Al-Ibrahim Eye Hospital Research Articles

Comparison of Retinal Thickness betweenDiabetic Patients without Diabetic Retinopathy and Non-Diabetic Controls Using SD-OCT

Purpose: To determine retinal thickness in diabetic patients without diabetic retinopathy and non-diabetic controls using Spectral Domain Optical Coherence Tomography (SD-OCT). Study Design: Cross-sectional observational study. Place and Duration of Study: Diabetic Eye Clinic and General Eye OPD of Al-Ibrahim Eye Hospital, Karachi from July 2018 to August 2018. Methods: Patients with type 2 diabetes and non-diabetic healthy control eyes of either genderand age between 20 and 60 years were recruited. Patients with any other systemic and ocular disease affecting retinal thickness were excluded. After initial examination and informed written consent, patients were referred to ocular investigation department for detailed retinal examination and SD-OCT for measuring central retinal thickness. Data were analyzed for continuous and categorical variable using SPSS. Results: Average Central Retinal thickness was 297±21 and 315±13µmand Central Foveal Thickness was 246±16 and 249±19µmin diabetic and non-Diabetic patients respectively. Quadrant-wise evaluation revealed retinal thickness as follows; nasal 310 and 324µm), temporal (291and 304µm), superior (297and 316µm) and inferior (292and 314µm) in diabetics and non-diabetics respectively. Retinal thickness was greater at nasal and lesser at temporal regions. Conclusion: Diabetic patients without DR had thinner central retinal thickness compared to non-diabetic controls, as measured by Spectral Domain Optical Coherence Tomography (SD-OCT). Specifically, the average central retinal thickness and central foveal thickness were slightly reduced in diabetic patients. Quadrant-wise analysis revealed that the retinal thickness was consistently greater in the nasal region and lesser in the temporal region in both diabetic and non-diabetic patients.

Primary Internal Limiting Membrane Peel and Its Effects on Epiretinal Membrane After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To determine the effect of internal limiting membrane (ILM) peel in post-operative development of epiretinal membrane and to see visual outcomes of patients undergoing pars plana vitrectomy with and without ILM peel. Study Design: Quasi experimental study. Place and Duration of Study: Retina clinic of Al-Ibrahim Eye Hospital from July, 2022 to Dec, 2022. Methods: A total of 60 eyes which underwent pars plana vitrectomy (PPV) with silicone oil for Rhegmatogenous retinal detachment (RRD) were included. Patients with previous vitreoretinal surgery or ocular trauma, macular diseases or coexisting conditions that could affect the outcomes or complicate the surgery were excluded. Group A included patients with ILM peel and Group B included patients with no ILM peel (30 eyes each). Frequency was calculated for gender, epiretinal membrane formation. and was compared between both groups using chi square. Results: Mean age in group A was 47.63 ± 8.61 years and in group B was 45.36 ± 6.63 years. Gender distribution showed 66.6% males in group A and 43.3% in group B. After 3 months the group A had significantly lower frequency of ERM formation (3.33%) as compared to group B (16.67%) with p <0.05. However, post operativevisual acuity was not significantly different between the two groups (p > 0.05). Conclusion: This study shows that primary ILM peel diminishes the development of ERM and decreases the need for second surgical procedure. However, postsurgical visual acuity between the two groups showed no significant difference.

Strabismus Measurements Using the Alternating and Simultaneous Prism Cover Tests

Purpose: Tocomparetheangleofdeviationbyperformingsimultaneousprismcover test (SPCT) and alternate prism cover test (APCT) at near (33cm) and far (6m). Study Design: Cross-sectional observational. Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi from July 2021 to December 2021. Methods: This study enrolled 32 participants diagnosed with constant esotropia, aged between 5 and 25 years, comprising 14 males and 18 females. Comprehensive ocular examinations for strabismus were performed, including simultaneous prism cover tests at both distance and near fixation, conducted with and without corrective glasses. Subsequently, an alternate prism cover test was administered at each fixation point, again both with and without glasses. Binocular single vision was evaluated using the Worth Four Dot test and the 10Δ test. Statistical analysis was conducted using SPSS version 20.0. Results: At distance fixation, the mean deviation angle measured by the simultaneous and alternate prism cover tests exhibited a significant difference of 9.78Δ (p=<.001). Similarly, at near fixation, the mean deviation angle between the simultaneous and alternate prism cover tests showed a significant difference of 10Δ (p=<.001). Conclusion: This study demonstrates a notable and statistically significant variance in the measured angle of deviation when employing different testing methodologies (SPCT and APCT).

Comparison between Two Doses of Suprachoroidal Triamcinolone Acetonide among Cases of Resistant Diabetic Macular Edema

Purpose: To compare the effectiveness and safety of two doses of supra-choroidal Triamcinolone Acetonide (TA)in patients of resistant diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi, from April 2023 to September 2023. Methods: Thirty-two cases of resistant diabetic macular edema were selected using a convenient sampling technique and divided into two groups. Group A received a single suprachoroidal injection of TA at a concentration of 2 mg/0.1 ml, while Group B received the same drug via the same route at a concentration of 4 mg/0.1 ml. All cases were monitored for any serious adverse effects the following day. Follow-up checkups were conducted for all cases at 1, 3, and 6 months. Results: Mean age of patients for group A and B was 56.24±1.2and 56.33±2.6years respectively. Both the groups were equivalent in all ophthalmological measurements best corrected visual acuity, central macular thickness and intraocular pressure (BCVA, CMT, IOP) at baseline checkups. At 6thmonth follow up, both groups showed improved BCVA and decreased CMT compared to baseline, but group B had a significant increase in IOP (p = 0.001). Additionally, cataract progression was slower in group A. Conclusion: Both doses of suprachoroidal TA are equally effective in cases of resistant diabetic macular edema in terms of improved BCVA and reduced CMT. However, the lower dose (2mg/0.1 ml) showed advantages in terms of fewer complications, specifically less likelihood of raised intraocular pressure and cataract formation.

Effectiveness of Silicone Oil Tamponade with Pars Plana Vitrectomy in Isolated Cases of Vitreous Hemorrhage with Advanced Diabetic Retinopathy

Purpose: To assess the effectiveness and safety of silicone oil as tamponade in vitrectomy performed for isolated cases of vitreous hemorrhage in patients with advanced diabetic retinopathy. Study Design: Quasi experimental. Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi from October 2022 to March 2023. Methods: Forty two cases of advanced diabetic retinopathy (either sex), with developing vitreous hemorrhage (active bleeding) were enrolled through convenient sampling. Demographic characteristics and pre-operative examination of eyes including Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscopy, gonioscopy and ultrasonography (in cases where fundus was not visible) were performed. All the patients underwent pars plana vitrectomy (PPV) and pan retinal photocoagulation (PRP). Silicone oil was used as tamponade. Post-operative follow up was at first week after surgery and repeated at 3rd month and 6th month. Effect of silicon oil tamponade on re-bleeding after surgery was specifically observed. Anatomical outcome and side effects were also noted during the study period. Results: Out of 42 cases, re-bleed occurred in 2 cases (4.76 %). However, intraocular pressure (IOP) was raised in 3cases (7.1%) and cataract formed in 2 cases (4.76%). No other side effect was observed throughout the study period. Conclusion: Use of silicone oil as tamponade effectively decreases re-bleeding in patients of advanced diabetic retinopathy after vitrectomy. However, few complications such as increased intraocular pressure and cataract can occur that are manageable both medically and surgically.

A comparative analysis of postoperative visual outcomes following cataract surgery with different brands of Monofocal Intraocular Lenses.

To compare visual outcomes after cataract surgery using three intraocular lenses (IOL) of different prices but similar properties. A comparative study with retrospective data of patients operated for phacoemulsification with monofocal IOL implants was carried out at Al-Ibrahim Eye Hospital (AIEH) from April 2021 to Feb 2022. Patients with diabetes, any preoperative ocular morbidity and unclear diagnosis were excluded from the study. Pre and post-operative best corrected visual acuity (BCVA) on 1st day, 7th day and 4-6 weeks were analyzed. IOLs were categorized on the basis of price into economical, standard and premium lenses. To minimize surgical bias, data was further stratified on the basis of surgical expertise. Data of 3237 patients was analyzed. Economical lens (A) was implanted in 2647, standard (B) in 254 and premium (C) in 336 patients. On average BCVA (6/6 to 6/12) was achieved in 88.2% of patients. No significant difference was found at third follow up among BCVA of three IOls operated by senior surgeon, χ2(2) = 3.216, p = 0.20, with median (IQR) is 0.2(0.2) logMAR for Group-A, 0.1(0.2) logMAR for Group-B and 0.2(0.1) logMAR for Group-C. When results of the rest of the surgeons was considered, significant difference was found among BCVA at 3rd follow-up, χ2(2) = 6.661, p = 0.036, with median (IQR) is 0.3(0.2) logMAR for Group-A, 0.2(0.1) logMAR for Group-B and 0.2(0.3) logMAR for Group-C. When surgical factors mainly, surgeon bias is removed, all three types of monofocal IOL had similar visual outcomes.

Immediate Rise in Intraocular Pressure After First-Time Intravitreal Injection of Bevacizumab.

Objective This study aims to report an immediate changein intraocular pressure (IOP) after the first injection of bevacizumab. Materials and methods An interventional case series was carried out at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from November 2018 to April 2020. All patients with various chorioretinal diseases requiring anti-VEGF treatment were included in the study. Patients with a history of previous anti-VEGF or steroid injections and personal or family history of glaucoma were excluded. Bevacizumab in a dose of 1.25 mg (0.05 ml) was injected intravitreally under topical anesthesia maintaining sterile aseptic conditions in the operating room. IOP was checked one hour prior to the injection, and hourly monitoring of it was continued for the next six hours. Data were analyzed using SPSS Statistics to compare the mean IOP readings before and after injection. Results A total of 191 eyes of 147 patients were included in the study. Among them, 92 (62.58%) were male and 55 (37.41%) were female with a mean age of 45.5 ± 8.8 years. The mean pre-injection IOP was measured as 12.12 ± 2.11 mmHg. The frequency of IOP elevation of ˃ 21 mmHg was observed in 169 (88.5%) eyes at five minutes, 104 (54.5%) eyes at 30 minutes, 33 (17.3%) eyes at one hour, and 16 (8.4%) eyes at two hours. The raised mean post-operative IOP was 30.44 ± 6.53 mmHg at five minutes, 26.27 ± 4.65 mmHg at 30 minutes, 26.12 ± 3.31 mmHg at one hour, and 25.63 ± 3.03 mmHg at two hours. The IOP reduced to pre-injection value at three hours measuring12.12 ± 2.11 mmHg and continued to stay at that level for the next three hours. Conclusions The majority of the eyes receiving first-time intravitreal bevacizumab injection showed a significant increase in IOP levelwithin five minutes to two hours post-injection.

Suprachoroidal injection of triamcinolone acetonide for management of resistant diabetic macular oedema.

To estimate the effects and safety of suprachoroidal triamcinolone acetonide injections in treating patients with resistant diabetic macular oedema. The quasi-experimental study was conducted at the Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from November 2019 to March 2020, and adult patients of either gender with uncontrolled diabetes mellitus. Central macular thickness, intraocular pressure and best corrected visual acuity were recorded at baseline, and the patients were followed up at one and three months after the suprachoroidal triamcinolone acetonide injection and post-intervention parameters were compared. Data was analysed using SPSS 20. There were 60 patients with a mean age of 49.25±5.6 years. Of the 70 eyes, 38(54.30%) belonged to male subjects and 32(45.70%) to female subjects. There were significant differences in terms of central macular thickness and the best corrected visual acuity at both follow-ups compared to the baseline readings (p<0.05). Suprachoroidal triamcinolone acetonide injection significantly reduced diabetic macular oedema.

Comparison between Suprachoroidal Triamcinolone and Intravitreal Triamcinolone Acetonide in patients of resistant Diabetic Macular Edema

Purpose: To compare the effectiveness and safety of suprachoroidal versus intravitreal Triamcinolone Acetonide in cases of resistant diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: This research was executed at Retina Department of Al-Ibrahim Eye Hospital, Karachi, Pakistan between 1st January 2022 till 30th June 2022. Methods: Thirty-four patients with resistant diabetic macular edema were selected through convenient sampling and divided equally into two groups. All patients underwent ocular examination. Group I was given single Intravitreal injection (IVI) of 0.1 mL Triamcinolone Acetonide at 4 mg per 0.1 mL concentration. Group II received same dosage of drug via Suprachoroidal injection (SCI). After 24 hours, they were assessed for side effects. After 6 weeks, second dose of same drug was administered. Patients were followed at 3 and 6 months. Results: No serious side effect was observed in any patient within 24 hours. At 1 month follow-up period, comparison between the two groups for BCVA, CMT and IOP was not significant (p &gt; 0.05). When the two groups were compared at 3 months, both routes were equally effective but IOP remained more stable via SCI route. At 6 months, IOP remained elevated in group I but decreased in group II (p = 0.003). Conclusion: Triamcinolone Acetonide was effective by both routes in resistant diabetic macular edema in terms of improved BCVA and CMT but SCI was better in terms of IOP and cataract progression.

Validity of Hand Held Fundus Camera by Optometrist using Slit lamp 90D bio microscopy as a reference standard for screening of Diabetes Retinopathy.

To find out the validity of hand-held fundus camera by optometrist using slit lamp 90D biomicroscopy as reference standard for screening of diabetes retinopathy. The observational cross-sectional study was conducted at the diabetic clinic of Al-Ibrahim Eye Hospital, Karachi, from August 2020 to May 2021, and comprised diabetics of either gender aged >16 years visiting the outpatient department. Un-dilated fundus photograph of both eyes were taken with non-mydriatic fundus camera. Pupils were then mid-dilated with one drop of tropicamide 1% before capturing retinal images by handheld fundus camera by another optometrist. Both the optometrists identified and recorded the presence and absence of diabetic retinopathy. Subsequently, a retinal specialist examined the fundus with slit lamp 90 D biomicroscopy. Data was analysed using SPSS 23. Of the 500 subjects, 291(58.2%) were males and 209(41.8%) were females. The overall mean age was 54.49±9.16 years (range: 16-83 years). Of the 1000 eyes, fundus was not readable in 130(13%) by hand-held fundus camera, 296(29.6%) eyes by non-mydriatic fundus camera and 76(7.6%) eyes by slit lamp. Sensitivity and specificity of hand-held fundus camera compared to non-mydriatic fundus camera was 89.86% and 80.36%, respectively. In comparison with slit lamp, the sensitivity was 91.71% and specificity was 71.10%. Kappa statistic for diabetic retinopathy detection by hand-held fundus camera versus non-mydriatic fundus camera was 0.705, indicating substantial agreement. Kappa statistic for diabetic retinopathy detection with hand-held fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy. Handheld fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy.

Ischemia modified albumin as a useful marker for diagnoses and management of diabetic retinopathy.

Objectives:Ischemia modified albumin (IMA) may aid in the early detection and management of diabetic retinopathy (DR). In this study, we examined the relationship between IMA and DR, and the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) on IMA levels in patients with DR.Methods:This Quasi-experimental study was conducted from March-December 2018 at a Al-Ibrahim Eye Hospital in Karachi, Pakistan. Adult patients (age ≥ 18 year) with Type-2 diabetes mellitus (T2DM) presenting to the Diabetic Clinic were categorized as control (Group-A n=30: DM without DR) or case (Group-B n=59: DM with DR). Patients in Group-B received an intravitreal injection of bevacizumab (anti-VEGF). Visual acuity, retinoscopy and serum IMA were recorded at baseline and at a 30-day follow-up for both groups.Results:A significant drop in IMA levels was seen one month after bevacizumab (IMA baseline: 1590.82±121.22 and follow up: 940.8±91.26; p<0.01) in Group-B subjects. Visual acuity (VA) of patient in Group-B also improved one month after bevacizumab injection in both eyes (p<0.001). Whereas, the IMA levels in Group-A showed an upward rising trend after one month (baseline 448.80±22.4ng/ml and follow up 522.21±33.15 ng/ml; p>0.05) indicating disease progression.Conclusion:Ischemia modified albumin may be used as an effective and novel screening biomarker for assessing oxidative stress associated with DR, and to quantify response to and prognosis after intravitreal bevacizumab injection for DR.

Effect of vision therapy on fusional vergences in intermittent exotropia

Significance: Intermittent exotropia is intermittently manifest squint at distance and latent exophoria at near. Most of the time, the eyes seems to be aligned with normal binocular single vision is maintained because its exodeviation is intermittently controlled by fusional mechanisms. Purpose: To evaluate the effect of vision therapy on fusional vergences in intermittent exotropia. Methods: This hospital-based, Quasi-Experimental study was carried out at the Orthoptics clinic of Al-Ibrahim Eye Hospital from August 2020 to July 2021. Non- probability, purposive sampling was used. This study involved the 40 subjects who were diagnosed with Intermittent Exotropia of age ranges 10 to 25 years, of both genders. A detailed history was evaluated. Orthoptics assessment included visual acuity, cover test, near the point of accommodation and convergence at a distance, and near and fusional vergences of positive and negative with prisms were measured. All subjects underwent vision therapies for 2 months. SPSS version 20.0 was used to analyze the data. Results: A total of 40 subjects with a mean age of 16.53±2.96 were included in this study. Out of 40 subjects, 22 subjects were females and 18 subjects were males. Subjects who received dot card therapy and executives bifocals therapy showed a significant change in the angle of deviation at distance and near (P=.001), followed by reduced the near point of convergence (P=.001), and increased the positive fusional vergences at distance and near (P=.001). There was no significant improvement seen in near point of accommodation (P=.16) with both therapies. Negative fusional vergences showed non-significant as (near: P=.14, distance: P=.05) with executives bifocals and (P=.26) with dot cards. Conclusions: This study showed that vision therapies with dot card and executive bifocals therapy have significantly improved the angle of deviation, positive fusional vergences, and near point of convergence in intermittent exotropia subjects.

Intraocular Pressure Control after Trabeculectomy with Adjunctive Use of Mitomycin-C versus Bevacizumab: A Hospital Based Study

Purpose: To compare the control of intra ocular pressure (IOP) after trabeculectomy with adjunctive use of Mitomycin–C (MMC) versus Bevacizumab. Study Design: Quasi experimental study. Place and Duration of Study: Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi, from August 2017 to August 2019. Methods: One hundred and six patients of either gender, fulfilling the inclusion criteria were planned for trabeculectomy with adjunctive use of Mitomycin-C (MMC) or Bevacizumab. Each group consisted of 53 patients (53 Eyes). The patients diagnosed with Primary Open Angle Glaucoma (POAG) with IOP ? 21 mm Hg and not controlled with topical anti-glaucoma medication were selected. Data were analyzed by using SPSS Version 22.0. Independent sample t test was used to check significance between two drugs. Paired sample t test was used to check significance of pre and post-operative IOP. Results: Mean age of patients was 56.67±7.34 years. Mean preoperative IOP was 31.51 ± 9.66 mm Hg in MMC group and 29.21 ± 7.69 mm Hg in Bevacizumab group. At first postoperative day, mean IOP after use of MMC was 14.75 ± 9.46 mm Hg and for Bevacizumab was 15.07 ± 6.47 mm Hg (p-value 0.001). Similarly, at one year follow-up, mean IOP for MMC group was 11.26 ± 2.31 mm Hg and for Bevacizumab was 11.73 ± 2.12 mm Hg(p-value 0.001). Conclusion: There was significant reduction in IOP in both MMC and Bevacizumab groups. However, the difference between the two groups was not statistically significant at mean follow-up of one year. Key Words: Primary Open Angle Glaucoma, Mitomycin–C, Intraocular Pressure, Bevacizumab, Trabeculectomy.

Assessment of pattern of refractive errors in infantile esotropia- A single-center cross-sectional study

This was a cross-sectional study conducted to explore the patterns of refractive errors found in infantile esotropia patients from newborns to the age of 15 years, attending the Pediatric clinic of Al-Ibrahim Eye Hospital, Karachi, Sindh, Pakistan. Data was collected on a pre-designed proforma. A total of 79 patients (total of 158 eyes) including 44 males (55%) and 36 females (45%) were recruited. All these patients had infantile esotropia. The study showed out of 79 patients (158 eyes), 89 eyes had hyperopia, 15 eyes had myopic astigmatism, 44 eyes had hyperopic astigmatism, while 4 eyes had mixed astigmatism, and 6 eyes had myopia. The hypermatropia was found to be the most commonly occurring refractive error in infantile esotropia resulting in inward eye deviation.

Comparison of Complications between Manual Small Incision Cataract Surgery and Phacoemulsification

Purpose: To compare per-operative and early post-operative complications between Manual Small Incision cataract surgery and Phacoemulsification in patients with Senile Cataract.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Al-Ibrahim Eye Hospital Karachi from December 2018 to October 2019.&#x0D; Methods: Two hundred and seventy patients with senile Cataract were recruited for this study by convenient sampling technique. They were divided equally into two groups. Group I underwent Manual Small Incision Cataract Surgery (MSICS), whereas Group II underwent Phacoemulsification. Per-operative and early post-operative complications were recorded on day 1 in both groups. Data was analyzed using SPSS 24.0. Independent t-test was carried out with P-value of ≤0.05 was considered statistically significant.&#x0D; Results: Mean age group – I was 54.95 ± 11.0 and in Group – II was 57.09 ± 10.59 (p = 0.546). There were 72 (53.3%) males in group – I and 74 (54.8%) in group – II with a non-significant difference (p-value &gt; 0.01). There was significant difference for posterior capsule rupture and striate keratitis between the two groups (p = 0.031 and 0.044 respectively). Rest of the study parameters was not statistically different in the both group. None of the groups had a nucleus drop and vitreous prolapse. No significant difference was seen between the two groups concerning iris trauma (p = 0.56), wound leakage (p = 0.15) and hyphema (p = 0.32).&#x0D; Conclusion: There is no significant difference between per-operative and early post-operative complications between MSICS and Phacoemulsification in patients with senile cataract except posterior capsular rupture and striate keratopathy which were more common in phacoemulsification group.&#x0D; Key Words: Cataract, Senile Cataract, Phacoemulsification, Small Incision Cataract Surgery.

Serum vitamin A, E &amp; C in cortical &amp; nuclear cataract patients.

Objective: To assess the status of antioxidant vitamins (A, E &amp; C) in cortical and nuclear cataracts patients. Study Design: Prospective Comparative study. Setting: Al-Ibrahim Eye Hospital and Biochemistry Department of Al-Tibri Medical College, Karachi. Period: Sept 2016 to Aug 2017. Material &amp; Methods: A non-probability random sampling technique was used on 80 pre-diagnosed cataracts (cortical and nuclear) patients, and 40 control subjects were selected for the study. The demographic data were collected, and the blood sample of control and cataract patients were analyzed for random blood sugar and antioxidant vitamins (A, E, and C) by Elisa Method. Results: The Blood level of vitamins E was low in cataract patients as compared to control subjects. Conclusions: The blood level of vitamin E is less in cortical and nuclear cataract patients as compared to control but had shown no significant difference between cortical and nuclear cataract patients.

Refractive Error in Juvenile Patients Presenting with Nystagmus at Tertiary Care Hospital of Karachi

Objective: To evaluate the types of refractive errors in nystagmus patients among the age (5-15 years) patients. Study Design and Setting: An observational cross-sectional study was conducted at Pediatric department of Al-Ibrahim Eye Hospital, Karachi from June 2018 to March 2019. Methodology: A total of 55 patients (110 eyes) were selected from study setting. The protocol for examination for all patients were evaluated at the special clinic of Orthoptics includes the demographic data, educational status, history of onset, type of nystagmus. The anterior segment was examined with a slit-lamp to exclude any other ocular disease. Orthoptic assessment includes cover uncover test, Hirschberg, ocular motility, prism cover test and pupillary reflex test, to observe any associated deviation. All the patients were examined after obtaining a fully informed consent. After the proper diagnosis of nystagmus patient was recruited as per inclusion and exclusion criteria with no restrictions of gender. All the observations were noted on a Proforma, Data analysis was done by using SPSS version 20. P-value &lt;0.05 was considered as statistically significant. RESULTS: A total of 55 patients, 29 male (52.7%) and 26 female (47.3%) were selected. This study shows out of 55 patients (110 eyes), 46 (42%) eyes had myopic astigmatism, while 33 (30%) eyes were found hyperopic astigmatism, 20 (18%) eyes were observed hyperopic and 11 (10%) eyes were observed myopic. CONCLUSION: Most common type of refractive error in nystagmus was myopic astigmatism. The refractive correction should be encouraged in children with nystagmus; improvement in visual function is likely to occur

Frequency of Refractive error in children with strabismus at tertiary Care Hospital Gadap Town, Karachi.

Objectives: This was conducted to determine frequency of various refractive errors with types of strabismus among the age group of 5-15 years children visited in the tertiary eye care hospital Gadap town, Karachi. Study Design: Cross Sectional Analytical Study. Setting: Al-Ibrahim Eye Hospital. Period: May 2019 to November 2019. Material &amp; Methods: This study was conducted on 300 strabismic subjects with a mean age of 5 to 15 years by non-probability convenience sampling. All respondents underwent visual acuity assessment by Snellen chart with and without correction, pinhole method, and fundus examination by retinoscope, Cardiff card, cover/uncover test, cycloplegic refraction by cyclopentolate 1%, and ocular movement examination. Results: Out of 300 patients, 43(14.3%) subjects were diagnosed as strabismus with refractive error. 20(46.5%) were boys, while 23(53.5%) were girls with a mean age of 9.62 ± 3.1. The hyperopic 20(46.5 %), 17(39.6 %) myopic, and 6(13.9%) had astigmatism. Conclusion: Strabismus was more frequently observed in females than in males. Hyperopia was in Strabismic respondents than myopic and astigmatism. The esotropia was commonly seen in hypermetropia, Exotropia, in Myopia. The vertical and alternate not frequently seen are these respondents. Hence it is necessary to diagnose the children as early as possible to prevent them from other ocular manifestations.

Efficacy of Ahmed Glaucoma Valve and Trabeculectomy With Mitomycin-C in Pediatric Glaucoma

Objective: To compare the efficacy between Ahmed glaucoma valve surgery and Trabeculectomy with Mitomycin-c inpediatric glaucoma.Study design and setting: Quasi-experimental study was conducted at Pediatric Ophthalmology Department, ISRA Postgraduate Institute of Ophthalmology/ Al-Ibrahim Eye Hospital, Karachi. Duration of study was February to August 2016.Methodology: Samples were divided into two groups. Group A Trabeculectomy with Mitomycin-C and Group B withAhmed Glaucoma valve surgery. Inclusion criteria were children (above 2 years and less than 15 years of age) visitingPediatric Ophthalmology OPD irrespective of gender, glaucoma diagnosed with the duration of symptoms &gt; 4 weeks.Exclusion criteria were patient with repeat surgery for glaucoma, combined ocular surgery i.e penetrating keratoplasty orcataract, Preoperative keratitis, uveitis or conjunctivitis, as determined by slit-lamp examination. Paired sample t-test wasapplied to compare the pre and post IOP examination findings. P-value = 0.05 considered as statistically significant.Results: A total of 110 patients were recruited in this study in which 97 patients were analyzed. Mean age of Group A was6.73±2.7 and mean age of Group B was 7.05±2.3. Mean pre-operative IOP in “Group A” was found to be 31.59±5.4 andpost-operative IOP was reduced to 17.95±4.8 with statistically significant P-value &lt;0.0001. In “Group B” Mean preoperativeIOP was 30.60±5.3 and post-operative IOP was 18.43±3.8 with statistically significant P-value &lt;0.0001.Conclusion: A significant difference found between efficacy of Ahmed glaucoma valve surgery and Trabeculectomy withMitomycin-C in pediatric glaucoma after 4th week of surgery.

To evaluate the retinal nerve fiber layer thickness in different types of glaucoma

Objective: Glaucoma is a multifaceted eye disease which is classified as physical damage of retinal ganglion cells which may effect in loss of vision and permanent blindness. While physical damage of glaucoma can be clinically evaluated the optic nerve head and peripapillary retinal nerve fiber layer (RNFL). Our objective is to evaluate the mean RNFL thickness in all types of glaucoma. Methodology: This prospective and cross sectional study was conducted in Glaucoma Clinic of Al Ibrahim Eye Hospital (AIEH), Karachi, for the period from May 2019 to October 2019, after ethical approval from Institutional Research Committee. A total of 64 glaucoma patients were chosen by using non-probability purposive sampling technique. The participant comprised, no known eye disease, no visual impairment, IOP below 22 mmHg, and no obvious retinal disease or defect were included while individuals having a history of ocular diseases or pathology with residual visual impairment, retinal diseases, amblyopia, and history of intraocular surgery or laser therapy were excluded from the study. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 64 patients of both genders with mean age of 55.54±15.58 years. The mean intraocular pressure of right eye and left eye was 16.46±8.06 and 16.75±7.82 mmHg, respectively. The mean RNFL thickness in superior, inferior, temporal and nasal quadrant of the right eye was measured 68.23±25.44, 66.79±27.50, 51.75±12.58 and 47.73±18.82 microns, respectively while the mean RNFL thickness in superior, inferior, temporal and nasal quadrant of the left eye was measured 76.01±22.72, 67.42±21.25, 54.37±13.0 and 49.62±11.57 microns, respectively. Conclusion: Our study showed that analysis of retinal nerve fiber layer thickness with optical coherence tomography is the best tool for the diagnosis of glaucoma. It has also been observed in our study that frequency of changes in retinal nerve fiber layer thickness was mostly found in primary open angle glaucoma patients