Comparison of Oxidant and Antioxidant Status in the Aqueous Humour of Cataract Patients with and without Type 2 Diabetes Mellitus.

OBJECTIVES: To compare the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) in the aqueous humour of cataract patients with and without type 2 diabetes mellitus (T2DM). STUDY DESIGN: Cross-sectional analytical study. Place and Duration of the Study: Department of Physiology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan in collaboration with Armed Forces Institute of Ophthalmology, from 1st June 2022 to 31st January 2023. METHODOLOGY: A total of 120 individuals were recruited and divided into 2 equal groups. Sample of aqueous humour was collected, and the total oxidant status, and total antioxidant status were measured by spectrophotometry. Blood samples were collected to measure the fasting glucose and glycosylated haemoglobin levels. Results were analysed by SPSS version 24 and p-value ≤0.05 was considered significant. RESULTS: Total oxidative stress and OSI were (55.57±5.46) vs. (33.75±4.28) = p (0.001), (32.79±9.23) vs. (13.28±3.02) = p (0.001) found significantly increased in aqueous humour of diabetic patients while TAC was reduced (1.86±0.41) vs. (2.62 ± 0.45) = p (0.001) compared to the non-diabetics. Fasting blood glucose (109.18±12.32 vs. 91.61±5.71 mg/dl, p=0.001) and glycosylated haemoglobin levels (6.46±0.85 vs.5.43±0.85, p=0.001) were also found significantly high in the diabetic group compared to the non-diabetics. CONCLUSION: Increased levels of glucose and glycosylated haemoglobin increase oxidative stress in the blood of T2DM patients. This raises the total oxidative stress in the aqueous homor while lowering the TAC. This disturbed oxidant-antioxidant status in the aqueous humour of diabetic patients plays an important role in the development of cataract in T2DM patients compared to non-diabetics. KEY WORDS: Cataract, Aqueous humour, Oxidative stress, Type 2 diabetes mellitus.

Cornea plana in a family from Pakistan: Case series and literature review on the principles of management.

Cornea plana (CP) is a rare ocular condition existing in two distinct clinical and hereditary forms: a milder, autosomal dominant type I and a more severe, autosomal recessive type II. The condition is more commonly found in Finnish, Saudi, and Czech families. We report three brothers from a consanguineous marriage that presented with complaints of decreased vision of varying degrees. All three of them have blue, thick, and hazy corneas with shallow anterior chamber depths. The additional features of CP type II were seen in the older two brothers including arcus lipoids, ill-demarcated limbus, and an accommodative squint. They were managed by the correction of refractive errors through spectacles and detailed counseling with follow-up visits to look for progressive complications. The management is mainly centered around optically or surgically correcting the developmental anomalies. This is complimented with proper genetic counseling and regular follow-up visits to look for and manage complications. There are, however, novel therapies that can be considered in these patients including corneal transplants or corneal stromal stem cellular therapies.

Anterograde Reconstruction of Severe Bi-Canalicular Obstruction with Autogenous Saphenous Vein Graft: A Novel Surgical Technique.

Severe lacrimal canalicular obstruction mandates a bypass surgery of conjunctivo dacryocystorhinostomy with Lester Jones tube or alternatively retrograde intubation and pseudopunctum generation with conventional, dacryocystorhinostomy (DCR). However, in each case, the natural pathway is violated and added commitment of Lester Jones tube maintenance often leads to patient dissatisfaction. This novel surgical technique aims at de novo, anterograde, reconstruction of lacrimal canaliculi and rehabilitation of the natural lacrimal passage with interposition of autogenous saphenous vein graft. This method offered promising long-term results of functional success in terms of alleviation of epiphora, excellent cosmesis, and an optimal patient satisfaction.

Intralesional corticosteroid injection vs surgical treatment of chalazia in pigmented patients.

OBJECTIVE: To compare the outcome of intralesional corticosteroid injection and surgical treatment of chalazia. DESIGN: An interventional comparative study. PLACE AND DURATION OF STUDY: PNS Shifa, Naval Hospital, Karachi from 1st September 2002 to 31st August 2003. PATIENTS AND METHODS: During a 9-month recruitment period all patients attending PNS Shifa, Naval Hospital, Karachi, for treatment of chalazia were inducted in the study. A 141 patients with chalazia completed the study. Patients received either incision-curettage (surgical treatment/ ST group) or intralesional corticosteroid injection treatment (steroid injection/ SI group). The same procedure was repeated in unsuccessful cases only once. Z-test of proportion was used as appropriate statistical test of significance at p <0.05 for the comparison of the results between the two groups. RESULTS: The success was achieved in 59 out of 75 patients (79%) in ST group and 41 of 66 patients (62%) in SI group at first visit after two weeks (p-value <0.01). The success in ST group improved to 89% (67 out of 75 patients) after second operation and to 80% (53 out of 66 patients) in SI group after second injection of the steroid given at second week (p-value < 0.14). CONCLUSION: Intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia. The results are comparable to surgical treatment especially after second injection. It is not associated with any serious complications although skin depigmentation is relatively common in coloured population.