Effect Of Intra Vitreal Injection Of Bevacizumab On Intra-Ocular Pressure.

BACKROUND: Bevacizumab has been in use as a therapeutic agent for macular oedema for several years. While its efficacy has been well documented, its use has been shown to cause a transient rise in the intra-ocular pressure. The aim of this study was to evaluate the long term effect of intravitreal injection of Bevacizumab on Intra-ocular pressure. METHODS: One hundred eyes (n=100) of one hundred patients, requiring intra-vitreal injection of Bevacizumab for diabetic macular oedema were recruited from Shifa Foundation Community Health Centre (SFCHC) between January and December 2014. Patients of glaucoma, ocular hyper-tension, known allergy to Bevacizumab or had injections of Bevacizumab prior to the study were excluded. Intra-ocular pressure was measured using a Goldmann applanation tonometer, prior to, and at six and twelve months after the injection. The pre- and post- injection Intra-ocular pressure was entered into the database. Test of significance was applied to investigate whether there was a significant change in intra-ocular pressure after the injection. RESULTS: The mean age of the patient was 56.97 years (±14.97). The mean intra-ocular pressure was 13.86 (±3.16) mmHg before injection, while postinjection mean Intra-Ocular pressure was 14.21 (±3.12) mmHg and 13.79 (±3.07) at six and twelve months respectively. Between baseline and six months there was a statistically significant difference in intra-ocular pressure (p=0.03), while no significant difference existed in the intraocular pressure between baseline and twelve months (p=0.92). CONCLUSIONS: Intra-vitreal injection of Bevacizumab is associated with a statically significant rise in intra-ocular pressure at six months, while no significant difference was seen at twelve months compared to baseline.

Analysis of retinal nerve fibre layer changes in anisometropic amblyopia by Heidelberg retina tomograph.

OBJECTIVE: To identify if anisometropic amblyopia is associated with changes in optic disk morphology. METHODS: The study comprised a total of 80 eyes recruited from Shifa Foundation Community Health Centre and the Pakistan Institute of Medical Sciences, Islamabad between May and October 2012. Anisometropic amblyopia was the only cause of disability (visual acuity > or = 6/12) in amblyopic eyes whereas normal eyes had a best corrected visual acuity of 6/6 and no morbidities. Patients with other causes of amblyopia, co-morbid ocular diseases, and in whom a good-quality image could not be obtained were excluded. Mean retinal nerve fiber layer thickness was analysed using Heidelberg retina tomograph. Analysis of frequency distribution, probability and regression were run on the data collected during the study using SPSS version 15.0. RESULTS: The mean age of the patients was 23.85 +/- 5.85 years. The retinal nerve fibre layer thickness ranged between 0.09 mm and 0.35 mm (mean: 0.23 mm +/- 0.07) in amblyopic eyes, and between 0.18 mm and 0.36 mm (mean: 0.25 mm +/- 0.05) in normal eyes. The difference was not statistically significant (p = 0.087). No association was found between the retinal nerve fiber layer thickness or the age and refractive error of patients. CONCLUSION: The optic disk does not appear to be the site of morphological changes in amblyopia.

Management of anisometropic abmlyopia in adults.

Amblyopia is characterised by decrease in vision in one or both eyes as a result of processing defect in the visual pathways of the brain. It is considered an irreversible process if detected in the adult age group. This study was conducted from July 1 to December 31, 2010, at Shifa Foundation Community Health Centre, Islamabad, to determine if anisometropic amblyopia detected in adults can be reversed. A total of 15 adults, 11 (73.33%) males and 4 (26.66%) females, were managed for anisometropic amblyopia. All the patients were prescribed full cycloplegic correction in the anisometropic eye simultaneously with part-time occlusion therapy. Success was defined as visual acuity of 6/18 or better at the end of the therapy. All patients were required to complete a structured questionnaire regarding their experiences with the therapy. Reversal of amblyopia was observed in 11 (73.33%) patients who felt more confident about performing tasks for which they had earlier considered themselves unsuitable. Poor compliance was responsible for not producing the desired outcome in 4 (26.66%) patients. Anisometropic amblyopia in adults is reversible with dedicated efforts on behalf of both the ophthalmologist and the patient.

Enhancing Empathy in Medical Students by Focused Learner Centered Activities.

OBJECTIVES: To determine the change in empathy levels of medical students during their progress in professional years internship, and to examine change in empathy after targeted empathy enhancing activities during the course of medical school. STUDY DESIGN: Longitudinal Study. PLACE AND DURATION OF STUDY: Shifa College of Medicine/ Shifa Tameer-e-Millat University, Islamabad, from January 2015 to December 2019. METHODOLOGY: Student version of Jefferson Scale of Physician Empathy was administered sequentially from 2015 to 2019 which evaluated the change in empathy of medical students in a class of 2019. Targeted empathy-enhancing activities included patient-centered module in year-three and stress management workshops in the final year of medical school. RESULTS: Empathy scores rose from the first year of study (4.27 ±0.38) to the third year (4.52 ±0.70). It fell over the next two years of study (4.25 ±0.62 & 4.21 ±0.40) before rising again during the internship (4.39 ±0.43) with focused empathy-enhancing activities. CONCLUSION: Patient-centered module which focused on activities that help develop empathy may have been a factor in the increase of empathy scores in the third year and internship. Placing recurring formal activities throughout all clinical years may help in enhancing empathy in medical students. KEY WORDS: Medical student empathy, Empathy enhancing targeted activities, JSPE.

Association of Severity of Allergic Conjunctivitis with Skin Prick Test.

OBJECTIVE: To investigate the association between skin prick test and severity of allergic conjunctivitis. STUDY DESIGN: Cross sectional observational study. Study Place and Duration of Study: Akbar Niazi Teaching Hospital, Bara Kahu, Islamabad, between March and September 2019. METHODOLOGY: 150 eyes of 150 diagnosed cases of allergic conjunctivitis, who had had a skin prick test, were included in the study. Cases with other concurrent ocular surface diseases, conjunctivitides, systemic allergies, and those on systemic steroids, anti-histamines and tricyclic antidepressant agents were excluded. Signs of allergic conjunctivitis were graded via slit-lamp examination using a 5-5-5 exacerbation grading scale. Allergic conjunctivitis was classified as being severe if the total score was ≥230, moderate if the score was >20 and <230, and mild if the score was ≤20. Frequency distribution was reported for age, gender and result of skin prick test. Test of significance and correlation analysis was carried out between the result of skin prick test and the severity of allergic conjunctivitis using Statistical Package for Social Sciences version 20.0. A p-value of <0.05 was taken as significant. RESULTS: Mean age was 18.62 (±8.15) years in 91 males and 59 females. Mild (n = 28), moderate (n = 77), and severe (n = 45) cases showed no statistically significant correlation with the skin prick test (positive or negative) in any of the three categories (mild p = 0.44, r = 0.153, moderate p = 0.89, r = 0.016, and severe p = 0.73, r = 0.052). CONCLUSION: Skin prick test did not show a significant association or correlation with the severity of allergic conjunctivitis. Key Words: Allergic conjunctivitis, Hypersensitivity, Skin prick test.

Relationship between Student Performances in Non-Cognitive Skills in Multiple Mini Interview and Integrated Practical Examination.

OBJECTIVE: To investigate the relationship between the performances of students in non-cognitive skills in Multiple Mini Interview (MMI) and Integrated Practical Examination (IPE) of the first year of medical school. STUDY DESIGN: Cross-sectional observation study with statistical support. PLACE AND DURATION OF STUDY: Shifa College of Medicine/Shifa Tameer-e-Millat University, Islamabad between December 2015 and March 2016. METHODOLOGY: Student performance in communication skills, domain of the 8-station Multiple Mini Interview, was compared with their scores in communication skills in the first Integrated Practical Examination taken at the end of first block. Descriptive statistics were calculated for student demographics, scores in communication skills in MMI as well as IPE. Pearson's Correlation was calculated to investigate the relationship between the two scores. A p-value of <0.05 was taken as significant. RESULTS: The mean score in MMI was 130.38 ±9.90 as compared to a score of 79.96 ±19.74 in the IPE. This relationship has a statistically significant (p<0.001) positive correlation, with a Pearson's correlation of 0.52. CONCLUSION: Student performance shows a positive correlation in non-cognitive skills between Multiple Mini Interview and Integrated Practical Examination.

Central Corneal Thickness and its Relationship to Intra-Ocular and Epidmiological Determinants.

OBJECTIVE: To measure central corneal thickness in Pakistani population and determine its relationship to intra-ocular pressure, age, gender and ethnicity. STUDY DESIGN: Cross-sectional observation study. PLACE AND DURATION OF STUDY: Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between December 2013 and February 2015. METHODOLOGY: The right eyes of 1000 cases (496 males and 504 females) were recruited for this study. Inclusion criteria were Pashtun or Punjabi ethnicity, intra-ocular pressure < 22 mmHg, gonioscopically open angles, cup-disk-ratio < 0.5, and age matched normal visual fields. Cases with prior ocular surgery, contact lens use, corneal pathologies, myopia or hypermetropia > ±3.0 diopters, astigmatism of > ±1.0 diopters were excluded. Central corneal thickness was measured using a TopCon non-contact specular microscope. Intra-ocular pressure was measured using Goldmann applanation tonometer. Frequency distribution, test of significance, and regression analysis was carried out using Statistical Package for Social Sciences version 20.0. RESULTS: Mean age was 47.31 ±11.78 years. Ethnic composition was 51.6% (n=516) Pashtun and 48.4% (n=484) Punjabi. The mean central corneal thickness was 503.96 (±12.47) µm, while the mean intra-ocular pressure was 15.61 (±2.68) mmHg. Regression analysis showed a significant association between central corneal thickness and intra-ocular pressure (p=0.00) and age (p=0.00). A±100 µchange in central corneal thickness was associated with change in IOPof ±3.30 mmHg, whereas central corneal thickness decreased by 0.12 µm per year. No significant association could be established between central corneal thickness and ethnicity (p=0.19). CONCLUSION: Central corneal thickness of the studied races was comparable to non-Caucasians which affects intra-ocular pressure measurements, and decreases with increasing age. No relationship was observed between central corneal thickness and ethnicity or gender.

Reducing postoperative pterygium recurrence: comparison of free conjunctival auto-graft and conjunctival rotation flap techniques.

OBJECTIVE: To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. METHODOLOGY: Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of ³ 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group (n=26) cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group (n=31) cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann-Whitney U-test was carried out using Statistical Package for Social Sciences (SPSS) version 20. RESULTS: The median (and inter-quartile range) age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 (51.50-63.00) and 57 (45.00-60.00) years, 28.50 (27.00-30.50) and 16.00 (15.00-17.00) minutes respectively. Recurrence was seen in 2 (7.96%) and 3 (9.76%) cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups (p=0.60). CONCLUSION: The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and complications are comparable.