Change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital.

Objectives: To determine the change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital. Methods: This study was conducted at Department of Ophthalmology Jinnah Postgraduate Medical Centre Karachi, for 6 months from 10th Dec 2019 to 10th June 2020. Sample size calculation of 52 eyes was done by using open epi software. Patients who fulfilled the inclusion criteria that is age ranging from 50 to 75 years, either gender with senile cataract having no preexisting ocular or systemic disease and those giving consent were included in this study. Patients with any comorbidity ocular trauma, having pre-existing ocular diseases such as active ocular infection, glaucoma, maculopathy or retinopathy were excluded from study. Patients with secondary cataract also excluded from study. After complete history, all patients underwent detailed ophthalmologic examination and Pre-surgery macular thickness recorded by using swept source OCT (DRI-OCT-2 Triton; Topcon). Surgery was performed and intraocular lens was implanted in all cases. Post procedure Macular thickness was measured using swept source OCT at 1st postoperative day, 1st month and 6th month after surgery. Results: The mean age of patients was 62.06 ± 5.1 years. Total of 52 eyes diagnosed with senile cataract were included in this study. There were 30 (57.7%) males and 22(42.3%) females. The mean preoperative central foveal thickness was 201.3±24.8µm. The postoperative central foveal thickness was 200.3±25.2µm (153-265µm) at day 1st of surgery, 224.1 ± 53.8 µm (151-458 µm) at 1st month and 212.4±28.3µm (167-255µm) 6th month after surgery. The mean preoperative BCVA was 0.70 ± 0.43 (0.1-1.7) logMAR. The postoperative mean BCVA was 0.26 ± 0.42 (0.00-3.10) logMAR at 1st day, 0.07± 0.10 (0.000.7) logMAR at 1st month and 0.05 ± 0.10 (0.00-0.3) logMAR at 6th month. Conclusion: In our study we found an increase in macular thickness but there was no loss of BCVA from changes of macular thickness after surgery and the mean BCVA increased progressively in postoperative period.

Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis.

OBJECTIVE: To assess the visual outcome after sling procedure using prolene sutures in children with simple congenital ptosis. METHODS: A descriptive case series study was performed in the Department of Ophthalmology of Jinnah Post Graduate Medical Centre, for a duration of six months in which 20 patients aged 3-10 years were selected with either unilateral or bilateral congenital ptosis. They were thoroughly examined and visual acuity and degree of ptosis were measured pre-operatively. Frontalis sling surgery was performed using prolene sutures on all patients after which their visual acuity and degree of ptosis were measured once again after three months post-operatively. Data were analyzed using SPSS version 20.0. For qualitative variables, frequency and percentages were calculated. Mean and Standard deviation was commutated for the quantitative variable. RESULTS: The mean age of the patients was 8.15±1.75. 11 (55%) male and 9 (45%) female participants were included in the study. Visual acuity improved in all the patients with all the patients attaining a visual acuity of 6/6 (n=12, 60%), 6/9 (n=7, 35%), and 6/12 (n=1, 5%). The degree of ptosis post-operatively was not found in any patient either. CONCLUSION: Sling procedure helped in eliminating ptosis and improved visual acuity in patients with simple congenital ptosis.

Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital.

OBJECTIVES: To compare the choroidal thickness in eyes of diabetic patients with eyes of age matched controls using optical coherence tomography in a tertiary care hospital. METHODS: This Cross sectional study was conducted at the Department of Ophthalmology, Jinnah Postgraduate Medical Centre Karachi, for six months from13thJanuary 2020 to13thJuly 2020. The study group comprised of 44 patients with 88 eyes. Patients who fulfill the inclusion criteria that is age ranging from 35 to 80years, either gender, known case of diabetes mellitus and having any type of diabetic retinopathy (HbA1c >7), non-diabetic healthy individuals (HbA1c < 7) and those giving informed consent were included in the study. However, patients having active ocular infections, history of myocardial infarction, stroke, uveitis, any ocular surgery, lasers, intravitreal injections, poor fundus view and not giving consent were excluded. A pre-designed proforma was filled. A baseline ocular examination was performed and choroidal thickness was assessed from retinal pigment epithelium to choroid sclera junction in diabetic and healthy participants of the study group using high resolution Swept source OCT (DRI-OCT-2 Triton; Topcon). RESULTS: The average age of the patients was 39.41±15.95 years. According to our study mean central subfoveal choroidal thickness in diabetic eyes was 268.5 ± 66.22 (95% CI 240 - 297) and in non-diabetic healthy participants it was 339.3 ± 71.49 (95% CI 308 - 369) with a p-value of 0.001. However, average choroidal thickness was 261.8 ± 61.93 (95% CI 235 - 288) and 336.0 ± 74.35 (95% CI 304 - 367) in diabetic and non-diabetic healthy population with a p-value of 0.001. Choroidal thickness comparison between gender in diabetic and non-diabetic population also showed similar trend. CONCLUSION: In this study, mean central choroidal thickness as well as average choroidal thickness was significantly reduced in eyes having diabetic retinopathy as compared to participants with non-diabetic healthy eyes. These findings indicate that changes in choroid may be a probable route in the pathogenesis of diabetic retinopathy.

Outcomes of secondary autologus dermo-fat orbital implants in anophthalmic sockets.

OBJECTIVES: To evaluate the outcomes of secondary autologous dermis-fat graft as an orbital implant in anophthalmic sockets. METHODS: In this prospective study, which was conducted at Jinnah Post Graduate Medical Centre, Karachi, between January 2015 and January 2020, we evaluated 12 patients between the ages of four and 60 years. Most of the adults were victims of trauma, whereas children were known cases of retinoblastoma or trauma and all underwent enucleation. All of them were primarily treated elsewhere and not offered primary orbital implants. We performed autologous dermis-fat graft as an orbital implant in these patients harvesting graft from gluteal region and followed them up to look for complications. RESULTS: Out of 12 patients two went into failure, while rest of the patients showed successful outcome. All patients underwent successful surgery. Initially, a silicon conformer was placed, which was later on replaced with artificial prosthetic eye. CONCLUSION: Regardless of the small sample size, this procedure proved to be a safe and effective method for augmenting orbital volume in anophthalmic sockets in children and adults.

Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan.

OBJECTIVE: This study was conducted to quantify the normal indices of anthropometric measures related to ophthalmology including Interpupillary distance (IPD), Inner canthal distance (ICD), Outer canthal distance (OCD) in a normal, healthy Pakistani population. METHODS: This is a cross sectional study. Total 500 patients were chosen randomly but 499 were included in this study. Patients were selected randomly in an outpatient department of Jinnah Post Graduate Medical Centre Karachi, over the period of five months. IPD, ICD & OCD all measurements were taken with the help of plastic rule by only one researcher to minimize chances of error as much as possible. IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by occluding one eye of researcher to reduce error. Participants were divided into four categories on basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and greater. RESULTS: Our study comprised a total of 499 patents of which 272(54.5%) were males, and 227(45.5%) were females. The mean age of the participants was 39.3 ± 14.5 years. The mean values for the IPD, ICD and OCD in mm were 61.8 ± 6.2, 30.9 ± 2.9 and 85.2 ± 6.6 respectively. A statistically significant difference was observed between IPD, ICD and OCD Indices among male and female study participants (p<0.001, p=0.043, p<0.001). While comparing the IPD, ICD and OCD indices amongst the different ethnic groups, we found no statistically significant difference (p=0.09. p=0.28, p=0.06). Overall, there was no correlation between the age and other variables i.e. IPD, ICD, OCD, (r = 0.07, p = 0.085), (r = 0.005, p = 0.906), (r = -0.08, p = 0.058). CONCLUSION: This work has recommended normative values of IPD, ICD and OCD in Pakistani population on the basis different variables including gender, age, and ethnicity.

Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview.

OBJECTIVE: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab. METHODS: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab (Avastin) 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab (Avastin). Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17. RESULTS: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab (Avastin) before surgery, intraoperative bleeding monitored was, no bleeding in 17 cases (60.7%), mild was observed in 6 cases (21.4%) and severe bleeding requiring diathermy to stop was observed in only 5 cases (17.9%). 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases (7.1%), mild in 6 cases (21.4%) and severe in 20 cases (71.4%). CONCLUSIONS: Intravitreal injection of Bevacizumab (Avastin) was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease.

Visual and anatomical outcome of macular hole surgery at a tertiary healthcare facility.

OBJECTIVE: To assess visual and anatomical outcome of full thickness macular hole (FTMH) surgery with ILM peeling using brilliant blue G dye. METHODS: Thirty patients who had clinically evident macular hole were selected. Pre-operative Optical Coherence Tomography (OCT) was done. In all cases vitrectomy was performed via 23guage 3 ports pars plana (3PPV) vitrectomy system and Brilliant blue G dye, 0.5ml dye was injected over macula which resulted in light blue stain of ILM and peeling was performed around hole in circular motion and after gas fluid exchange gas tamponade with SF6 was done. Final visual and anatomical outcome was measured as postoperative BCVA and postoperative OCT at three months respectively. Descriptive statistics were computed. Paired t-test was applied. P value≤0.05 were considered as significant. RESULTS: There were 12 male and 18 female patients. The mean age was 57.40±4.76 years. The mean size of macular hole was 452.20±242.33µm. The mean duration of symptoms was 16.73±13.49 weeks. Mean pre operative BCVA was 1.30±0.73 log MAR and post operative was 0.51±0.23 log MAR. Mean increased BCVA was found to be 0.22±0.13 log MAR. Primary closure of hole was achieved in 29(96.7%). Significant mean difference was found in pre operative and post operative BCVA. CONCLUSION: Brilliant blue G exhibits sufficient staining qualities and safety profile to peel ILM in the management of full thickness macular hole with significant visual and anatomical improvement.

Surgical audit of outcome of rhegmatogenous retinal detachment repair at Vitreoretinal unit JPMC in year 2014.

OBJECTIVE: To investigate the outcome of rhegmatogenous retinal detachment repair at Vitreoretinal unit of Jinnah Post Graduate Medical Centre Karachi in year 2014. METHODS: One hundred and three eyes of one hundred and three patients, who underwent three ports parsplana vitrectomy + band + silicone oil, three ports pars plana vitrectomy + silicone oil, three ports pars plana vitrectomy + C3F8 for rhegmatogenous retinal detachment (RRD) repair, at Jinnah Post Graduate Medical Centre, were included in this observational prospective study. Parsplana vitrectomy was done using 23G vitrectomy system. Duration of study was one year. Removal of silicone oil (ROSO) was done on the basis of completely flat retina at least for eight weeks or because of complications due to silicone oil. Patients were followed up post operatively on day one and after one week and then at four weekly interval till the end of the study. RESULTS: Anatomical success was achieved in 91 eyes (88.3%). However in 12 eyes (11.7%) retina redetached after removal of silicone oil. Functional success achievement of visual acuity of 3/60 or better was achieved in 85 (82.5%) of eyes post operatively after removal of silicone oil or absorption of gas C3F8 as the case may be. CONCLUSION: Re-detachment is common after removal of silicone oil and incidence of re-detachment is related to the degree of preoperative PVR and location of breaks. Re-detachment occurs more commonly if the breaks are inferiorly located as compared to the superior ones.

Frequency of Hepatitis-B and C in patients undergoing cataract surgery in a tertiary care Centre.

OBJECTIVE: To analyze the frequency of hepatitis B and C in patients undergoing cataract surgery. METHODS: This descriptive study was conducted at department of Ophthalmology Jinnah Post Graduate Medical Centre. The duration of study was seven months from May 2013 to November 2013. After taking informed consent from the patient and hospital ethical committee all patients presenting with cataract and undergoing cataract surgery were evaluated for the existence of hepatitis C and B. Diagnosis of hepatitis C or B was made on the criteria that a patient must be positive for either Anti-HCV or HBsAg or both. Proformas were filled and data was collected and analysis was done. Pearson's correlation coefficients were calculated to calculate the occurrence of hepatitis C and B in general population undergoing cataract surgery. RESULTS: Six hundred and forty-eight patients were operated on for cataract surgery at Jinnah Post Graduate Medical Centre during the study period. Mean age of patients was 63 years, 300 (46.29%) were male and 348 (53.70%) female. Out of them 57 (8.79%) patients were carriers of either Hepatitis C or B. Hepatitis B accounted for 17 cases (2.62%) however Hepatitis C positive were 40 cases (6.17%). Nobody was simultaneously affected by both hepatitis C and B. CONCLUSION: Significant number of asymptomatic carriers of hepatitis C and B were found in preoperative cataract patients. It is recommended that preoperative screening of all cataract patients should be done so that asymptomatic carriers might not become a threat for spread of disease.

NAEVUS SEBACEOUS OF JADASSOHN'S OF EYELID.

Naevus Sebaceous of Jadassohn is a rarely seen hamartomatous lesion and is a fourth type of sebaceous gland tumour, in which sebaceous glands show nevoid character of growth composed partly or completely of sebaceous glands. A detailed research revealed that very little data is available; no case of this disorder has been reported as an isolated eye lid lesion. Majority of the published cases are associated with systemic involvement. We present here a case report of this rare disorder. A middle age female patient presented with a mass of left lower lid since childhood without any other ocular and systemic abnormality. Excision biopsy along with rotation flap surgery was done. Histopathological examination of the specimen revealed the diagnosis. To our best of knowledge this is a unique presentation of naevus sebaceous of Jadassohn on eye lid which has not been documented till yet anywhere.

Intravitreal injection of Bevacizumab in diabetic macular edema.

OBJECTIVE: To assess the effectiveness of intravitreal injection of Bevacizumab in the treatment of diabetic macular edema. METHODS: This case series was conducted at Department of Ophthalmology, Jinnah Post Graduate Medical Centre (JPMC), Karachi. The duration of study was six months from May 26, 2011 to November 25, 2011. The study group comprised of 54 patients of the Diabetic Macular Edema (DME). Intravitreal injection of 1.25 mg of bevacizumab (Avastin) was injected 3.5 mm from the limbus under topical anaesthetic drops. Post procedure follow up was scheduled on 1(st) post procedure day and after one month. Post procedure Optical Coherence tomography (OCT) was performed in all patients 1 week before and 1(st) month after 1(st) injection. The results were statistically analyzed through SPSS 17. RESULTS: Out of the 54 Eyes of 54 Patients who were given the Intravitreal injection of Avastin (Bevacizumab), 43 Eyes (79.6%) showed more than ten percent decrease in macular thickness from pre-injection thickness, 10 Eyes (18.5%) showed less than ten percent decrease and 1 Eye (1.9%) showed increase in macular thickness post operatively after one month. CONCLUSIONS: Intravitreal injection of Bevacizumab (Avastin) is effective in the treatment of diabetic macular edema.

Outcome of unilateral lateral rectus recession and medial rectus resection in primary exotropia.

BACKGROUND: The purpose of this study was to measure the success rate of unilateral lateral rectus recession and medial rectus resection in primary exotropia. METHODS: This is an interventional case series of 55 patients with primary exotropia (degree of deviation 15-85 PD), above the age of 5 years. Patients were treated in the Department of Ophthalmology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, during the period of July 2009 to March 2010. All the patients underwent surgical procedure i.e., lateral rectus muscle recession (maximum up to 10 mm) and medial rectus muscle resection (up to 6 mm) of one eye, according to the Park's method. Surgery was done based on prism cover test measurements obtained at 6 m with appropriate optical correction in place. Patients were re evaluated at one day, one month, two months and six months post operatively. Final outcome was considered at the end of six months at which achievement of ≤10 PD of exotropia was the success. Data was analyzed on SPSS version 17.0. RESULTS: We obtained success (≤10 PD) in 42 out of 55 patients (76.4%) and 13 out of 55 patients (23.6%) did not meet our criteria for surgical success (>10 PD). Analysis of success with the type of primary exotropia showed that success was achieved in 22 out of 24 cases of intermittent type (91.6%) and 20 out of 31 cases of constant type (64.5%)(P Value 0.019). The highest percentage of success was achieved in patients with the pre-operative deviation of ≤70 PD i.e., 93.3% (42 out of 45 cases), while none of the patients with the pre-operative deviation of >70 PD (10 out of 10 cases) achieved the criteria for success. CONCLUSION: We conclude that pre-operative deviation is one of the strongest predictor for favorable surgical outcome. Therefore, eliminating the factors causing error in the correct determination of pre-operative deviation should improve the success and predictability of the surgical outcome. Despite the obstacles in the surgical management of strabismus, our results are encouraging.

Sodium hyaluronate eye drops in the treatment of dry eye disease: an open label, uncontrolled, multi-centre trial.

BACKGROUND: Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. The objective of this study was to assess the performance of sodium hyaluronate eye drop for eight weeks in patients with DED. PATIENTS AND METHODS: This was a multi-centre, open-label, uncontrolled clinical trial carried out at different centres of Pakistan, from August 2009 to November 2010. A total of 250 diagnosed patients of Dry Eye who met the inclusion criteria were included in the study. After informed written consent, all patients having at least 2 of the Dry Eye symptoms, and at least 1 of the tests (Tear Film Break-up time (TBUT) < or = 10 second, Schirmer's test < or = 6 mm/5 min, and positive corneal staining) were enrolled. Tolerability/safety assessments consisted of monitoring and recording of adverse events and physical examinations at baseline, 4th week and 8th week. RESULTS: Out of 250 allocated patients 13 dropped out. The mean age of the patients was 47.6 +/- 13.8 year and out of 237 patients 86 (36.3%) were men and 151 (63.7%) were women. At the initial visit the foreign body sensation was 80%, itching 68%, burning 58%, watering 38%, photophobia 38%, and feeling of dryness was 16%. At the 3rd visit the foreign body sensation decreased to 32%, itching to 32%, burning to 20%, watering to 12%, photophobia to 18%, and feeling of dryness to 14%. CONCLUSION: Sodium hyaluronate has a beneficial effect on the conjunctival epithelium in a well-defined and homogeneous population of patients with dry eye and can be considered useful for the treatment of dry eye.

Visual outcome and complications after removal of posterior segment intraocular foreign bodies through pars plana approach.

OBJECTIVE: To assess the visual outcome and complications after removal of posterior segment retained intraocular foreign bodies through pars plana approach. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi, from May 2005 to May 2006. METHODOLOGY: Fifty patients with history of ocular foreign body were admitted through outpatient department and emergency. History, visual acuity, ocular and general examination was done. The foreign body was localized with the radiograph of the skull and ultrasonography. Primary repair was done in patients with open wounds. Pars plana vitrectomy, magnetic or forceps extraction of foreign body was done as required visual outcomes and complications were noted. RESULTS: Among the 50 patients, there were 45 (90%) males and 5 (10%) females. Average age of the patients was 31.52 +9.52 (ranging from 20 to 50) years. The pre-operatively visual acuity finger counting to perception of light was 78% cases. The best corrected final visual acuity was 6/6 in 1 (2%) patient, 6/9 in 5 (10%) patients, 6/12 in 5 (10%) patients, 6/18 in 3 (6%) patients, 6/24 and 6/36 in 4 (8%) patients each, 6/60 in 4 (8%) patients, finger counting in 8 (16%) patients, hand movement in 4 (8%) patients, projection of light in 9 (18%) patients and no projection of light in 3 (6%) patients. The postoperative complications were corneal opacity in 8 (16%) patients, anterior chamber inflammatory reaction in 6 (12%) patients, increased intraocular pressure in 1 (2%) patient, silicone oil in anterior chamber in 1 (2%) patient, macular scar in 7 (14%) patients, cystoid macular edema in 1 (2%) patient, endophthalmitis in 4 (8%) patients, retinal detachment in 11 (22%) patients and phthisis bulbi in 3 (6%) patients. CONCLUSION: Acceptable visual results were achieved after the removal of posterior segment intraocular foreign bodies by vitrectomy. However, multiple complications can be encountered which require meticulate postoperative care.

Management of periocular post burn scarring in the epileptics.

OBJECTIVE: To assess the clinical presentation and management of patients with epilepsy presenting with periocular post burn scarring. DESIGN: Prospective and descriptive study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Jinnah Postgraduate Medical Centre, Karachi from September 1999 to September 2002. SUBJECTS AND METHODS: This study included 23 patients who had epilepsy and presented with periocular post-burn scarring to the eye department for management. All patients had contractures of their lids with variable amounts of corneal scarring and damaged to the eye ball. The surgical procedure performed consisted of release of contracture, horizontal lid shortening and application of free skin graft. RESULTS: There were 18 (78.26%) female and 5 (21.73%) male patients. The age range was from 18 to 45 years with a mean of 28 years. In 17 (73.91%) patients, lid contracture was released to cover their eyeballs. In 6 (26.08%) patients the eyeball was lost due to late presentation. CONCLUSION: There should be a high index of suspicion in facial burns for ophthalmic damage and early referral to an ophthalmologist should be made to prevent complications. Early release of contracture with application of full or partial thickness skin grafts is advisable.