Al-Ibrahim Eye Hospital Research Articles

Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan

Objectives:To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi.Methods:An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient’s BCVA was found to be ≤ 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment.Results:A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week.Conclusions:The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.

Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

Purpose: To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019.&#x0D; Methods: Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age &gt; 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated.&#x0D; Results: A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg.&#x0D; Conclusion: Phacoemulsification produces a useful decrease in IOP in glaucoma patients.&#x0D; Key Word: Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

Visual outcomes in diabetic macular edema patients after avastin injection

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.

Surgical Outcomes of Combined Phacoemulsification and Silicone oil Removal in Post Retinal Detachment Surgery Patients

Purpose: To evaluate the surgical outcomes of Combined Phacoemulsification with IOL implantation and Silicone oil removal in patients with previous retinal surgery.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Al-Ibrahim eye Hospital Karachi from January 2019 to December 2019.&#x0D; Methods: Total 30 eyes of 30 patients between ages of 25 to 65 years, who had retinal detachment surgery with silicone oil used as internal tamponade and later on developed cataract were re-operated once confirming that retinal was attached. The time interval between two surgeries was 8 to 10 months. Phacoemulsification with IOL implantationwas done followed by silicone oil removal by 23-gauge pars plana method. Postoperative follow-ups were done at day 1, 1 month and at 6 months to record visual acuity and retinal status.&#x0D; Results: Best corrected Visual acuity was recorded pre and post-operatively using Snellen chart. Preoperatively 12 patients had visual acuity of 6/60, 12 with vision 6/95 and 6 with 6/120. There was improvement of 2 lines of visual acuity post operatively as recorded by Snellen chart. Retina was attached in 28 (93.33%) patients and 2 (6.66%) had re-detached retina at the end of 6 months.&#x0D; Conclusion: Visual outcomes were found to be better with low rate of retinal re-detachment after 6 months follow-up of combined phacoemulsification with IOL implantation and silicone oil removal. Hence, Combined Phacoemulsification with Silicone oil removal is a method that is associated with better visual and anatomical outcomes as well as decrease the chances of patients undergoing third surgery for cataract extraction.&#x0D; Key Words: Retinal Detachment, Phacoemulsification, Silicon Oil.

Management of Glaucoma Capsulare: Outcomes and Complications of Trabeculectomy

Purpose: To analyze the results of filtration surgery in cases of Glaucoma Capsulare.&#x0D; Study Design: Experimental study.&#x0D; Place and Duration: Al-Ibrahim Eye Hospital, Karachi, from January 2018 to December 2018.&#x0D; Methods: Forty eyes of forty patients, between 50 to 80 years of age, with Glaucoma Capsulare, not controlled with topical medication were included in the study. Patients not willing for filtration surgery and those who had any other ocular disease were excluded. Pre-operative examination, including visual acuity, retinoscopy, intra ocular pressure and fundus examination was done. Complete blood count, blood sugar and urine complete were also carried outto rule out any other illness. All collected data was analyzed through software SPSS version 20.&#x0D; Results: There were 26 (65.0%) males and 14 (35.0%) females. Mean age was 62.1 ± 12.44 years. Mean IOP was 34.0 ± 2.43 mm of Mercury. At first follow-up mean IOP (mm.Hg) was 11.44 ± 3.2 and at 12 weeks follow-up, the IOP was 10.14 ± 4.1. Angle 0 – I (closed angle) was seen in 6 (15.0%), Angle grade II – III (Open angle) was seen in 10 (25.0%) and grade III – IV (open angle) was seen in 24 (60.0%) patients. Visual acuity 6/9 were in 4 (10.0%), 6/12 – 6/18 in 10 (25.0%), 6/18 – 6/24 was in 12 (30.0%) and visual acuity 6/36 – 6/60 was noted in 14 (35.0%) patients. Early complications were flat anterior chamber in 4 (10%) and corneal edema in 4 (10%) patients. However late complications were hyphema and cataract in 2 (5%) and 25 (62.5%) patients respectively.&#x0D; Conclusion: Trabeculectomy significantly lowers the intraocular pressure in patients with Glaucoma Capsulare.&#x0D; Key Words: Glaucoma Capsulare, Trabeculectomy, Gonioscopy, Hyphema, Pseudoexfoliation glaucoma.

Diagnostic Accuracy of Direct Ophthalmoscopy and Non-Mydriatic Retinal Photography by Trained Optometrists for Screening of Diabetic Retinopathy

Purpose: To determine the reliability of direct ophthalmoscopy and Non-Mydriatic fundus photography for screening of Diabetic Retinopathy by optometrist.&#x0D; Study Design: Observational, cross sectional.&#x0D; Place and Duration of Study: Al-Ibrahim eye hospital, Karachi from October to December 2018.&#x0D; Material and Methods: All individuals with type 2 diabetes of≥ 40 years of age were screened for diabetic retinopathy (DR) by two trained optometrists and an ophthalmologist. First Optometrist used Non Mydriatic Fundus Camera (NMFC) and second optometrist used direct ophthalmoscopy (DO) after dilating the pupils. Final examination was done by the Ophthalmologist with slit lamp using Volk fundus lens which was considered as reference standard. Every investigator was kept unaware of the findings of others.&#x0D; Results: A total of 698 eyes of 349 respondents were screened. Ophthalmologist could not make decision by bio microscopy in 44 (6.3%) individuals as compared to 128 (18.3%) by 1st optometrist by NMFC and 142 (20.3%) by 2nd optometrist with DO. Diabetic retinopathy (DR) was diagnosed in 1493 (21.4%) with slit lamp, in 1172 (16.8%) with NMFC and in 1333 (19.1%) with DO. Sensitivity of NMFC was 76% and that of DO was 64.8%. Specificity of NMFC was 97.45% and that of DO was 96.63%. Positive predictive value (PPV) of NMFC was 89.33% and that of DO was 84.3% Negative predictive value (NPV) of NMFC was 93.33% and that of DO was 90.7%.&#x0D; Conclusion: NMFC is recommended tool for DR screening; but DO by well-trained optometrist can be reliable where neither ophthalmologist nor NMFC is available.

Visual Outcomes of Pars Plana Vitrectomy Alone or with Intravitreal Bevacizumab in Patients of Diabetic Vitreous Haemorrhage.

To evaluate the visual outcomes of pars plana vitrectomy (PPV) alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. A quasi-experimental study. Al-Ibrahim Eye Hospital, Malir, Karachi, from March to November 2018. Patients between 40-70 years of age, irrespective of gender with non-resolving dense diabetic vitreous haemorrhage were divided into two groups. Group A received injection bevacizumab 7 days before PPV surgery. Group B received no preoperative injection. Log Mar chart was used for documenting postoperative vision. All patients completed their 6 months follow-up. SPSS was used to analyse the data. Best corrected visual acuity (BCVA) was documented as improved, same, or worse. In Group A, 21 (70%) patients had improved VA; whereas, in Group B, 17 (56.6%) patients showed improved visual acuity postoperatively. Patients were examined at four weeks, three months, and six months, respectively for recurrent vitreous haemorrhage. In Group A, 25 (83.3%) patients had no vitreous haemorrhage up to six months, whereas, in Group B, 13 (43.3%) patients had no vitreous haemorrhage up to six months with p-value of 0.021. Anti VEGF injection bevacizumab before PPV in patients with non-resolving diabetic vitreous haemorrhage is good to get better results in terms of BCVA, as well as reduce the incidence of recurrent vitreous haemorrhage.

Frequency of Neurogenic Strabismus in Al-Ibrahim Eye Hospital, Karachi

Purpose: To determine the frequency of Neurogenic Strabismus presenting at the Orthoptics Clinic in Al-Ibrahim Eye Hospital, Malir Karachi. Study Design: Cross-sectional study. Sampling Technique: Non-probability convenient sampling. Place and Duration of Study: Orthoptics Clinic of Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2018. Material and Methods: This study included 349 subjects age ranged from 5 to 75 years. All ocular examinations for strabismus were performed, including cover test, prism cover test and Hess chart. Demographic features and etiologies were recorded, and the causes of extra ocular muscle palsies were grouped as; trauma, diabetes, hypertension and others. SPSS version 20.0 was used to analyze the data. Results: Frequency of neurogenic strabismus was found to be 6%. Out of 21 subjects, 8 (38.1%) subjects had diabetes, followed by 2 (9.5%) subjects with hypertension, 5 (23.8%) subjects with ocular trauma and 6 (28.6%) subjects with other causes. The most commonly affected side was the right eye seen in 13 (61.9%) subjects. The most common ocular motor nerve involved was abducent (sixth) nerve in 13 (61.9%) subjects, followed by oculomotor (third) nerve in 4 (19%) subjects. Out of the patients with third nerve palsy 3 (14.3%) subjects had pupil sparing and only 1 (4.8%) subject had no pupil sparing. Conclusion: Sixth nerve was the most common nerve involved and most common etiology was uncontrolled diabetes. Keywords: Neurogenic Strabismus, Cranial nerve palsies, Paralytic strabismus

Surgical Outcomes of Idiopathic Macular Epiretinal Membrane Peeling.

To evaluate the surgical outcomes of idiopathic macular epiretinal membrane (IERM) peeling in terms of visual acuity and macular thickness. Observational cross-sectional study. Al-Ibrahim Eye Hospital, Karachi, from June 2017 to February 2018. Patients aged >50 years having IERM confirmed with optical coherence tomography (OCT) were included in the study. All patients underwent 3-port pars plana vitrectomy (PPV) followed by epiretinal membrane peeling. Log Mar visual acuity chart was used for documenting visual acuity pre- and postoperatively. OCT was performed for documenting changes in macular thickness pre- and postoperatively. Every patient completed their follow-up of six months. Mean age of the 43 patients was found to be 59.98 ±6.1 years. Mean pre- and postoperative visual acuity of Log Mar showed 0.59 ±0.21 and 0.33 ±0.21, respectively (p<0.001). Mean macular thickness on OCT pre- and postoperatively were 479 ±82.5 and 315 ±82.4 m, respectively (p<0.001). In thirty-one (72.1%) eyes, there was improvement in best corrected visual acuity (BCVA) postoperatively, 9 (20.9%) eyes remained stable; whereas, 3 (7%) eyes had decreased visual acuity at final follow-up of six months. Peeling of IERM is a safe surgical procedure. It is associated with significant improvement in best corrected visual acuity postoperatively along with improvement in anatomical outcomes in terms of decrease macular thickness as measured by OCT.

Outcomes of cataract surgery in Microophthalmia.

Objective:To find out outcomes of cataract surgery with Microophthalmia in children less than two yearsMethods:This cross-sectional study was conducted at Al-Ibrahim Eye Hospital, Karachi from January 2016 to August 2017. It included thirty micro ophthalmic eyes of infants with visually significant cataract of age less than two years who had cataract surgery without intraocular lens implantation. Axial length of globe was 19 mm or less in all thirty eyes of seventeen infants. in which thirteen infants had bilateral cataract and four had unilateral cataract.Result:Thirty Simple Micro ophthalmic eyes from seventeen patients having visually significant congenital cataract were studied. Thirteen had bilateral cataract and four had unilateral cataract. Mean preoperative IOP was 9.0±1.2 mmHg and postoperative IOP after three months was 10.9±3.2 mmHg. Three patients had secondary capsular opacification 17.6%. Two patients had posterior synachae 11.8% after three months.Conclusion:The results suggest that cataract surgery in simple microophthalmia is safe procedure. Postoperative complications in this study were within acceptable limits. Long term study with intraocular lens is required to confirm our observation.

Raised intraocular pressure following Intravitreal Triamcinolone Acetonide in diabetic versus non-diabetic patients.

Objective:To determine the frequency of an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide (IVTA) in diabetic versus non-diabetic patients with various chorio-retinal disorders.Methods:This prospective, interventional comparative case series was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi from May 2012 to April 2014. Two hundred thirty seven eyes of 180 patients were enrolled with 90 patients each in diabetic and non-diabetic group, requiring IVTA. IVTA 4mg/0.1ml was injected and IOP was measured at one week, one month, three months and six months in both groups of patients.Results:In diabetic group, 43 patients were male (47.8%) and 47 were female (52.2%), while in non-diabetic group, 56 (62.2%) patients were male and 34 (37.8%) were female. Mean age of patients in diabetic group was 52.21 ± 9.6 years and in non-diabetic group was 51.13 ± 10.75 years. The mean preoperative IOP was 13.6 ± 2.8 mmHg and 14.1 ± 2.4 mmHg in diabetic and non-diabetic group respectively. In diabetic group, mean (±SD) IOP was 16.4 ±4.9 mmHg, 14.6 ±3.6 mmHg, 17.6 ± 9.7 mmHg and 15.5 ± 7.09 mmHg at one week, one month, three months and 6 months post injection. While in non-diabetic cases, mean (±SD) IOP was 14.8 ± 3.33 mmHg, 15.9 ± 4.2 mmHg, 15.5 ± 4.2 mmHg and 14.1 ± 3.2 mmHg at one week, one month, three months and 6 months follow up. The raised IOP was observed in 117 eyes (49%) in both groups of patients, with 78 eyes (65%) in diabetic group and 39 eyes (33%) in non-diabetic group.Conclusions:After IVTA, an IOP rise was observed more in diabetics than non-diabetic patients.

An assessment of knowledge, attitude and practices (KAP) towards diabetes and diabetic retinopathy in a suburban town of Karachi.

Objective:To assess the Knowledge, Attitude and Practices (KAP) towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town (BQ), Karachi.Methods:An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of (BQ) Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data.Results: Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 (39.2%) had diabetes. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate respondents. Male’s Mean Knowledge score (7.61 ± 6.600) was better than female’s (5.46 ± 6.21) with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 ± 2.57. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination.Conclusion:Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes.

Visual outcome and complications in Ab-externo scleral fixation IOL in aphakia in pediatric age group

To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens in pediatric age group (15 years or less). This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2012 to December 2012. All cases included were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL under general anesthesia. Patients were followed up at 1(st)day, 1(st)week, 1(st)month, 2(nd)month and 3(rd)month. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Thirty patients were included in the study, with mean age of 8.6 years (±3.93569). Most of the patients, 20 (66.7%), had visual acuities of 6/18 or better. No complication was seen in 18 (60%) of the patients intra operatively while soft eye was observed in 7 (23.3%) of the patients. Another complication noted was vitreous hemorrhage, which was seen in 5 (16.7%) patients. Most common post-operative complication was Uveitis followed by astigmatism. Lens dislocation and iris abnormalities were seen in only one patient. Most of the patients showed significant visual improvement after surgery. Ab-externo scleral fixation of an IOL was found to be safe and showed favorable postoperative results with fewer complications.

Primary effects of intravitreal bevacizumab inpatients with diabetic macular edema

To evaluate the efficacy of primary intra vitreal bevacizumab (IVB) injection on macular edema in diabetic patients with improvement in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT). This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study (ETDRS) charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography (FFA) and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. The mean BCVA at base line was 0.42±0.14 Log Mar units. This improved to 0.34±0.13, 0.25±0.12, 0.17±0.12 and 0.16±0.14 Log Mar units at 1 month after 1(st), 2(nd) 3(rd) injections and at final visit at 6 months respectively, a difference that was statistically significant (P>0.0001) from base line. The mean 1mm CMT measurement was 452.9 ± 143.1 µm at base line, improving to 279.8 ± 65.2 µm (P<0.0001) on final visit. No serious complications were observed. Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME.

Pattern of Ocular Problems in School going Children of District Lasbela, Balochistan

Purpose: To find out the pattern of eye problems in children of age 6 to 15 years, attending schools and madaris (religious schools) and also to determine the difference in prevalence of ocular disease in students attending these different types of institutions. Material and Methods: The study was conducted in Madaris of district Lasbela were screened from February 2008 to September 2009. All students of schools / madaris of district Lasbela were included in the study. The visual acuity (VA) was measured using standard Snellen’s chart; external examination was carried out with the help of magnifying loop and direct ophthalmoscope. The children with VA < 6/12 were refracted to the best correction. The study team included a community ophthalmologist, an ophthalmologist, an ophthalmic technician and a community social worker. A structured questionnaire was prepared and operational methods were field tested and refined by piloting at the outpatient of Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital (AIEH), Karachi. An ophthalmic technician with community social worker checked vision of all the students and an Ophthalmologist examined the children for any abnormality and referred them to the base hospital (AIEH). All children with VA < 6/12 were refracted. Every school and madarsa of the target area was visited. Results: Out of 25,437 examined school going children, 19,629 (77.16%) were found to be normal while 5,808 (22.84%) had ocular problems. The ocular conditions in order of frequency were conjunctivitis in 2,826 (11.10%) children, vitamin A deficiency disorders in 839 (3.29%) children, refractive error in 740 (2.90%) children, vernal conjunctivitis in 484 (1.90%) children, blepheritis in 373 (1.46%) children, strabismus in 119 (0.46%) children, cataract in 45 (0.17%) children, ptosis in 33 (0.12) children, nystagmus in 26 (0.10%) children, glaucoma in 2 (0.007%) children and non-specific ocular changes were found in 259 (1.01%) children. The prevalence of ocular problems occurred in 20.68% of children in main stream schools compared to 34.33% in children studying in madaris. The main difference in prevalence was of conjunctivitis noticed in 10.03% of school children, compared to 17% of madaris students and of refractive error present in 2.14% of school children, compared to 7% of students in madaris. Conclusion: Almost 23% of school going children in Lasbela district needed treatment for their ocular problems. The prevalence of conjunctivitis and refractive error was more in madaris compared to schools. School screening could play an important role in the promotion of eye health and the prevention of childhood blindness.

Frequency and Patterns of Eye Diseases in Retina Clinic of a Tertiary Care Hospital in Karachi

Purpose: To evaluate the Frequency and Pattern of Eye Diseases in Retina Clinic of a Tertiary Care Hospital in Karachi Material and Methods: A total number of 27,000 new patients were seen at the Al Ibrahim Eye Hospital (AIEH), retina clinic between July 2009 and June 2010, their data was obtained from the ophthalmic outpatient attendance register. Their records were analyzed for data according to age, sex and clinical diagnoses made after detailed fundus evaluation with binocular indirect ophthalmoscope and slit lamp using 20 D and 90 D lenses respectively. Data was entered and analyzed for simple frequency using SPSS version 14.0. Tests for significant inter group differences were performed using the chi square test with a p<0.001 considered statistically significant. Results: Out of 27,000, 3615 patients were registered in retina clinic. Diabetic related retinal conditions were the most common cause (39.8%) for registration in the retina clinic. 648 (45% of total DR) patients had clinically significant macular edema (CSME) and 102 (7%) eyes had advanced diabetic eye disease (ADED). Conclusion: There is a tremendous impact of increasing retinal blindness secondary to retinal diseases especially diabetic retinopathy in Pakistan. The impression based on hospital practice is that the problem is on the rise. This entails the necessity for accessible comprehensive eye care services, establishment of human resources, screening and awareness of the disease and affordable eye health policy.

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study.

To determine the frequency of type-II Diabetes mellitus (DM) in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy (DR) in this group. Descriptive study. Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care (PHC) facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 (6.55%) known and 419 (2.18%) newly diagnosed cases. DR was seen in 460 (27.43%) of the Diabetic cases with 126 (7.51%) patients requiring urgent intervention for vision threatening complications. The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system.

Dacryocystorhinostomy without intubation with intraoperative mitomycin-C.

To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy (DCR) surgery. Quasi-experimental study. Isra postgraduate institute of Ophthalmology, Al-Ibrahim Eye Hospital, Malir, Karachi, from January 2003 to December 2004. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria. The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2 mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% (p-value < 0.001). This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery.