Efficacy and safety of transepithelial collagen cross linking for progressive keratoconus

Objective: To evaluate the efficacy and safety of transepithelial [TE] collagen cross-linking [CXL] in patients with progressive keratoconus [KC]

Methods:This Quasi Experimental Study was conducted at PNS Shifa Naval Hospital, Karachi from June 2015 to June 2016. Sixty eyes of 32 patients who underwent TE CXL for progressive KC from June 2015 to June 2016 were analysed to ascertain efficacy and safety of TE CXL procedure. Statistical analysis of the data was done using SPSS version 17.0

Results:Twenty eight [87.5%] patients underwent TE CXL bilaterally, while 4 [12.5%] underwent unilateral CXL. Mean change in astigmatism, Maximum simulated Keratometry value [Kmax], Spherical equivalent [SE] and Central Corneal Thickness [CCT] were -0.67+/-0.35D, 1.28+/-0.64D, -0.58+/-0.17D and 0.40+/-7.58micro m respectively, from baseline. Mean gain in lines on Snellen's visual acuity chart was 1.13+/-0.83 lines. Changes in astigmatism, Kmax and SE were statistically significant [p<0.001], while change in CCT was not statistically significant. The procedure had excellent safety profile, with no major complication till 6 months follow up period

Conclusion:TE CXL is a safe and effective procedure with statistically significant reduction in corneal astigmatism, Kmax and SE with reasonable gain in Snellen's visual acuity

Amniotic membrane transplantation in primary pterygium compared with bare sclera technique

To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation [AMT]. An experimental study. Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. A pilot study of 70 patients was conducted. Patients were divided in two groups. In group I, pterygium excision was done by bare sclera technique while in group II, AMT was done after excision. Patients were followed for 6 months. Proportion of recurrence of pterygium was noted in each group and compared with chi-square test with significance at p < 0.05. Number of patients who presented with recurrence of pterygium in group-I were 12 [37.5%] and in group-II were 4 [12.9%]. Chi-square tests showed that there was a statistically significant difference in frequency of recurrence between the two groups [p = 0.025]. AMT after excision of pterygium appeared to be safe and effective way of treating primary pterygium as compared to bare sclera technique due to lesser recurrence at 6 months

Comparison of preoperative and intraoperative mitomycin C in prevention of pterygium recurrence and postoperative complications

To compare the frequency of recurrence and corneoscleral complications with pre-operative and intraoperative mitomycin C when used with excision of primary pterygium by bare sclera technique. Quasi experimental study. Armed Forces Institute of Ophthalmology Rawalpindi. Ten months [October 2006 to July 2007]. A total of 70 cases with primary pterygium were selected and divided equally into group A and B. in cases of group A, 0.1cc of 0.15 mg/ ml of MMC was injected sub-conjunctivally and pterygium excision with bare sclera technique, a sponge soaked in 0.04% MMC was applied over the bare sclera for three minutes intraoperatively. The patients were followed up to see recurrence and corneoscleral complications for three months. A total of 70 cases, 35 in each group were analyzed statistically. Mean age of group A was 40.83 +/- 12.655 years whereas that of group B was 44.57 +/- 13.718 years. Group A had 28 [80%] males and 7 [20%] females. Group B had 23 [65.7%] males and 12 [34.3%] females. Number of patients who presented with recurrence in group A was 1 [2.9%] and group B were 4 [11.4%]. In group A no patient presented with corneoscleral complications during the study whereas in group B these complications were seen in 7 [20%]. Chi-square test revealed no significant difference in recurrence [P=0.356] whereas it showed significant difference in corneoscleral complications between the groups [P=0.011]. Preoperative MMC is as effective as intraoperative MMC in preventing recurrence but it is much safer than intraoperative MMC causing less corneoscleral complications

Retinopathy risk factors among diabetics in a tertiary care military hospital

To determine the frequency and risk factors for severity of retinopathy in diabetic patients referred to a tertiary military hospital. Cross-sectional study. Armed Forces Institute of Ophthalmology, Rawalpindi from Jun 2008 to Dec 2009. Diabetic patients aged 40 to 79, referred for suspected diabetic retinopathy [DR] on fundoscopy from medical outpatient clinic of Military Hospital Rawalpindi were randomly included in the study. Participants underwent a standardized interview and examination Retinopathy was assessed through dilated pupils, and graded into absent retinopathy, mild to moderate, or advanced. Presence of clinically significant macular edema [CSME] was also recorded. To evaluate the simultaneous effect of significant risk factors on the different stages of DR, multivariate regression analysis was carried out. Out of five hundred and ten patients, DR was confirmed in 63% cases with advanced retinopathy in 21.3%. In univariate analysis, duration of diabetes, fasting blood glucose, and presence of oedema were significantly associated with retinopathy [P<0.005] On multivariate analysis, however, only duration of diabetes [Odds Ratio 6.15 for 5 to 10 years and 38.29 for more than 10 years] and macular oedema [OR 6.617 95% CI 3.95-11.07] remained significant. CSME was present in 173 [33%] patients and its frequency increased with the severity of DR [P<0.001]. The frequency of DR among military personnel and their dependants was high with strong association to duration of diabetes. This underscores the importance of regular retinal detect DR in the early stages and timely intervention to prevent diabetes related blindness

Effects of 5.5 millimeters clear corneal temporal versus steeest meridian phacoemulsification incision on preexisting corneal astigmatism

To compare the effects on astigmatism of 5.5 mm clear corneal phaco-incision at steepest meridian [group A] with uniformly selected temporal site [group B]. Randomized control trial [RCT] Armed forces institute of ophthalmology Rawalpindi [AFIO]. January 2007 to December 2007. One hundred cases were enrolled and randomly divided into two groups, 50 in each group. Subjects were divided by simple random method [lottery method] into two groups, group A and B. Cataract surgery was performed by phaco and PCIOL was implanted. In group A, incision was made on steepest meridian. While in group B, incision was made on uniformly selected temporal site [irrespective of steepest meridian]. On 12th post-operative week corneal astigmatism of group A [1.46 +/- 0.377] was significantly [p<0.05] less than pre-operative astigmatism [2.151 +/- 0.404]. For group B, difference between 12th week post-operative [1.73 +/- 0.344] and pre-operative astigmatism [2.03 +/- 0.342] was also statistically significant but the effects of phaco-incision in reducing pre-corneal astigmatism was much superior in group A than in group B. The difference was statistically significant at p<0.05. Steepest meridian phaco-incision results in significant decrease in pre-operative astigmatism than routine phaco-incision on temporal side

Interferon associated retinopathy

Interferon is an immunomodulating cytokine which is used to treat different diseases. Nowadays it is being commonly used for the treatment of chronic hepatitis C. Few patients develop ocular complications secondary to the use of Interferon. We report here a case in which a young soldier with no other risk factors developed retinopathy changes after five months of interferon alpha 2b therapy which included cotton wool spots at the posterior pole and dot-blot haemorrhages in both fundi. These changes gradually started resolving after cessation of treatment and completely disappeared after six months

Raised intraocular pressure; frequency after Nd: YAG laser capsulotomy

To measure the rise in intraocular pressure after neodymium:yttrium-aluminum-garnet [Nd:YAG] Laser capsulotomy in pseudophakic patients aged 50 years and above. Prospective study. Study was done from May 2005 to Dec 2005. [Eight months duration] Eye department Military Hospital Rawalpindi. A total of 100 patients, presenting in Eye department, Military Hospital Rawalpindi, fulfilling inclusion and exclusion criteria were included. With a minimum number of bursts of 3.6 mj / shot energy level with Nd: YAG laser, a 3 to 4 mm hole in the posterior capsule was created. The intraocular pressure was measured 1 hour, 3 hours, 1 day and 1 week after the laser. The rise in intraocular pressure was noticed in 6 [6%] patients after Nd:YAG laser capsulotomy. Five out of six patients had fibrous type of posterior capsular opacification while one patient had Elschnig's pearl. Male to female Ratio was 7:3. Our findings suggest that the rise in intraocular pressure is an infrequent complication of Nd:YAG Laser capsulotomy