Corneal Astigmatism in Cataract.

OBJECTIVE: To measure preoperative corneal astigmatism in cataract patients. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Mughal Eye Hospital, Lahore, from 2018 to 2022. METHODOLOGY: The amount of preoperative corneal astigmatism was noted in cataract patients. Inclusion criteria included cataract patients above 16 years of age. Exclusion criteria included any preexisting corneal pathology (including corneal scar, corneal oedema, pterygium, etc.) and any previous ocular surgery, e.g. trabeculectomy, pterygium excision. SPSS version 25 was used for recording the data. RESULTS: Descriptive statistics were determined for demographic data and keratometry variables. Range of corneal astigmatism was zero to 5.75 dioptre with a mean of 1.05 dioptre (D) and standard deviation of 0.83. Corneal astigmatism of one or less than one diopter was recorded in 468 eyes (66.7%). Corneal astigmatism of 1.1 to 2 D was noted in 166 eyes (23.6%). Forty-nine eyes (7%) had corneal astigmatism of 2.1 to 3.0 D. Corneal astigmatism of 3.1 to 4.0 D, 4.1 to 5.0 D and 5.1 to 6 D was encountered in 11 (1.6%), 5 (0.7%) and 3 (0.4%) eyes respectively. CONCLUSION: A marked proportion of patients undergoing cataract operation have corneal astigmatism, so the phacoemulsification surgeon should consider difference of keratometry findings preoperatively. KEY WORDS: Corneal curvature, Corneal astigmatism, Phacoemulsification, Incision, Keratometry.

Management of Complications after Levator Resection for Ptosis.

OBJECTIVE: To analyse the complications after external levator resection (ELR) for ptosis, and their management. STUDY DESIGN: Observational Study. Place and Duration of the Study: Mughal Eye Hospital Trust, Lahore, from June 2018 to December 2022. METHODOLOGY: A total of 256 eyes were operated for ptosis cases having good levator function who were treated by ELR. The exclusion criteria was any history of operation of lids or orbits or poor levator function, Marcus Gunn jaw-winking phenomenon, and neurogenic ptosis. The frequency of complications and their management was documented. RESULTS: Age ranged from 6 to 65 years. The follow-up ranged from 8 weeks to 3 years. Eleven (4.3%) cases developed complications. Two cases had mild undercorrection and did not require any treatment. In moderate overcorrection encountered in one eye, pulling the lid down for a few times daily improved lid level in four weeks. Four eyes had severe overcorrection, 2 patients required one operation and the other two patients required two operations each. These included hang-back sutures in two eyes (with 5/O Ethibond in one eye and 6/O Vicryl sutures in another eye) and simple incision in the levator (disinserting it partially from the tarsal plate) in two eyes. Lagophthalmos in two eyes improved with conservative treatment. Notching in two eyes improved with partial disinsertion of levator by cutting one Vicryl suture attaching levator to the tarsal plate and leaving 2 Vicryl sutures connecting levator to the tarsal plate. CONCLUSION: Ptosis correction by ELR is a low-complication procedure with good corrective results. KEY WORDS: Ptosis, Good levator function, Overcorrection after ptosis operation, Hang-back sutures, Partial levator disinsertion.

Strategies for the Management of Congenital Iris Cysts.

Iris cysts can arise from iris pigment epithelium or stroma. We present 3 cases of iris cysts which have been managed in different ways. In a one-month neonate, cyst was punctured with keratome and gentle diode laser endophotocoagulation was applied to the base. A2.5-month infant presented with watering and blepharospasm since birth. Clear fluid was aspirated from the cyst with a 27-gauge needle and Ethanol 96% (ETOH) was injected into the cyst and then aspirated. It was followed by injection/aspiration of 0.3 ml of balanced salt solution thrice. Cyst wall was excised. A13-month toddler presented with 4-month history of intermittent irritation and photophobia. The cyst was aspirated with a 25-gauge needle and the cyst walls were nibbled with 20-gauge vitrectomy cutter. Excision is better than injection of sclerosing solutions. The aim is to remove the whole cyst to avoid recurrence and to prevent amblyopia.

Use of botulinum A toxin (BOTOX) in different types of facial dystonia.

UNLABELLED: This study was carried out in the Eye Departments of Combined Military Hospital, Kharian and Military Hospital, Rawalpindi, from January 2007 to August 2008. To determine the effects of botulinum A toxin (Botox) injection in different types of facial dystonia. A total of 23 botulinum A toxin (Botox) injections were given in 13 patients including 7 males and 6 females. Patients were followed up at 1 week, 6 weeks and 6 months after the injection. The indications were essential blepharospasm in 4 (30.77 %) cases and hemifacial spasms in 9 (69.23%) cases. Age ranged from 28 to 60 years (mean 41 +/- 12 years). Four patients were given injections three times and 2 patients were injected twice. Onset of action of botulinum A toxin (Botox) was variable, starting on the same day in 3 patients while in the rest of patients it started on the next day. Mean duration of action was 12.77 weeks +/- 4.68 (range 6-23 weeks). Dystonia improved in all the cases. Temporary slight facial paresis and lagophthalmos occurred in 3 (23%) cases while ptosis occurred in 2 (15.4%) cases. Two patients (15%) had mild ocular irritation and conjunctival congestion after injection, which settled with topical mild steroid (fluorometholone). CONCLUSION: Botulinum A toxin (Botox) is useful treatment for different types of facial dystonia.

Choroidal metastasis from renal cell carcinoma presenting with cataract.

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous.