Cataracta nigra (black cataract): a challenging task made easy with sutureless manual extracapsular cataract extraction.

BACKGROUND: Cataract surgery is constantly evolving and various procedures having their merits and demerits are practiced by ophthalmologists all over the world. The objective of this study was to evaluate the safety, efficacy, visual outcome and complications of sutureless manual extracapsular cataract extraction (SMECE) in the management of patients with black cataracts using envelop anterior capsulotomy and soft shell technique. METHODS: In a prospective observational study conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, from January 2008 to December 2009, a total of 125 consecutive patients with black cataract underwent cataract extraction using SMECE with an envelop or V-type anterior capsulotomy and soft shell technique. Their operative, postoperative complications, visual outcome and efficacy were analysed. RESULTS: Of 125 eyes with black cataracts SMECE was performed through a 12 O'clock sclerocorneal tunnel. The main Intraoperative complication was hyphaema in 10 (8%) patients. Postoperatively 9 (7.2%) patients had hyphaema. Fifteen (12%) eyes had some amount of striate keratitis superiorly. Twenty (16%) of patients had mild iritis. On 6th week follow-up 100 (80%) patients achieved uncorrected visual acuity of 6/6 to 6/18. CONCLUSION: SMECE with envelop or V-type anterior capsulotomy and soft shell technique is a safe and effective technique of cataract extraction in Cataracta Nigra (black cataract).

Clinico-pathologic study of 70 enucleations.

OBJECTIVE: To assess patients' history, demographic charactertics, cause for enucleation and orbital implant trends. METHODS: A cross-sectional descriptive case study of 70 patients who underwent enucleation for various reasons between January 2004 to June 2007 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar were reviewed. The patients' history, demographic characteristics, cause for enucleation after histopathology and the type of orbital implant were analyzed. RESULTS: Seventy eyes of patients who underwent enucleation were reviewed. The male patients were 62.85% and female 37.14%. The most common age group involved was paediatric in 51.42%. Retinoblastoma was the most common indication for enucleation in 42.85% of children followed by choroidal melanoma in 17.14%, painful blind eye in 11.42% and phthisis bulbi in 8.57% in adults. Enucleation with orbital implant was done in 45.71%, with dermofat graft in 34.28% and no implant in 20%. The most common complication being erosion in 21.87% and excessive discharge in 15.62%. CONCLUSIONS: Males were the usual victims. Majority of patients were of paediatric age group. The most common indications for enucleation was retinoblastoma in children and choroidal melanoma and painful blind eye in adults.

Risk factors of preseptal and orbital cellulitis.

OBJECTIVE: To estimate the frequency and major risk factors of preseptal and orbital cellulitis. STUDY DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. METHODOLOGY: All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. RESULTS: The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant (p>0.5). Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. CONCLUSION: For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II.

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.

Frequency and causes of bilateral occular trauma.

OBJECTIVE: To determine the frequency and causes of bilateral ocular trauma. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from October 1999 to September 2006. PATIENTS AND METHODS: All patients coming to the hospital with bilateral eye trauma and requiring admission were recruited into the study. The details of patients' demographics, risk factors, ocular examination, treatment offered and final visual acuity were noted and described as frequency and percentages. RESULTS: Out of a total of 1551 patients of hospitalized ocular trauma, 46 (2.9%, 92 eyes) had bilateral ocular trauma. The majority (54.3%) were due to landmine blast injuries followed by dynamite blast in 10.8%, coalmine blast and firearm injury in 6.5% each. Pressure cooker explosion and road traffic accident was the cause in 4.3% each. Gas cylinder and automobile battery explosion, alkali and acid burn, assault and incidental trauma occurred in 2.1%. Sixty three percent were between 16 and 40 years of age. Males were affected in 93.4%. Corneal and / or scleral repair was done in 58.6%, conjunctival and or corneal foreign body removal in 26% and extracapular cataract extraction with intraocular lens implantation in 16.3%. The visual acuity was in the range of 6/60 and perception of light in 54.3%, while in 21.7%, there was no perception of light at the time of admission. Due to severity of injury, the final visual acuity was poor and only 28.2% regained vision between 6/18 and 6/60. CONCLUSION: In this series, landmine, dynamite and coalmine blasts were the major causes of bilateral ocular trauma. Victims were usually young males. Due to severity of ocular trauma, majority had poor visual outcome.

Spectrum of ocular surface squamous neoplasia.

OBJECTIVE: To describe the pattern of ocular surface squamous neoplasia (OSSN), clinical presentations, the risk factors and treatment options. DESIGN: An observational case series. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. PATIENTS AND METHODS: The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterality and risk factors were entered into a specially-designed proforma. Each patient was also assessed biomicroscopically for type and complications of ocular surface neoplasia. RESULTS: The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female (65.7% vs 34.3%) with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. CONCLUSION: The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality.

Patterns of ocular trauma.

OBJECTIVE: To describe the patterns of ocular trauma, cause of injury and its effects on eye. DESIGN: A retrospective case series. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from January 1999 to June 2004. PATIENTS AND METHODS: Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. RESULTS: Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common [520 eyes (46.18%)] than closed globe injuries [484 eyes (42.98%)]. 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. CONCLUSION: Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes.

Proptosis: etiology and demographic patterns.

OBJECTIVE: To determine the demographic pattern of patients presenting with proptosis and its etiology. DESIGN: A cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex, Peshawar from July 2001- December 2002. PATIENTS AND METHODS: Sixty cases of proptosis presenting at KIOMS were included. Thirtysix patients were male while 24 were female. They were divided into two age groups; 0-15 years (paediatric group) and above 15 years (adult group). An elaborate work up plan was formulated for all patients, which included detailed history, clinical examination (ocular, orbital and systemic), radiological and histopathological investigations. RESULTS: Neoplasms (33%) were the most common causes of proptosis in all the patients followed by orbital inflammations (23%), orbital infections (20%), structural abnormalities (12%), vascular abnormalities (7%) and trauma (5%). CONCLUSION: Neoplasms were the most common cause of proptosis in both paediatric and adult group. Proptosis was the cardinal feature and visual deterioration was present in more than half of the patients. Timely referral, early diagnosis and appropriate management can result in reduction of visual morbidity.

Corneal complications of vernal catarrh.

OBJECTIVE: To identify the magnitude and types of corneal complications of vernal catarrh and the extent of visual impairment caused by them. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex (HMC), Peshawar, from March, 1999 to May, 2000. SUBJECTS AND METHODS: All cases of vernal catarrh who agreed to an informed consent were included in the study. Patients who were difficult to be examined by a slit lamp were excluded from the study. The diagnosis was made mainly on the basis of history and clinical examination. Slit lamp examination was done in every case together with fluorescein staining of cornea. The variables were recorded and statistically analyzed. RESULTS: Superficial punctate keratitis (45%) was the most common corneal complication. Visual impairment was more pronounced in cases with shield ulcers (14%) and corneal plaques (8%). A strong association with keratoconus (15%) was also noted. Corneal opacification (9%), hydrops (6%) and pseudogerentoxon (3%) were also found. CONCLUSION: Corneal complications in VKC are common, potentially serious and may cause marked visual impairment.

A review of 120 cases of dacryocystorhinostomies (Dupuy Dutemps and Bourguet technique).

BACKGROUND: The study was conducted at the DHQ hospital Lakki Marwat from Jan, 1999 to Dec, 2002 to assess the intra and postoperative complications and success rate of external dacryocystorhinostomy (DCR) with suturing of the bridge between anterior flaps of nasal mucosa and lacrimal sac with the muscle layer. METHOD: We operated upon 120 patients suffering from chronic dacryocystitis (CDC). Females were 81 (67.5%) and males were 39 (32.5%). Majority of the patients were between the age group 40 to 60 years. Indications for dacryocystorhinostomy (DCR) were epiphora, acute on chronic dacryocystitis and a mucocele. All the cases were operated under local anaesthesia with external approach and only anterior flap suturing and engaging it in the muscle layer. These patients were followed for a period of six months. RESULTS: The overall success rate was 98.33%. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing. CONCLUSIONS: Dacryocystorhinstomy is a safe procedure under local anaesthesia. It is associated with minimal complications, which can be easily managed. This technique has a very high success rate and a short learning curve.