Determination Of Association Of Pigmentary Glaucoma With Pigment Dispersion Syndrome.

BACKGROUND: Pigment Dispersion Syndrome (PDS) is an autosomal dominant disorder of white males between 20 to 40 years of age characterized by deposition of pigment on the lens, zonules of lens, trabecular meshwork and corneal endothelium (Krukenberg's spindle) in addition to radial, spoke like transillumination defects in the mid peripheral iris. This study was conducted to determine the frequency of occurrence of Pigmentary Glaucoma in patients with Pigment Dispersion Syndrome (PDS). METHODS: This longitudinal follow up study included patients presenting with Krukenberg's spindle on the endothelial side of cornea and pigmentation of angle of anterior chamber seen on slit lamp examination and gonioscopy. RESULTS: Seventy-two cases of PDS were included in the study, amongst them 63 (87.50%) were males. Mean age was 35.00±6.54 years (range 24-46 years). Forty-seven (65.28%) patients had an IOP in the range of 10-14 mmHg, 22 (30.56%) patients had an IOP in the range of 15-18 mmHg and 3 (4.17%) patients developed an IOP of greater than 19 mmHg. Fundoscopy showed myopic degeneration in 49 (68.06%) patients and optic disc cupping in 3 (4.17%) patients. Four (5.56%) patients had refractive error between +1D to +3D, 9 (12.50%) patients had refractive error between -1D to -4D, 21 (29.17%) patients had refractive error between -5 D to -8 D and 38 (52.78%) patients had refractive error between -9 D to -12 D. Our study showed that one patient having PDS developed glaucoma at 5 years of follow up and three patients developed glaucoma at 14 years of follow up. CONCLUSIONS: On the basis of this study we conclude that early onset primary open angle glaucoma associated with PDS or Juvenile glaucoma associated with PDS might have been mistaken as Pigmentary Glaucoma in Pakistani patients and a distinct entity in the form of Pigmentary Glaucoma may be non-existent.

Outcome of recurrent pterygium with intraoperative 0.02% mitomycin C and free flap limbal conjunctival autograft.

OBJECTIVE: To determine the re-recurrence and the postoperative complications in recurrent pterygium cases treated by intraoperative 0.02% Mitomycin C (MMC) and conjunctival autograft (CAG). STUDY DESIGN: Quasi-experimental. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad and Chandka Medical College Hospital, Larkana, from January to December 2010. METHODOLOGY: Cases with recurrent pterygium were included in this study. Cases with history of first time pterygium and pterygium with conjunctival scarring, dry eye, glaucoma and vitreoretinal disease were excluded. After topical and subconjunctival anaesthesia, pterygium was excised in single piece. Intraoperative 0.02% MMC was applied on bare sclera for 2 minutes. CAG was excised from supero-temporal conjunctiva, and implanted on bare sclera. All cases were followed-up for 6 months. Re-recurrence was defined as postoperative fibrovascular re-growth of 1.0 mm or more crossing the corneo-scleral limbus. Data was analysed as descriptive statistics. RESULTS: A total of 65 eyes of 65 cases were studied having mean age of 43.26 ± 12.81 years. Among those, 41 (63.1%) were males and 48 (73.8%) belonged to rural area. The size of pterygium on cornea was 2-3 mm in 44 (67.7%) cases and 4-5 mm in 21 (32.3%) cases. Re-recurrence of pterygium was seen in 3 (4.6%) cases. Postoperative complications included conjunctival granuloma in 2 (3.1%) cases, graft necrosis in 2 (3.1%) cases, graft oedema in 3 (4.6%) cases and graft displacement in 3 (4.6%) cases. CONCLUSION: The intraoperative application of 0.02% MMC with CAG markedly reduces the risk of re-recurrence of pterygium and postoperative complications.

Incidence and visual outcome of acute postoperative endophthalmitis.

OBJECTIVES: To assess the incidence and visual outcome of acute post operative endophthalmitis treated by intravitreal antibiotics. METHODS: This Prospective study was conducted at Department of Ophthalmology, Liaquat University Eye Hospital Hyderabad from November 2002 to October 2010. One hundred and nine patients of acute post operative endophthalmitis were treated with intravitreal antibiotics. The inclusion criteria of the patients was the clinical diagnosis of acute post operative endophthalmitis within 14 days of post operative period and visual acuity better than or equal to hand movement close to face. After enrolment, vitreous tap was carried out followed by intravitreal antibiotics injection. The outcome was measured in terms of clinical resolution of endophthalmitis and post resolution best corrected visual acuity. RESULTS: Of the 109 patients 97 meet the criteria and followed completely were included. Sixty patients (61.9%) had extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation while phacoemulsification done in 37 (38.10%) patients. The visual acuity at presentation was 6/60 or worse in 80 (82.5%) patients. Vitreous tap was done in 86 (88.7%) patients. Vitreous biopsy yields an organism in 32 (33%) patients. Coagulase positive were the most common organism. 75 (77.3%) patients received single dose of intravitreal antibiotic. Forty five (46.4%) patients received single antibiotic, cetazidime while two antibiotics given in 52 (53.6%) patients. Twenty five (25.8%) patients also had oral steroids. Ninety one (93.8%) patients responded to intravitreal antibiotics. Seventy five (77.32%) patients achieved final visual outcome better than 6/60 in meantime of 54.08 days. Six (6.2%) patients developed no perception of light and another six patients (6.2%) referred for vitrectomy. CONCLUSION: The final visual outcome of the patients with acute postoperative endophthalmitis is strongly associated with the visual acuity at presentation as well as type of infective organisms.