Spontaneous resolution of direct carotid cavernous fistula.

Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind.

Intralenticular foreign body with a clear lens.

Intraocular foreign bodies (IOFBs) are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normal within 2 months.

Frequency of ocular manifestations of chronic graft versus host disease.

BACKGROUND: With the advancement of techniques for haematopoietic cell transplantation, the number of transplant survivors is increasing rapidly and so are the chances of chronic graft versus host disease (cGVHD). The ocular manifestations of this disease have not been explored in our local population. This study was conducted to determine the frequency of ocular complications in cases of cGVHD following successful bone marrow transplantation. METHODS: Twelve diagnosed cases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestations were noted especially the ocular surface disorders, using double staining method with fluorescein and rose-bengal. RESULTS: Nine patients (75%) were having dry eyes, 7 (58.3%) with mebomian glands dysfunction, 4 (33%) with acute conjunctivitis, 2 (16.7%) with bilateral lacrimal canalicular occlusion, and 1 (8.3%) each of bilateral posterior subcapsular cataract, unilateral sterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema. CONCLUSION: The higher frequency of dry eyes along with other ocular manifestations in patients of cGVHD suggests the need of close ophthalmic monitoring in all such cases.

Phthiriasis palpebrarum.

Phthiriasis palpebrarum (lice infestation of palpabrae) is a rarely reported disorder and may present as blepharoconjuctivitis. It is usually seen in lower socioeconomic groups and spreads through either sexual contacts or directly through linen or clothing. We report a family with phthiriasis palpebrarum in which the primary source of infestation was the paternal uncle of two children. Mechanical removal proved to be quite effective in treating the disease and preventing its recurrence.

TNF-α Genetic Predisposition and Higher Expression of Inflammatory Pathway Components in Keratoconus.

Purpose: To date keratoconus (KC) pathogenesis is undefined; however, the involvement of inflammatory pathways in disease development is becoming apparent. In the present study, we investigated the role of a promoter region polymorphism rs1800629 (-308G>A) in the inflammatory pathway component TNF-α and its effects on the expression of TNF-α and downstream molecules tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2), v-rel avian reticuloendotheliosis viral oncogene homolog A (RELA), and interleukin 6 (IL-6) in KC development. Methods: TNF-α promoter polymorphism rs1800629 (-308G>A), was genotyped in 257 sporadic KC patients and 253 healthy controls. Enzyme-linked immunosorbent assay (ELISA) was performed to assess for the -308G>A genotypes. Quantitative polymerase chain reaction (qPCR) was carried out to compare the mRNA expression of TNF-α, TNFR1, TNFR2, RELA, and IL6 in the corneal tissues of 20 KC patients and 20 donor controls. Results: The -308G>A genotype GA was found to be significantly associated with KC development (dominant model [odds ratio (OR) = 6.67 (95% confidence interval [CI] = 4.28-10.42), P < 0.001]) and allele-A (OR = 4.30, 95%CI = 2.93-6.34, P < 0.001). TNF-α serum levels were significantly raised in patients with GA genotype (196.5 ± 69.5 pg/mL) compared to reference genotype GG (21.7 ± 8.2 pg/mL) (P < 0.0001). There was a significant overexpression of TNF-α (P = 0.002), TNFR2 (P = 0.0001), RELA (P = 0.0117), and IL6 (P = 0.0007) in the KC corneal tissues as compared to the control. Conclusions: The GA genotype of the TNF-α -308G>A polymorphism is a significant genetic risk factor for the pathogenesis of KC. Moreover, this single nucleotide polymorphism (SNP) was observed to be associated with deregulated expression of downstream molecules, thus further reinforcing the role of the inflammatory pathway components in the development of KC.

HLA typing in patients of Eales disease.

OBJECTIVE: To determine any predisposition of haplotypes with Eales disease. DESIGN: A case control study. PLACE AND DURATION OF STUDY: This study was started in February 2002 and data collected till April 2003 at Eye Department of Military Hospital, Rawalpindi. PATIENTS AND METHODS: The frequency of HLA antigens both class-I and II by complement dependent standard lymphocytotoxicity test was studied in 32 patients of Eales disease (group-I) and 32 age and gender matched normal persons as controls (group-II). Both patients and controls underwent complete ocular and clinical examination and were followed up for one year. RESULTS: Mean age was 30.8 years. HLA DR3 was found in 20 patients of group-I and none in group-II. HLA types A1, B8, B5 (51) and DR 15 (2) were found in 12 out of 32 patients of eales disease and none in controls. HLA DQ2 and DR52 was found in 28 cases of group-I as compared to 18 cases of group-II (p = .005). CONCLUSION: HLA phenotypes HLA DR3, A1, B8, B5 (51) and DR 15 (2) occurred in majority of cases of Eales disease, whereas these were not found in controls which was statistically significant. Similarly, HLA DQ2, DR52 and Bw6 was found in higher frequency in Eales patients and thus strongly associated with it. We conclude that certain HLA haplotypes have a possible predilection for Eales disease.

Partial Oculocutaneous Albinism: Two Siblings with Features of both Hermansky Pudlak and Waardenburg's Syndrome.

Albinism is an inherited abnormality of melanin synthesis with incidence of one per 20,000 births. Its clinical manifestations are related to the reduction or absence of pigmentation in the visual system and/or the skin and teguments. The clinical spectrum of Oculocutaneous Albinism (OCA) has four types ranging from OCA 1 - 4, of which OCA 1, A-1 is the most severe form. Partial cutaneous albinism which is a subtype of OCA is associated with systemic immunodeficiency disorders like Chediak Higashi (CHS), Griscelli (GS) and Hermansky-Pudlak (HPS) syndromes. A7 years boy was labeled initially as a case of Hermansky Pudlak syndrome at the age of 01 year. He as well as his 4 years old younger brother when examined in detail along with audiological investigations were diagnosed as a rare presentation of both Hermansky Pudlak and Waardenburg's syndrome.

Role of ACE and PAI-1 Polymorphisms in the Development and Progression of Diabetic Retinopathy.

In the present study we determined the association of angiotensin converting enzyme (ACE) and plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms with diabetic retinopathy (DR) and its sub-clinical classes in Pakistani type 2 diabetic patients. A total of 353 diabetic subjects including 160 DR and 193 diabetic non retinopathy (DNR) as well as 198 healthy controls were genotyped by allele specific polymerase chain reaction (PCR) for ACE Insertion/Deletion (ID) polymorphism, rs4646994 in intron 16 and PAI-1 4G/5G (deletion/insertion) polymorphism, rs1799768 in promoter region of the gene. To statistically assess the genotype-phenotype association, multivariate logistic regression analysis was applied to the genotype data of DR, DNR and control individuals as well as the subtypes of DR. The ACE genotype ID was found to be significantly associated with DR (p = 0.009, odds ratio (OR) 1.870 [95% confidence interval (CI) = 1.04-3.36]) and its sub-clinical class non-proliferative DR (NPDR) (p = 0.006, OR 2.250 [95% CI = 1.098-4.620]), while PAI polymorphism did not show any association with DR in the current cohort. In conclusion in Pakistani population the ACE ID polymorphism was observed to be significantly associated with DR and NPDR, but not with the severe form of the disease i.e. proliferative DR (PDR).

Comparison of latanoprost and dorzolamide in the treatment of patients with open angle glaucoma.

BACKGROUND: This study was conducted to compare the effects on intraocular pressure and side effects of monotherapy with either latanoprost or dorzolamide in patients with open angle glaucoma, pseudoexfoliation glaucoma or ocular hypertension. METHODS: Sixty patients with open angle glaucoma or ocular hypertension were recruited to a 3-month study. Previous glaucoma medications were washed out and the patients were randomised to receive either latanoprost 0.005% once daily or dorzolamide 2% three times daily. The follow-up visits were conducted at two weeks, one months and three months of study and intraocular pressures and slit lamp examinations were carried out to look for response of therapy and detect complications. RESULTS: After 3 months, latanoprost reduced mean baseline intraocular pressure from 27.2 +/- 3.0 mm Hg by 8.5 +/- 3.3 mm Hg. The corresponding figures for dorzolamide were 27.2 +/- 3.4 and 5.6 +/- 2.6 mm Hg. The difference of 2.9 mm Hg (95% CI: 2.3-3.6) was highly significant (p < 0.001). Both drugs were well tolerated systemically and locally. CONCLUSION: Latanoprost was superior to dorzolamide in reducing the intraocular pressure, judged from the effect on mean intraocular pressure. The once daily dose in the evening ensures better compliance and the problem of hyperpigmentation of the iris were not encountered.

Usefulness of pars plana vitrectomy in managing asymptomatic eyes of Eales' disease.

BACKGROUND: Eales disease is an idiopathic obliterative vasculopathy that commonly affects the peripheral retina of healthy young males characterized by recurrent vitreous haemorrhage. We did this study to evaluate the usefulness of Pars Plana vitrectomy in asymptomatic eyes of patients presenting with Eales' Disease. METHODS: Fifty-five patients with Eales' Disease demonstrable on the basis of three mirror fundus exam and Florescein Fundus Angiography with vitreous hemorrhage underwent either Pan retinal photocoagulation or vitrectomy in a span of 3 years. Their fellow asymptomatic eyes were initially treated with laser photocoagulation and after being followed for six months, they were grouped into either progressive cases (Group A) comprising of eleven eyes that underwent early vitrectomy, or non-progressive cases (Group B) comprising forty-four eyes that did not undergo any further treatment. These cases were followed for at least three years (range 38-42 months). RESULTS: Out of the eleven eyes of group A, seven (63.63%) showed regression of disease process as compared to only ten out of forty-four eyes (22.72%) in Group-B. CONCLUSION: Early vitrectomy in established cases of Eales' disease provides satisfactory results and helps in preventing complications, which are difficult to treat. Regular checkup of peripheral retina by triple mirror examination should be performed in all asymptomatic fellow eyes of Eales disease to detect the disease process at an early stage and prevent further complications.

Usefulness of laser photocoagulation in managing asymptomatic eyes of Eales disease.

BACKGROUND: Eales disease is an idiopathic obliterative vasculopathy that commonly affects the peripheral retina of healthy young males characterized by recurrent vitreous haemorrhage. We did this study to evaluate the usefulness of prophylactic scatter photocoagulation in asymptomatic eyes of patients presenting with vitreous haemorrhage due to Eales Disease. METHODS: Ninety nine patients with Eales' Disease demonstrable on the basis of 3 mirror fundus exam and Florescein Fundus Angiography with vitreous haemorrhage underwent either Pan retinal photocoagulation or vitrectomy in a span of 3 years. Their fellow asymptomatic eyes were grouped on the basis of their visual acuity, fundus findings and FFA picture. Group A comprising of forty-three cases underwent PRP whereas forty-three cases of Group B were not given any treatment. These cases were followed for at least three years (range 38-42 months). RESULTS: Out of the forty-three cases of group A, thirty-nine (83.82%) showed visual improvement as compared to only nine cases in Group-B (p < 0.001). Vitreous involvement was present in only 16 cases in Group-A as compared to 33 cases in Group-B. Twenty-eight cases of Group-B showed signs of persistence of disease process in the retina compared to 13 cases in Group-A (p < 0.005). CONCLUSION: Prophylactic photocoagulation is an effective method of controlling the secondary complications in asymptomatic eyes of Eales disease especially if managed at an early stage. Regular checkup of peripheral retina by triple mirror examination should be performed in all asymptomatic fellow eyes of Eales disease to detect the disease process at an early stage and prevent further complications.

Radial keratotomy: effects of corneal thickness on final outcome.

BACKGROUND: Corneal thickness may contribute in the final outcome of radial keratotomy operation for the correction of myopia. We present our study on ninety-nine consecutive eyes with a mean follow-up of one year. METHODS: Ninety-nine eyes with preoperative/uncorrected Myopia between 2.5-6.0D and a mean age of 29.2 (+/- 7) years underwent radial keratotomy between January 1999-December 2001 in the Department of Ophthalmology, Military Hospital, Rawalpindi. The eyes were divided based on their corneal thickness into group-A (51 eyes), with a pachymeter reading of 500-540 microns, and Group-B (48 eyes), with a pachymeter reading of 541-580 microns. The comparison between the Postoperative visual acuity of two groups was made at the end of study after one years' follow up. RESULTS: Forty-five eyes (88.23%) in Group-A improved to an uncorrected acuity of 20/20 as compared to forty eyes (83.33%) in Group-B (p > 0.05). Hyperopic shift occurred in two eyes (3.92%) in Group-A, as compared to ten eyes (20.83%) of Group-B (p > 0.05). Refraction showed that 94.11% cases of Group-A to be within 1 diopter of Emmetropia as compared to 93.75% cases in Group-B. Similarly, 98.03% cases of Group-A were within 2 diopters of Emmetropia as compared to 95.83% cases of Group-B. Glare and variation of vision in the initial four weeks were the most frequently reported complications in both groups. CONCLUSION: Thickness of cornea does not significantly affect the outcome of surgery in cases of low to moderate degrees of myopia.

Amniotic membrane transplantation in primary pterygium compared with bare sclera technique.

OBJECTIVE: To compare the excision of primary pterygium by bare sclera technique and excision combined with amniotic membrane transplantation (AMT). STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Eye Department, Military Hospital, Rawalpindi, presently known as Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2007 to July 2008. METHODOLOGY: 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. RESULTS: 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). CONCLUSION: 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.