Recurrence rate with use of intraoperative Mitomycin C versus Conjunctival Autograft following pterygium excision.

UNLABELLED: Objective s : To determine the recurrence rate following Conjunctival Autograft versus Mitomycin C for pterygium excision. METHODS: Fifty Patients in this Randomized Clinical Trial who underwent pterygium excision from July 2013 to October 2013 at Department of Ophthalmology, Ziauddin University Hospital, Keamari, Karachi were included. All patients underwent detailed ophthalmic examination before surgery. Few drops of lidocaine were instilled, subconjunctival xylocaine 2% was injected. The pterygium was then excised from bulabar conjunctiva and peeled off from the corneal surface. Mitomycin C was applied to bare sclera in group A and Conjunctival autograft taken from superior bulbar conjunctiva of same eye was sutured to the bare sclera in group B. Data for pterygium recurrence was collected and analyzed using SPSS version 17. RESULTS: Among the 50 patients operated 64% (n=32) were male and 36% (n=18) female. Their age ranged from 28 -58 years with mean age 44.8yrs. Right eye was affected in 54% (n= 27) patients and left in 46% (n= 23). In group "A" (intraoperative MMC) conjunctival granuloma was noted in 1(4%), pterygium recurrence 4(16%) and ocular irritation was experienced by 5 (20%) patients. In group "B" (CAG) graft retraction was seen in 2(8%), patients, 1(4%) patients experienced persistent redness over the grafted tissue and pterygium recurrence was seen in 2(8%) patient. All of them were followed at day 1, week1, week 4 and week 12. CONCLUSION: Both Conjunctival Autograft and Mitomycin C are effective in reducing the recurrence of pterygium but CAG gives better cosmetic results, the only drawback with it is the duration of the procedure.

Sodium hyaluronate eye drops in the treatment of dry eye disease: an open label, uncontrolled, multi-centre trial.

BACKGROUND: Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. The objective of this study was to assess the performance of sodium hyaluronate eye drop for eight weeks in patients with DED. PATIENTS AND METHODS: This was a multi-centre, open-label, uncontrolled clinical trial carried out at different centres of Pakistan, from August 2009 to November 2010. A total of 250 diagnosed patients of Dry Eye who met the inclusion criteria were included in the study. After informed written consent, all patients having at least 2 of the Dry Eye symptoms, and at least 1 of the tests (Tear Film Break-up time (TBUT) < or = 10 second, Schirmer's test < or = 6 mm/5 min, and positive corneal staining) were enrolled. Tolerability/safety assessments consisted of monitoring and recording of adverse events and physical examinations at baseline, 4th week and 8th week. RESULTS: Out of 250 allocated patients 13 dropped out. The mean age of the patients was 47.6 +/- 13.8 year and out of 237 patients 86 (36.3%) were men and 151 (63.7%) were women. At the initial visit the foreign body sensation was 80%, itching 68%, burning 58%, watering 38%, photophobia 38%, and feeling of dryness was 16%. At the 3rd visit the foreign body sensation decreased to 32%, itching to 32%, burning to 20%, watering to 12%, photophobia to 18%, and feeling of dryness to 14%. CONCLUSION: Sodium hyaluronate has a beneficial effect on the conjunctival epithelium in a well-defined and homogeneous population of patients with dry eye and can be considered useful for the treatment of dry eye.

Anatomic pattern of arteriovenous crossings in branch retinal vein occlusion.

OBJECTIVE: To determine the relative position of the two vessels at the site of venous obstruction, as it facilitates Arteriovenous adventitial sheathotomy and to look for the associated diseases with branch retinal vein occlusion (BRVO) so as to create more awareness among the masses. METHODS: It was a case series carried out at the Ophthalmology out-patient department of Ziauddin University Hospital Karachi, Pakistan, from April 2005 to March 2006. The diagnosis of BRVO was made on the clinical basis. The fundus was photographed for confirmation and record purpose. The relative anatomic position of artery and vein at the site of occlusion, and the quadrant of occlusion were recorded. The associated diseases with BRVO were also identified. RESULTS: Seventy patients were enrolled in the study. Forty nine were males and twenty one were females. Mean age of the male group was 51.5 + 8 years Mean age of the female group was 49.4+ 8.5 years. In all, there were seventy-two eyes with branch retinal vein occlusion. In seven eyes the relevant position of the artery and vein could not be ascertained. In 63 eyes (96.9%) the artery was anterior to the vein, and in the remaining 2 eyes (3.1%) the vein was anterior to the artery. There was a greater number of superotemporal occlusions as compared to inferotemporal occlusions. Fifty seven (81.4%) cases had associated hypertension, two (2.85%) had diabetes, seven (10%) had diabetes and hypertension, and four (5.7%) had no associated diseases. Fellow eyes were compared with the vein occlusion sites and the vein occlusion eyes. The differences were statistically significant (p.001), with a greater prevalence of arterial over crossings in the affected eye. CONCLUSIONS: The study shows that artery lies anterior to the vein in almost all cases of BRVO. The study shows that more hypertensives present with BRVO as compared with diabetics and diabetics cum hypertensives.

Branch retinal vein occlusion.

Retinal vein occlusions (RVO) are the second commonest sight threatening vascular disorder. Branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) are the two basic types of vein occlusion. Branch retinal vein occlusion is three times more common than central retinal vein occlusion and- second only to diabetic retinopathy as the most common retinal vascular cause of visual loss. The origin of branch retinal vein occlusion undoubtedly includes both systemic factors such as hypertension and local anatomic factors such as arteriovenous crossings. Branch retinal vein occlusion causes a painless decrease in vision, resulting in misty or distorted vision. Current treatment options don't address the underlying aetiology of branch retinal vein occlusion. Instead they focus on treating sequelae of the occluded venous branch, such as macular oedema, vitreous haemorrhage and traction retinal detachment from neovascularization. Evidences suggest that the pathogenesis of various types of retinal vein occlusion, like many other ocular vascular occlusive disorders, is a multifactorial process and there is no single magic bullet that causes retinal vein occlusion. A comprehensive management of patients with retinal vascular occlusions is necessary to correct associated diseases or predisposing abnormalities that could lead to local recurrences or systemic event. Along with a review of the literature, a practical approach for the management of retinal vascular occlusions is required, which requires collaboration between the ophthalmologist and other physicians: general practitioner, cardiologist, internist etc. as appropriate according to each case.