An audit of 3-snip procedures performed at the Aga Khan University Hospital, Karachi, Pakistan.

OBJECTIVE: To assess the functional outcome of three-snip punctoplasty procedure for punctal stenosis at a tertiary care hospital. METHODS: The retrospective study was conducted at the Aga Khan University Hospital Karachi, and comprised medical records of all patients aged >18 years who underwent three-snip punctoplasty between January 2013 and December 2017. Data was retrieved on age, gender, diagnosis, signs and symptoms, laterality, date of procedure, resolution of symptoms post procedure, date of last eye followup, symptoms at last follow-up, functional outcome (epiphora at 1 month). SPSS 20 was used for data analysis. RESULTS: Of the 30 patients, 22(73.3%) were females. Overall mean age at the time of punctoplasty was 57.5±15.57 years. Of all the cases, 17(56.7%) had undergone bilateral puntoplasty. At one month, 20(66.7%) patients were completely symptom-free. Females had better results than males but the difference was not significant (p=0.078). CONCLUSIONS: Three-snip punctoplasty was found to be a minimally invasive procedure with good functional outcome that was comparable to other procedures.

Microbial profile and antibiotic susceptibility trend in postoperative endophthalmitis: a 12-year review.

OBJECTIVE: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis. RESULTS: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were culturepositive. Of them, 55(51.8%) had gram-negative bacteria, 41(38.6%) had gram-positive bacteria, and 10(9.4%) had fungi. Among gram-positive bacteria, coagulase-negative staphylococcus was the principal isolate 18(17%) and among gram-negative bacteria, it was pseudomonas species 20(18.8%). Spectrum of gram-positive sensitivities included vancomycin 100%, gentamicin 91.5%, amikacin 100%, ciprofloxacin 68%, chloramphenicol 100%, and tetracycline 84.6%. Among gram-negative organisms, the sensitivities were ciprofloxacin 52.9%, ofloxacin 66.6%, ceftazidime 91.8%, amikacin 100%, tobramycin 100% imipenem 91.6%, gentamicin 81.2% and tetracycline 75%. CONCLUSIONS: Vancomycin and ceftazidime were the best empirical antibiotic selection to treat postoperative endophthalmitis.

Characteristics Of Preterm With Sight Threatening Retinopathy Of Prematurity.

BACKGROUND: Retinopathy of prematurity (ROP) is a preventable and treatable vasoproliferative disorder of the retina which develops mostly in preterm babies. It is a leading cause of childhood blindness and more common in under developed countries. Prevalence of the severe ROP is 7.7% in Pakistan. We reviewed the characteristics of preterm babies with severe ROP to evaluate the predictors of sight threatening ROP. METHODS: Our study was conducted at the NICU of Aga Khan University Hospital which is a tertiary care private sector hospital in Karachi. Ninety-seven cases of severe ROP were found out of which 83 cases were enrolled. Data on determinants for ROP were collected including gestational age, birth weight, weight gain at two and four weeks, h/o blood transfusion, supplementary oxygen, presence of PDA and its treatment. Data analysis was done by using SPSS version 20.0. RESULTS: Frequency of severe ROP in our cohort was 5.95%. Mean gestational age for severe ROP was 28.27±1.79 and mean birth weight was 1069.16±271.71 grams. The overall mean weight gain per week in these babies was 94.62±75.64 grams. Supplementary oxygen was provided in almost 100% (82/83 cases) of cases. Surfactant was given to 56.6 % babies. PDA was found in 23 cases out of which 19 were treated by medical therapy whereas surgical treatment was done in 4 cases. CONCLUSIONS: Severe Retinopathy of prematurity was directly correlated with low birth weight, and gestational age. An average, weight gain in four weeks was lower in ROP babies (94.62±75.64 grams) than the recommended weight gain (WHO recommended 140-210 gm per week). This could be associated with the development and severity of ROP requiring treatment. Therefore, a prospective case control study is required to further identify risk factors associated with the above cohort. Screening and follow up of all such babies according to the international criteria is the need of the day.