Institute Of Ophthalmology Research Articles

Incidence and Risk Factors of Macular Edema After Phacoemulsification in Southern Pakistan

Objective: To determine the incidence and risk factors of macular edema (ME) after phacoemulsification at Institute of Ophthalmology, Liaquat University of Medical and Health Sciences (LUMHS)/ Jamshoro Sindh. Methodology: This descriptive cross-sectional study was conducted in Institute of Ophthalmology LUMHS, Jamshoro, during six months from December 2020 to June 2021. Patients who underwent phacoemulsification surgery for cataract removal, aged 18 years or older, both male and female patients with adequate follow-up post-surgery were included. All patients underwent Phacoemulsification, receive standard post-operative topical medication i.e, Moxifloxacin 0.5% and Prednisolone 1% (1 hourly for 1 week, and 4 times per day after 1 week). The patients were undergone routine follow up and were subjected to visual acuity measurement. The measurement of postoperative CME by SS-OCT was done 1 week postoperatively followed by 3th week and 6th week. All the information was entered ana analyzed into SPSS 26 version. Results: A total of 96 patients, those who underwent phacoemulsification were studied; their mean age was 54.11 +8.97 years. Males were 58.3% and females were 41.7%. Out of all, 24.0% cases were diabetes, 8.3% were hypertensive. After surgery on 3rd post-operative week macular edema was found in 9.4% of the cases and on 6th post-operative week it was found in 19.8% of the cases. Post operative macular edema was found statistically significant according to diabetes mellitus and hypertension, (p = < 0.05), while it was statistically insignificant according to age, gender, ME in fellow eye and high myopia on 3rd postoperative week p-values were quite insignificant (p= >0.05), while macular edema (6th week) was found statistically significant according to age (p-0.038) while statistically insignificant according to gender, diabetes mellitus, hypertension, ME in fellow eye and high myopia on 3rd postoperative week p-values were quite insignificant (p= >0.05). Conclusion: As per study conclusion the occurrence of macular edema was observed to be the less frequent after phacoemulsification. Male gender, age more than 45 years and diabetes mellitus were observed to be the most common risk factors.

Benefit-Cost Analysis of Nonprofit Cataract Surgery Services: A Social Return on Investment Approach at the Mexican Institute of Ophthalmology

Cataract is the primary cause of treatable blindness in low- and middle-income countries. Due to limited resources, the public sector often fails to provide adequate services, resulting in long waiting times, low quality or significant quantity gaps. Nonprofits are crucial in providing supplementary or complementary funding and resources for affordable eye care and other public goods and services. This study evaluates costs and benefits of cataract surgery at the nonprofit Mexican Institute of Ophthalmology (IMO) using data from interviews conducted in 2022 to estimate its social return. For every peso invested, the average stakeholder receives a 12:1 return in improved autonomy, self-confidence, and reduced stress levels. Sensitivity analysis suggests a SROI ratio of at least 2:1 in the most restrictive scenario, increasing to 33:1 under more lenient assumptions. Measuring and communicating the social value of nonprofit activities is critical for optimizing resource allocation, enhancing accountability, and generating valuable insights into their effectiveness.

Retinal Nerve Fiber Layer Thickness (RNFLT) in Myopic & Hypermetropic Eyes in a Subset of Pakistani Population

Objective: This study aimed to evaluate retinal nerve fiber layer (RNFL) thickness in healthy individuals with myopic and hypermetropic eyes, using optical coherence tomography (OCT).Study Design: A cross-sectional study. Place and Duration of Study: The study was carried out at the Department of Ophthalmology, Dr. Akil bin Abdul Qadir Institute of Ophthalmology, Karachi, Pakistan from January 2015 to June 2015.Methods: In this study, 300 eyes were included were examined using standard protocols by a single examiner. Subjects with a history of diabetic or hypertensive retinopathy, raised intraocular pressure (> 21mmHg), and previous intraocular or laser surgery were excluded from the study. The mean retinal nerve fiber layer thickness was calculated in both myopic and hypermetropic eyes. Results: The mean global retinal nerve fiber layer thickness (RNFLT) in myopic eyes was found to be 93.98 ± 8.57 μm. In hypermetropic eyes, it was found to be 101.00 ± 6.58. This variation was found to be statistically significant with p-value of 0.001.Conclusion: We concluded that individuals with myopic eyes had significantly reduced retinal nerve fiber layer thickness whereas those with hypermetropic eyes showed an insignificant increase in RNFLT compared to emmetropic eyes.How to cite this: Mukhtar S, Hassan N, Lakhani M, Fatima U, Shaheen S, Raza I. Retinal Nerve Fiber Layer Thickness (RNFLT) in Myopic & Hypermetropic Eyes in a Subset of Pakistani Population. Life and Science. 2024; 5(1): 54-60. doi: http://doi.org/10.37185/LnS.1.1.480

Association of High Sensitivity C-reactive Protein with Type II Diabetic Retinopathy

Objective: The objective of this study is to find out the association of diabetic retinopathy with serum homocysteine and high sensitivity (hs) CRP levels.
 Methods: The research was conducted out at the Army Medical College's Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Rawalpindi, in partnership with the Armed Forces Institute of Ophthalmology, Rawalpindi for a tenure of 12 months. Ninety subjects, were included in the study, thirty in each group: controls, diabetic subjects, and the patients suffering from diabetic retinopathy (DR).
 Results: Healthy controls, diabetic subjects, and patients with DR were found to have mean Fasting Blood Glucose (FBG) values of 5.51 0.34 (mmol/l), 8.11 0.67 (mmol/l), and 8.73 0.90 (mmol/l), respectively (p=0.001). The mean HbA1c level in normal subjects was noted as 5.08 ± 0.27 in healthy controls as compared to 7.70 + 0.89 (mmol/l)) in diabetic subjects and 9.02 + 1.76 (mmol/l) in patients with DR (p=0.001 by ANOVA). 
 In normal subjects, the mean hs CRP levels were noted to be 3.74 + 1.97 (mg/l) in healthy controls as compared to 15.32 + 2.93 (mg/l) in diabetic subjects and 26.71 + 4.88 (mg/l) in patients with diabetic retinopathy (p=0.001 by ANOVA).
 Conclusion: During the study, it was found that elevated levels of these inflammatory biomarkers can accurately predict the onset of diabetic retinopathy and that hs CRP levels are strongly related with the development of diabetic retinopathy. Monitoring these inflammatory signs in the serum can therefore help prevent diabetic microangiopathic consequences, including DR.

Big data enabled keratoconus care

Keratoconus is a disorder affecting the cornea in which its normal round shape progressively thins causing a cone‐like bulge to develop. Because the cornea does most of the focusing of the eye, this change in shape causes significant problems with vision. As the disease gets worse, the cornea gets steeper, and vision continues to decline. It is a significant cause of visual loss in the UK, affecting up to 1 in 450 young people and is the commonest indication for corneal transplantation in young people. Corneal cross‐linking (CXL) is the only proven treatment to prevent keratoconus getting worse. However there is limited reports of its long term safety in large numbers and we reported one of the largest series in the world.We used data from the Early Keratoconus Clinic over the past 10 years to generate our results, looking at how many patients progressed despite treatment. What we also did that was innovative was to create personalized progression threshold definitions. We know that early progression can be quite hard to detect, and in later disease the imaging is poorly repeatable. Therefore a personalized threshold, derived from repeated scans from our dataset, will be able to pick up disease earlier, before more progressive visual loss.We used real world data from our patients to create a predictive model, a calculator, that predicts when a patient is likely to need treatment. The reason for creating this calculator is that it allows patients to better understand their risks in a visual format, gives clinicians an objective marker for an individual's risk, and also allows the hospital to plan services based on needs.We were able to also use genetic data to see how it influenced disease progression, based on the gene segments that were identified by the Institute of Ophthalmology and Moorfields. This work has resulted in an open access calculator available on https://beta.moorfieldscxl.com.This talk will also look at the opportunities and challenges of deploying artificial intelligence algorithms in the management of keratoconus, and how we can adapt our own routine practices to contribute to the development of big datasets that can further train and validate AI algorithms.

Evaluating the forces involved in bubble management in DMEK surgery: mathematical and computational model with clinical implications.

To model postoperative forces involved in Descemet membrane endothelial keratoplasty (DMEK) tissue adherence and bubble management, including the impact of surface tension on graft support, with a view towards clinical applications. Tennent Institute of Ophthalmology, Glasgow, and James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom. Mathematical modelling and computer simulation. Theoretical modelling of biphasic flow and interaction of gas, liquid and tissue within the anterior chamber for static horizontal scenario A (adherent DMEK with mobile bubble) and dynamic vertical scenario B (release of bubble due to pupil block following DMEK). The model assumed incompressibility for both fluids within realistically achievable pressure ranges. Cahn-Hilliard Navier-Stokes equations were discretised through the application of the Finite Element Method. Mathematical modelling and computer simulation showed bubble size, corneal curvature and force intensity influences surface tension support for DMEK tissue in scenario A. Scenario B demonstrated complex, uneven distribution of surface pressure on the DMEK graft during uncontrolled bubble release. Uneven pressure concentration can cause local tissue warping, with air/fluid displacement via capillary waves generated on the fluid-air interface adversely impacting DMEK support. We have quantitatively and qualitatively modelled the forces involved in DMEK adherence in normal circumstances. We have shown releasing air/gas can abruptly reduce DMEK tissue support via generation of large pressure gradients at the liquid/bubble/graft interfaces, creating negative local forces. Surgeons should consider these principles to reduce DMEK graft dislocation rates via optimised bubble size to graft size, longer acting bubble support and avoiding rapid decompression where possible.

Refractive Outcome of Femtosecond Assisted Laser in situ Keratomileusis in 1564 cases of Myopia and Compound Myopic Astigmatism.

To determine the outcomes of Femtosecond Assisted Laser in situ Keratomileusis (Femto LASIK) on eyes with myopia and compound myopic astigmatism in terms of efficacy, safety, accuracy, predictability, and stability of the procedure. Quasi-experimental study. Place and Duration of the Study: Refractive Surgical Department, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, from January 2014 to August 2019. Participants aged 18 years and above with upto -12D (dioptre of myopia, underwent preoperative detailed work-up with history, ocular examination, subjective refraction and assessment on topography, tomography, and aberrometry. Suitable candidates underwent Femto LASIK and were re-evaluated at 1stpostoperative day, end of 1stweek, 1month, 3 months, 6months and 1year. Results were analysed and represented in form of standard graphs for refractive surgery. Results: Postoperative UDVA (uncorrected distance visual acuity) of 20/40 was achieved in 99% of patients. Efficacy index was 1.02 + 0.15. Safety index was 1.04 + 0.199. None of the patients lost more than one line in postoperative CDVA (corrected distance visual acuity) when compared to preoperative CDVA. All the eyes (100%) were accurately treated within +1.0 DS of intended spherical equivalent (SEQ) range. Mean SEQ showed stability with 1% eyes recorded to have more than 0.5D change or more over 12 months. Femto LASIK is an effective, safe, accurate, predictable, and stable procedure for correction of myopia and compound myopic astigmatism. Femtosecond, Laser in situ Keratomileusis, Refractive surgery, Myopia, Compound myopic astigmatism, Uncorrected distance visual acuity.

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value <0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectisassisted nucleus delivery method compared to the viscoexpression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, viscoexpression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study

Introduction: Keratoconus is a non inflammatory disease characterised by progressive corneal thinning that results in a cone-like ectasia, irregular astigmatism, and decreased vision. Advanced disease can result in corneal scarring and blindness, necessitating penetrating keratoplasty. The only treatment believed to have the ability to stop or decrease the progression of keratoconus is Collagen Cross-Linking (CXL). Aim: To evaluate the efficacy of corneal collagen cross-linking with riboflavin (C3R) in patients with keratoconus by studying the outcomes in terms of Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), manifest refraction, and corneal topography. Materials and Methods: A hospital-based prospective cohort study was conducted at the Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India from June 2017 to June 2018. Fifteen eyes of 12 patients who underwent corneal collagen cross-linking for progressive keratoconus were included. Routine ophthalmological examinations was done for all patients. Patients under the age of 35 years with progressive keratoconus, an average K value not exceeding 60 D, and who had not undergone any other surgical modalities of treatment were included in the study. Patients with scarred cornea or hydrops, active ocular infection, or pachymetry <400 µm were excluded. Detailed informed consent was obtained from all patients before surgery. Preoperative UCVA, BCVA cylinder, Spherical Equivalent (SE), and topography values were obtained. All patients were followed-up at three and six months postoperative period to look for changes in UCVA, BCVA, manifest refraction, and corneal topography. Data were expressed as the mean±Standard Deviation (SD) pre- and postoperatively and analysed statistically using the paired t-test, with p<0.05 considered statistically significant. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: On follow-up at six months post-treatment, UCVA (log MAR) improved from 0.87±0.40 to 0.65±0.35 (p-value=0.001), and BCVA (log MAR) changed from 0.37±0.21 to 0.17±0.22 (p-value=0.001). K max decreased from 54.90±6.05 to 52.67±5.02 (p-value=0.001), and K min decreased from 48.14±4.24 to 45.93±4.07 (p-value=0.001). Astigmatism and SE also showed statistically significant improvement post-procedure (p-value 0.001 and 0.002, respectively). Astigmatism reduced from -3.50±1.58 to -2.90±1.37. SE reduced from -4.93±3.92 to -4.28±3.48. No significant complications were noted in any of the patients. Conclusion: The CXL is an effective procedure for stabilising the progression of keratoconus, thus reducing the burden of preventable blindness and the need for keratoplasty.

Indications and Outcomes of Repeat Keratoplasty for Graft Failure at a Tertiary Eye Care Center in Nepal.

Graft failure is a common complication following keratoplasty requiring repeat keratoplasty (re-KP). To determine the indications and outcome of repeat keratoplasty at a tertiary eye care centre in Nepal. This was a retrospective study of 78 patients who underwent re-KP for graft failure in Tilganga Institute of Ophthalmology from Jan 2015 to Dec 2020. Indications for the primary keratoplasty, causes of graft failure and outcomes of re-KP in terms of vision acuity, graft clarity and secondary glaucoma were evaluated. Cases of regraft with less than one-year follow-up period were excluded. A total of 78 re-KPs had been performed in 78 patients during the study period. Seventy eyes had undergone single corneal regraft and 8 eyes had undergone multiple (second or third) regraft surgery. Most common indication of primary keratoplasty was infectious keratitis (n=36; 46.2%). On follow up, 36 eyes (46.2%) were clear at the last visit, of which 31 eyes were single regraft cases and 5 were of multiple regraft cases. Most common cause of graft failure was graft infection (n=34; 43.6%) followed by corneal scarring (n=12; 15.4%). Of 42 eyes with failed regrafts, recurrence of the preoperative infection was commonest cause (n=15, 35.7%) followed by secondary glaucoma (n=11; 26.2%). Of 36 eyes with clear regraft, only 4 eyes (11.11%) achieved best corrected vision of ≥6/18 and remaining 32 eyes had BCVA <6/18 due to associated cataract, secondary glaucoma and high astigmatism. The most common cause for re-KP includes graft infection followed by secondary glaucoma. Outcomes of corneal regrafts in the form of graft clarity and visual acuity are suboptimal.

Surgical Outcomes of Ahmed Glaucoma Valve and Aurolab Aqueous Drainage Implant in Nepalese Eyes: Comparison in the First Year.

Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.

Indication and Outcome of Paediatric Keratoplasty at a Tertiary Referral Eye Hospital in Nepal.

Paediatric keratoplasty is rarely performed surgery with high risk of graft failure. Developing countries have not benefited due to lack of sufficient facilities and trained surgeons. The objectives of the study were to analyze the indications and its outcome in terms of vision and graft survival. This retrospective chart review used electronic medical records from January 2017 to December 2019 of all consecutive patients aged upto18 years or below that underwent paediatric keratoplasty after ethical approval at Tilganga Institute of Ophthalmology. Outcome was defined as anatomical or visual success and graft clarity. Different demographic and surgical parameters were studied among 59 eyes of 48 patients. Mean age of recipient was 12.23± 3.81 years. Majority 37 (52.5%) had unilateral grafts with keratoconus being the most common 24 (40.6%) acquired non-traumatic indication. Mean post-operative best corrected visual acuity 0.6 Logmar was significantly (p <0.001) low as compared to preoperative 1.3 Logmar. Overall graft survival rate was 47 (78%) at one-year follow-up; keratoconus accounting for 24 (100%). Major factors in contributing for graft failure were rejection, infection, and glaucoma. A good outcome in terms of anatomical and visual success was achieved in our study. Keratoconus has an excellent graft survival. Visual rehabilitation by cycloplegic refraction should be done to prevent amblyopia. Enhancing the training of surgeons and addressing challenges faced in a paediatric population will help decrease corneal blindness among paediatric patients in the future.

European Glaucoma Society – A guide on surgical innovation for glaucoma

PROLOGUE: Glaucoma surgery has been, for many decades now, dominated by the universal gold standard which is trabeculectomy augmented with antimetabolites. Tubes also came into the scene to complement what...

Effect of intrastromal corneal ring segments on in vivo corneal biomechanics in keratoconus: 1-year results.

To evaluate the 1-year effects of the implantation of intrastromal corneal ring segments (ICRS) in keratoconus (KC) on the dynamic corneal response (DCR) parameters obtained with the Corvis. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Prospective, single-center, clinical study. Included were patients who underwent ICRS implantation for KC over a period of 1 year. On the day of the surgery and at least 6 months after ICRS implantation, the following measurements were made: corrected distance and uncorrected distance visual acuity, corneal tomography indices with the Pentacam, biomechanically corrected intraocular pressure and the Corvis DCRs (integrated inverse concave radius, deformation amplitude ratio, stiffness parameter at first applanation, stress-strain index [SSI] and the highest concavity radius). 30 eyes were included with a mean follow-up time of 15 months. Statistical analysis showed that ICRS implantation induced significant improvements in corneal biomechanics measurements between preoperative and long-term follow-up as demonstrated by a significant increase in SSI (P = .003). To confirm that this difference was actually induced due to a stiffening between early postoperative (previously published) and long-term an additional t-test was done between month 1 and late follow-up which confirmed a significant stiffening in the value of SSI (P = .01). Patients implanted with ICRS alone for KC showed a significantly stiffer response due to increased structural support compared with preoperative values and 1 month postoperative.

Clinical Outcome of Amniotic Membrane Transplantation in Chemically Injured Eyes

Purpose: To evaluate the clinical outcome of Amniotic Membrane Transplantation (AMT) in chemically injured eyes for ocular surface reconstruction. Methods: A prospective study of 30 consecutive chemically injured eyes was performed from December 2022 to May 2023 in National Institute of Ophthalmology &amp; Hospital (NIO&amp;H), Dhaka, Bangladesh. Twenty-seven patients (30 eyes having corrosive chemical injuries) were included in the study according to the inclusion &amp; exclusion criteria. AMT was performed within 21 days of injury by single surgeon with modified surgical procedure. Post operative evaluation was done by Snellen chart, slit lamp biomicroscope and Schirmer-II test. Results: After 3 months of AMT, there was no pain or inflammation. Improvement of vision found in 20 (66.67%) of 30 eyes, 4 (13.33%) eyes of rest 10 eyes showed inaccurate Projection of Rays (PR) vision and rest 6 (20.0%) eyes of rest 10 eyes found deteriorated vision. Epithelialization occurred in all eyes. Twenty-four (80.0%) eyes had limbal stem cell deficiency and they experienced superficial corneal vascularization. Symblepharon was seen in 18 (60.0%) eyes, 6 (20.0%) of these 18 eyes developed marked conjunctival shortening with ankyloblepharon. None of the eyes showed perforation. Conclusions: AMT increases patient comfort and reduces inflammation. In mild burns, AMT alone restores corneal and conjunctival surfaces. In moderate to severe burns, it reduces conjunctival scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further limbal stem cell transplantation. In the acute stage, AMT has a protective role against the progressive melting and perforation. J.Natl.Inst.Ophthalmol.2023;6(1): 21-26

Socio-economic Factors Responsible for Delayed Presentation of ROP in a Tertiary Neonatal Care Unit in Bangladesh

Purpose: To evaluate the socio-economic factors responsible for delayed presentation of ROP in a tertiary neonatal care unit in Bangladesh. Methods: This observational study was conducted on fifty babies, who were presented delay at screening were purposively selected for the study at Dhaka Shishu Hospital, National Institute of Ophthalmology &amp; Hospital. Study period was 12 months and data collection was done by face to face interview from legal guardians with pre designed questionnaire. Information regarding gestational age, birth weight, condition of health at birth,parents education level and economic condition were obtained by face to face interview from parents. They were also asked whether the baby was advised for screening or not. Screening was done by indirect ophthalmoscopy by using 20D condensing lens. Results: Among the 50 babies, prevalence of ROP was 66.0% (95% CI: 52.87-79.13). Mean gestational age was 29.10(±1.5) weeks and mean birth weight was 1250(±0.24) gm. After taking account of all possible confounders, we found that place of residence of the parents is associated (p=0.011) as well as adviced for screening is marginaly assocated (p= 0.05) with delayed presentation of ROP for screening. Conclusion: There are many risk factors for delayed presentation of ROP at screening. Among the factors palce of residence (rural) and advice for screening are found to be significant. Further study regarding this issue is necessary to explore all other factors and formulate plans to overcome them. J.Natl.Inst.Ophthalmol.2023;6(1): 9-15

Experimental study on the therapeutic effect and mechanism of erlotinib on non-proliferative diabetic retinopathy

Experimental study on the therapeutic effect and mechanism of erlotinib on non-proliferative diabetic retinopathy

PROSTAGLANDIN ANALOG OR RHO KINASE INHIBITOR – WHICH ONE IS BETTER IN PRIMARY OPEN-ANGLE GLAUCOMA

Objective: The aim of the study was to compare the efficacy, safety, and adverse drug reactions of ripasudil and bimatoprost. Methods: An open-label, prospective, observational, randomized study was carried out in the Department of Pharmacology M.L.N. Medical College in association with Manohar Das Regional Institute of Ophthalmology, Prayagraj, for 1 year after ethical clearance. A total of 118 patients with primary open-angle glaucoma fulfilling the inclusion and exclusion criteria were taken and randomized into two groups. Only 109 patients completed the study, Group 1 received ripasudil (n=54) and Group 2 received bimatoprost (n=55). Intraocular pressure (IOP), ocular surface disease index (OSDI), tear brake-up time (TBUT), and hyperemia were measured at the initiation of treatment and then measured at different time intervals. Results: Group 1 and Group 2 patients were observed and followed up for 3 months. At the end of the 2nd, 4th, 6th, and 12th week in Group 1, ripasudil significantly showed better results in reducing IOP as compared to Group 2 bimatoprost. In terms of TBUT, both groups at the 12th week did not show any significant difference. The OSDI score of both groups showed a non-significant difference at the 12th week. At the end of 2nd week, hyperemia was comparable for both groups but ripasudil showed more hyperemia at the end of the 12th week. Conclusion: We concluded that ripasudil is more effective than bimatoprost in reducing IOP in patients with primary open-angle glaucoma. In terms of adverse effect profile, both drugs showed similar effects in TUBT and OSDI scores. The safety profile of both drugs is similar but the hyperemia score of ripasudil is more than bimatoprost.

Analysis of Corneal Topographic Changes after Upper Lid Surgery in Congenital and Acquired Ptosis

Objective: To assess the corneal topographic and refractive changes after ptosis surgery. Study Design: Prospective longitudinal study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2020 to Jul 2021. Methodology: A total of 90 individuals were selected by non-probability convenience sampling. Patients with diagnosed Ptosis and planned for surgery were followed up for six months post-surgery. Corneal topography, visual acuity, and physical assessment for Ptosis were done pre and post-surgery and compared for differences. Result: There were more cases of acquired Ptosis than congenital in our sample (p=&lt;0.001). The patients had more poor levator function pre-operatively (p=0.291), which improved to fair post-operatively (p=&lt;0.0001). Post-operatively, a significant decrease in the SimK and Cylinder power was observed in the sample. The visual acuity improved significantly, and the MRD also improved. With no significant change in CCT post-operatively. Conclusion: Our study showed that post-surgery SimK, visual acuity, MRD, and cylindrical power improved. However, the CCT did not show significant alterations.

Intraocular Pressure Changes in Myopic Patients Undergoing Laser In-Situ Keratomileusis and Photorefractive Keratectomy.

To assess the variation in intraocular pressure measurements between Ocular Response Analyzer (ORA) and Goldmann Applanation Tonometer (GAT) in myopic patients undergoing laser assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences, Rawalpindi, Pakistan, between September 2020 and 2021. Myopic patients undergoing LASIK and PRK during the study period were selected. Baseline examinations and postoperative follow-ups were carried out to measure intraocular pressure at 1, 3, and 6 months after LASIK or PRK, using Goldmann Applanation Tonometer (GAT) and Ocular Response Analyzer, corneal compensated IOP (ORA IOPcc). One hundred and thirteen eyes underwent myopic refractive surgery, LASIK (n = 60) or PRK (n = 53). Mean age of patients was 23.6 ± 4.11 years in the PRK group and 24.4 ± 5.94 years in LASIK group. For the PKR group, the GAT IOP value increased at 1-month (p <0.001), decreased at 3-month (p <0.001) and further decreased at 6-month (p <0.001) follow-up postoperatively. In the LASIK group, the GAT IOP value decreased at all time points (p <0.001). In both groups, the mean ORA IOPcc value increased at 1 month (p <0.001), decreased at 3-month (p <0.001) and further decreased at 6-month (p <0.001) follow-up postoperatively. The IOP mean values were generally found to be higher when measured using ORA as compared with GAT. Corneal refractive surgery markedly decreased IOP. This decrease in IOP was observed more after LASIK than after PRK. ORA was less likely to underestimate the intraocular pressure than GAT. Myopia, Laser in-situ keratomileusis, Photorefractive keratectomy, Tonometery ocular, Intraocular pressure.