Treatment Of Senile Entropion: A Comparison Of Standard And Modified Surgical Technique.

Background: The aim of this study is to compare the postoperative functional outcomes of two different surgical techniques for the correction of senile lower lid entropion. It was a Quasi experimental study, carried out at BHY Hospital, Karachi, Pakistan from January to December 2018. Methods: This study recruited fifty patients belonging to either gender with an age range of 60-70 years having unilateral lower lid senile entropion. All the patients were briefed about the study dynamics and divided into two groups with twenty-five patients in each group via convenience-based sampling technique. Those with a prior history of lid surgery or bleeding diathesis were excluded from the study. Patients of group A underwent the standard Weis surgical procedure whereas Group B patients underwent a modified surgical approach using an external tamponade. Main outcome measure was the rectification of abnormal lid position to the normal level. All the patients were followed for a period of six months postoperatively. Study approval was obtained from the institutional ethical review board. Results: This study included a total of fifty patients with twenty-five patients in each group. Mean age was 64.5±3.23 years. Recurrence was observed in 32% patients of group A and 4% patients of group B. Conclusion: The modified surgical technique for entropion repair using an external tamponade has a favourable outcome with minimal recurrence and symptomatic relief.

Modified Treatment Of Shallow Fornix For Better Retention Of Ocular Prosthesis.

Background: The purpose of this study is to share the experience of a modified surgical technique for treating shallow inferior fornix to enhance the retention of cosmetic ocular prosthesis in a tertiary care hospital. It was a Quasi experimental study, carried out at Khalid Eye Hospital, Karachi, Pakistan from January to December 2018. Methods: This study included twenty-five patients between the ages of 20-40 years belonging to either gender having an anophthalmic socket with shallow inferior fornices unable to retain cosmetic ocular prosthesis. Three pieces of Silicone tube were placed deep within the inferior fornix with the help of 2-0 Vicryl suture, taking bite of the inferior orbital rim periosteum. Main outcome measure was deepening of the inferior fornix with better retention of the ocular prosthesis. All the patients were followed up for a period of one year after the surgery. Study dynamics were briefed to all the patients and study approval obtained from the hospital ethical review committee. Results: This study included a total of twenty-five patients of both genders. Mean age was 29.6±6.53 years. By the end of the follow up period, twenty-four (96%) out of the twenty-five patients were satisfied with a proper retention of ocular prosthesis within the fornix along with complete lid closure. One (4%) patient required revision surgery because of extrusion of the silicone tube piece after one month. Mean follow up period was 358.5±16.76 days. Conclusion: This modified technique does not require expensive consumables and proved to be effective in terms of cosmetic and functional outcome.

Cosmetic Outcome Of Autogenous Dermis Fat Graft As An Orbital Implant After Enucleation.

BACKGROUND: The surgical method of removing the complete intact globe while leaving the extraocular muscles and orbital fat behind is called as enucleation. The intention behind this study is to share the experience of autogenous dermis fat graft as an orbital implant following enucleation and its cosmetic outcome. It was a prospective study conducted at the Orbit and Oculoplastic department of LRBT Tertiary Teaching Eye hospital from July 2018 to June 2019. Methods: Eighty-five patients were recruited for this study belonging to either gender with ages ranging from 20 to 50 years. None of the recruited patients had undergone prior enucleation or evisceration. All the patients were informed and counseled about the surgical modus operandi and the expected outcomes and verbal consent was taken from each patient along with approval from the hospital's ethical review committee before proceeding with the surgery. Every participant underwent primary enucleation followed by autogenous dermis fat graft orbital implant and followed up for duration of up to 3 months after the surgical procedure. Results: At ninety days after the procedure, 78.2% of patients had a very good cosmetic result. Conclusion: The placement of autogenous dermis fat graft as an orbital implant following primary enucleation has a good accomplishment rate with excellent cosmetic outcome.

Ocular manifestations in a patient with Dandy-Walker malformation: A case report.

We present a unique case of a ten-month-old boy with a protruding left globe and vitreous haemorrhaging, and later being diagnosed as a case of a dandy-walker syndrome (DWS) with buphthalmos and vitreous haemorrhage. Treatment is depending on the symptoms reported, thus close monitoring and a multidisciplinary approach are essential. We would like to recommend that even if there are no cardinal symptoms of DWS, paediatric patients with ocular signs should have Dandy walker Malformation (DWM) considered as a differential diagnosis.

Added Advantage Of Injecting Subtarsal Steroid Injection After Incision And Curettage Of Multiple Chalazion.

BACKGROUND: Being one of the most common eye lid inflammatory lesions, there is an abundance of ways its treatment can be approached; however, the dearth of consensus on its management guidelines still remains a point of interest in peer reviewed literature. PURPOSE: To evaluate the additional advantage of injecting subtarsal steroid injection simultaneously with incision and curettage of multiple eye lid chalazion. METHODS: This intervention study was carried out in the Ophthalmology unit of Khalid Eye Clinic, Karachi from February to July 2019 and included fifty patients of both male and female with age ranging between 15-45 years. The patients were distributed into two groups with twenty-five patients in each group. Group A included patients undergoing incision and curettage only for eye lid multiple chalazion, whereas, Group B included patients undergoing incision and curettage with simultaneous subtarsal steroid injection. Post operatively patients were advised to do hot compresses for at least five days and observe the resolution of swelling and recurrence of chalazion for up to six months. RESULTS: The average time for resolution of the swelling in group A patients was 4.4±1.45 days, but eleven out of the twentyfive patients developed chalazion on the same eye lid again within the follow up period. Although group B patients took 6.0±2.7 days for the resolution of swelling but none of them developed recurrent chalazion within the follow up period. CONCLUSIONS: Patients undergoing incision and curettage with simultaneous steroid injection proved to have an additional benefit in terms of reduction in recurrence of chalazion.

The Experience Of Intralesional Bleomycin For Orbital Vascular Anomalies.

BACKGROUND: Orbital vascular anomalies are congenital and pose a challenge. They require various treatment modalities which are often unsuccessful. The use of intralesional Bleomycin has gained popularity in recent times as a scar less procedure when other treatment modalities are not effective. PURPOSE: To share the experience of using intra lesional Bleomycin in orbital vascular anomalies in a Tertiary care hospital. METHODS: This quasi-experimental study was carried out at Layton Rahmatullah Benevolent Trust (LRBT) Teaching Tertiary care hospital, Karachi from 1st June to 31st December 2018. It included fifteen patients of various orbital vascular anomalies treated with injection of intra lesional sclerosing (Bleomycin) agent. Patients were given multiple injections and the effects of sclerosing agent on orbital vascular anomalies were observed. RESULTS: Results were excellent in terms of regression of vascular anomalies. CONCLUSIONS: Intralesional sclerosing agent (Bleomycin) has an outstanding role in vascular tumour.

Ocular surface symptoms in veterans returning from operation Iraqi freedom and operation enduring freedom.

PURPOSE: To correlate situational exposures and psychiatric disease with self-reported ocular surface symptoms in a younger veteran population involved in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF). METHODS: Cross-sectional study of all veterans evaluated in the OIF/OEF clinic between December 2012 and April 2013 who completed the dry eye questionnaire and screening evaluations for environmental exposures, posttraumatic stress disorder (PTSD), and depression. The main outcome measures were the influence of environmental exposure and psychiatric disease on ocular surface symptoms. RESULTS: Of 115 participants, the average age was 33 years. While overseas, exposure to incinerated waste (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.23-5.81, P = 0.02) and PTSD (OR 2.68, 95% CI 1.23-5.85, P = 0.02) were associated with self-reported ocular surface symptoms. On return to the United States, older age (OR per decade 2.66, 95% CI 1.65-4.31, P = 0.04) was associated with persistent symptoms and incinerated waste was associated with resolution of symptoms (OR 0.25, 95% CI 0.07-0.90, P = 0.04). When evaluating symptom severity, 26% of the responders complained of severe ocular surface symptoms, with PTSD (OR 3.10, 95% CI 1.22-7.88, P = 0.02) and depression (OR 4.28, 95% CI 1.71-10.68, P = 0.002) being significant risk factors for their presence. CONCLUSIONS: PTSD was significantly associated with ocular surface symptoms both abroad and on return to the United States, whereas air pollution in the form of incinerated waste, was correlated with reversible symptoms.