ABSTRACT
Objective: To determine how many patients with glaucoma do not comply with medical therapy and study the factors which make them distinguishable from complying patients
Study Design: Cross sectional comparative study
Place and duration: At Glaucoma clinic, Al-Shifa Trust Eye Hospital, Rawalpindi over a period of 6 months from 1[st] May 2006 to 30[th] Nov 2006
Methodology: A pre-tested structured questionnaire was used. The data collected was of patient's age, years of glaucoma diagnosis, number of medicines advised their educational level, socioeconomic conditions and distance they travel to the hospital. Patients were asked of difficulty in self administration of medicines and whether or not the medicine finished before the visit and is it available near their home? Non compliance was regarded as the missing of prescribed medicines for 1 day or more as reported by the patient. The patients were grouped as compliers [group 1] and non-compliers [group 2], and all the variables were analyzed to find any significant intergroup differences by using SPSS version 16
Results: Of 100 patients, 65% were males and 35% were female patients of glaucoma. Among them, the compliers were 61 [group 1] and non compliers were 39 [group 2]. Statistically significant difference in compliance behavior was found in relation to number of medicines prescribed [p=0.039], problems with self administration of drops [p=0.05], eye drops finished before follow up visit [p=0.001], and non-availability of medicines at pharmacy near home [p=0.034]
Conclusion: Several interrelated factors may contribute to noncompliance. Poor compliance may be due to less educated patients, problems with managing multiple eye drops and the complex regimens. Problems with self administration of medicines and poor socioeconomic status may be the reason behind discontinuation of medicines. All these factors must be looked into in a glaucoma patient non compliant to medical treatment
ABSTRACT
Objective: To document the variations in keratometry, axial length of eye and intra-ocular lens [IOL] power observed during biometry of cataract patients and to find any significant gender difference
Study Design: A retrospective review of the biometry records
Place and Duration: Saeed Eye and Medical Complex, Rawalpindi from 1st Nov 2010 to 31st Dec 2014
Methodology: Patients of senile cataract were included from the biometry records. Keratometry readings of vertical and horizontal corneal meridian [K1 and K2] were measured with automated keratometre and axial length was measured with contact A-scan. Power of IOL was calculated by using SRK-T formula in patients with axial lengths between 22 and 26, Hoffer Q for axial lengths <22mm and Haigis for axial lengths >26 mm with A-constant of 118. The data was analyzed with SPSS version 16
Results: 908 patient records were analyzed. The mean +/- SD keratometry readings [K1 and K2] were 43.46 +/- 1.68 D and 44.41 +/- 1.98 D respectively. The mean +/- SD axial length was 23.45 +/- 1.20mm. SRK-T was used in 818 [90.1%] cases, Hoffer Q in 68 [7.5%] and Haigis in 22 [2.4%] of cases. The mean +/- SD intra-ocular lens power was 20.22 +/- 3.06D. Gender based comparison showed that the mean +/- SD K1 in males [42.95 +/- 1.54D] was less than 43.88 +/- 1.67D for females [p=0.0001]. The mean +/- SD K2 for males [43.9 +/- 1.66D] was also less in females [44.78 +/- 1.70D] [p=0.0001]. The mean +/- SD axial length of eyes in males was 23.81 +/- 1.23mm significantly more than 23.16 +/- 1.08mm in females [p=0.0001]. The mean +/- SD IOL power was 19.68 +/- 3.19D in males and 20.67 +/- 2.86D in females [p=0.0001]
Conclusion: The mean keratometry readings [K1 and K2] were 43.46 +/- 1.68 D and 44.41 +/- 1.98 D respectively. The mean axial length was 23.45 +/- 1.20mm and mean intra-ocular lens power was 20.22 +/- 3.06D. Gender based analysis showed that females have more keratometric readings but shorter axial lengths than males and required more power of IOL to be implanted after cataract surgery
ABSTRACT
To assess the quality of human amniotic membrane [HAM] processing at Al-Shifa HAM bank and to analyze the outcome of amniotic membrane transplant in different corneal pathologies at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Prospective Interventional Case Series .Consecutive 102 eyes of as many patients [72 males and 30 females] from July 2006 to August 2007 presented at Corneal Clinic were included in the study. Average age of patients was 38 years [4.5-90 years]. Frozen human amniotic membrane [HAM] from a seronegative donor stored at -80°C in Dulbecco's Modified Eagle Medium [DMEM] and glycerol was used for transplant in different corneal diseases after thawing at room temperature for half an hour. HAM was applied epithelial side up. It was spread over the whole cornea beyond limbus and anchored through continuous/interrupted 10/0 monofilament nylon sutures on the corneal side and 7/0 vicryl on the conjunctival side. Over lay [patch] and in lay [graft] technique was used in most of the cases while multilayered technique was used in case of deep ulcer and corneal perforation. Bandage contact lens [BCL] was applied and discontinued after epithelialization in all the cases. The follow up visits were on post operative day one, one week, one month, three months and then after every six months. In clinical examination luster and lubrication of the eye and stability of corneal surface was noted. In subjective examination, a performa was designed to assess reduction in pain, watering, irritation and status of overall comfort of the patient. Average follow up period was 132 days. Overall 85.3% patients had subjective improvement while 74.5% showed clinical improvement; Visual acuity improved in 49% patients. AMT was repeated in 8 patients. No intraocular infection was reported in study cases. The study concludes that AMT is a useful treatment option in a variety of ocular surface pathologies. However, its efficacy varies in different diseases. The study also proved reliability of processing technique at Al-Shifa Human Amniotic Membrane Bank
ABSTRACT
Purpose: To highlight the importance of intra-ocular pressure monitoring to reduce incidence of visual loss in children being treated with topical steroids
Study design: Case report
Participant: An 11 year old boy with gradually decreasing vision using topical steroids
Discussion: Of all the various routes of steroid administration, topical steroid therapy most commonly causes elevation of IOP by decreasing the outflow facility of aqueous. Topical steroids can cause an IOP rise correlated with the duration and frequency of drug administration. The height and duration of the pressure rise depends upon factors like drug potency, penetration, dosage, length of administration as well as individual susceptibility and age. Children younger than 10 years of age show marked elevation of IOP when treated with topical preparations. Despite their popularity as anti-allergic and anti-inflammatory agents, corticosteroids can have tragic consequences and should be used only with judicious monitoring in young children. This case report highlights the problem of glaucoma in a child following unsupervised use of the steroids