTS: Out of 14 patients, 9 patients (64.2%) were male and 5 patients (35.7%) were female with age ranging between 5 months to 6 years. Mean duration of follow-up was 8.25 months. Seventeen eyes (85%) showed improvement in corneal clarity from baseline at their last follow-up. Mean intraocular pressure decreased from 32 ± 2.5 mmHg pre-operatively to 13 ± 2.5 mmHg postoperatively at the last follow-up (p < 0.001). Complete success (intraocular pressure < 20 mmHg) was obtained in 16 (80%) out of 20 eyes. Complications encountered were vitreous loss per-operatively while performing iridectomy in 1 eye (5%), shallow anterior chamber on the first postoperative day in 1 eye (5%) and hyphema in 1 eye (5%). CONCLUSION: Combined trabeculotomy and augmented trabeculectomy for primary congenital glaucoma resulted in improvement in reduction of intraocular pressure as well as improvement in corneal clarity. Hence, combined trabeculotomy and augmented trabeculectomy is a safe and effective procedure for primary congenital glaucoma.

Visual outcome of pars plana vitrectomy for dropped nucleus after phacoemulsification.

OBJECTIVE: To determine the visual outcome of patients who underwent pars plana vitrectomy for dropped nucleus after phacoemulsification. STUDY DESIGN: Interventional case series. PLACE AND DURATION OF STUDY: LRBT Free Base Eye Hospital, Karachi, from February 2008 to January 2011. METHODOLOGY: Forty-eight eyes of forty eight patients having history of dropped nucleus (soft remnant, half nucleus or complete nucleus) underwent 20 gauge pars plana vitrectomy within 24 days of phacoemulsification. After complete vitrectomy nucleus was lifted with the help of perfluorocarbon and removed either through a limbal incision or by using phacofragmenter, whereas small lens remnants were removed with a vitreous cutter. Intraocular lens was implanted at the end of surgery. Postoperative visual acuity, and any complications were assessed. Patients were followed for a period of 12 months. RESULTS: Final visual acuity ranged from 6/9 to 6/18 in 34 eyes (70.83%), 6/24 to 6/36 in 8 eyes (16.66%) and 6/60 or less in 6 of 48 eyes (12.5%). Complications included raised intraocular pressure in 6 eyes (12.5%) and retinal detachment in 2 eyes (4.1%), corneal oedema and decompensation in 3 eyes (6.25%) and cystoids macular oedema in 4 cases (8.33%) out of 48 cases. CONCLUSION: The loss of crystalline lens in the vitreous during phacoemulsification is a severe complication, but appropriate and timely management can restore good visual outcome and minimize complications.