Institute Of Ophthalmology Research Articles

Prevalence of Keratopathy in Vernal Keratoconjunctivitis

Background: Vernal keratoconjunctivitis is a chronic allergic eye disease that primarily affects young individuals and can lead to significant discomfort and visual impairment. Keratopathy, in the context of Vernal Keratoconjunctivitis (VKC), refers to corneal changes and complications that can occur as a result of this chronic allergic eye condition. VKC primarily affects the conjunctiva and the cornea, and keratopathy is a significant concern due to its potential to cause visual impairment. Objective: To determine the frequency of keratopathy in vernal keratoconjunctivitis. Study Design: Cross-sectional. Settings: Sindh Institute of Ophthalmology and visual sciences at LUMHS Eye Hospital Hyderabad Pakistan. Duration: From February 16, to August 15, 2019. Methods: All the patients with VKC, aged 5-15 years and both genders were included. History was taken from patient or parent about presenting complains and duration of disease. Clinical (slit lamp) examination was performed to look for corneal lesions. Both eyes of each patient were examined for corneal involvement, including SPEE (positive Florescence staining), corneal epithelial defects, corneal shield ulcer and corneal subepithelial scars. Florescence staining with blue filter was used where indicated. All the data was entered in the proforma and analyzed by SPSS version 20. Results: Total 232 patients were studied, most of the patients 84.1%, belonged to age group of 5-10 years, while 15.9% presented with age range of 11-15 years. Males were most common 78.0%. Frequency of keratopathy was 22.0%. Most of the cases 51.3%, had >1 years duration. According to type of keratopathy, superior punctate epithelial erosions was most common type among 35.3% patients out of 51, scarring was among 24.5% patients, shield ulcer was among 9.8% patients and macro erosion was in 2 patients. No significant impact was found of age on Prevalence of keratopathy, (p-0.419). Male gender, duration of VKC and bilateral eyes were significantly associated with Prevalence of keratopathy, (p-0.001). Conclusion: It was concluded that frequency of keratopathy in vernal keratoconjunctivitis is 22.0%.

Results of one decade of optical keratoplasty in pediatric patients.

Keratoplasty in the pediatric population has been considered a high-risk procedure. To know the demographic data of patients younger than 18 years treated with optical keratoplasty, indications for surgery and its results. A retrospective study was carried out at Conde de Valenciana Ophthalmology Institute, in which the medical records of patients younger than 18 years treated with optical keratoplasty from 2009 to 2019 were analyzed. A total of 53 eyes were included. The most common diagnosis and procedure were keratoconus and penetrating keratoplasty, respectively. Mean initial visual acuity was 2.05 ± 0.99 logMAR, and 0.82 ± 1.33 at last visit. Survival time was 130.34 months. Four failures were recorded. As for associated surgeries, corneal wound closure was recorded in seven eyes prior to transplant; during the keratoplasty procedure, anterior vitrectomy in two eyes, and after the transplant, Ahmed valve implantation and re-suture. A total of eight eyes had glaucoma, five of them diagnosed prior to transplantation. Regarding rejection, 15 eyes had an episode during follow-up, and mean time to transplant rejection was 10.8 months. Prolonged graft survival can be achieved with better knowledge and management of different associated factors.

Management of eyelids’ primary malignancies

ABSTRACT Purpose: We report our experience in surgical management of primary malignant tumors of the eyelids. We have specified the various surgical techniques used, as well as functional and anatomical results. Patients and methods: A review of patients admitted for malignant tumor of the eyelids in the oculoplastic department of the Hedi Raies Institute of Ophthalmology from January 2012 to December 2021. Results: One hundred and twenty-three patients with malignant eyelid tumors were hospitalized. Surgical treatment involved 114 tumor lesions, which represents 95% of the cases. One hundred and eleven lesions (97.4%) had been operated by simple tumor resection. Safety margins were, respectively, 4 mm in 63.2% and from 5 to 6 mm in 34.2%. Extemporaneous histological examination was performed in three cases (2.6%). Reconstruction involved the anterior lamella (AL) in 92 cases (80.7%), the posterior lamella (PL) in 66 cases (57.9%), the medial canthus in 18 cases (15, 8%), and lateral canthus in 4 cases (3.5%). The excision was oncological in 85 cases (74.6%) and incomplete in 19 cases (16.7%). Tumor recurrence occurred in seven cases (6.1%), after an average delay of 36 months. Conclusion: The anatomical and functional features of the eyelids require a good reconstruction of the transfixion eyelid defect. Many reconstruction methods are available, allowing extensive and complex palpebral repairs. Oncologic prognosis is conditioned by the surgical quality.

Comparison of Oxidant and Antioxidant Status in the Aqueous Humour of Cataract Patients with and without Type 2 Diabetes Mellitus.

To compare the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) in the aqueous humour of cataract patients with and without type 2 diabetes mellitus (T2DM). Cross-sectional analytical study. Place and Duration of the Study: Department of Physiology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan in collaboration with Armed Forces Institute of Ophthalmology, from 1st June 2022 to 31st January 2023. A total of 120 individuals were recruited and divided into 2 equal groups. Sample of aqueous humour was collected, and the total oxidant status, and total antioxidant status were measured by spectrophotometry. Blood samples were collected to measure the fasting glucose and glycosylated haemoglobin levels. Results were analysed by SPSS version 24 and p-value ≤0.05 was considered significant. Total oxidative stress and OSI were (55.57±5.46) vs. (33.75±4.28) = p (0.001), (32.79±9.23) vs. (13.28±3.02) = p (0.001) found significantly increased in aqueous humour of diabetic patients while TAC was reduced (1.86±0.41) vs. (2.62 ± 0.45) = p (0.001) compared to the non-diabetics. Fasting blood glucose (109.18±12.32 vs. 91.61±5.71 mg/dl, p=0.001) and glycosylated haemoglobin levels (6.46±0.85 vs.5.43±0.85, p=0.001) were also found significantly high in the diabetic group compared to the non-diabetics. Increased levels of glucose and glycosylated haemoglobin increase oxidative stress in the blood of T2DM patients. This raises the total oxidative stress in the aqueous homor while lowering the TAC. This disturbed oxidant-antioxidant status in the aqueous humour of diabetic patients plays an important role in the development of cataract in T2DM patients compared to non-diabetics. Cataract, Aqueous humour, Oxidative stress, Type 2 diabetes mellitus.

Identification and Association of Polymorphism rs2073618 of the Osteoprotegerin Gene in Type 2 Diabetics with and without Retinopathy.

To identify and determine the association of SNP (rs2073618) of OPG gene in diabetics with and without retinopathy and in healthy controls. Descriptive study. Place and Duration of the Study: Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi in collaboration with Chemical Pathology Laboratory, Pak Emirates Military Hospital, Rawalpindi and Armed Forces Institute of Ophthalmology, Rawalpindi, from June 2021 to May 2022. Participants aged 25-70 years were inducted and divided into three equal groups. Group I consisted of diabetics with retinopathy (n = 50), group II was diabetics without retinopathy (n = 50), and group III was healthy individuals (n = 50). DNA was extracted and allele specific PCR technique was adopted using specifically designed primers. Results were analysed using the software Statistical Package for Social Sciences (SPSS) version 22.0 and online bio-informatics tool SNPstats. CC, CG, and GG genotypes were found to be present in 94%, 4%, and 2% in diabetics without retinopathy, 92%, 4%, and 4% in diabetics with retinopathy, respectively, and 100% presence of CC genotype only in healthy controls. C and G alleles were present in 96% and 4%, respectively, in diabetics without retinopathy, with 100% presence of only C allele in healthy subjects. The genotypic assessment using the models showed no significant association. SNP rs2073618 of OPG gene was identified in all study groups without any significant distribution or association with the development of diabetic retinopathy. The major genotype C/C was found in the majority of subjects in all groups. Allele specific PCR, Diabetic retinopathy, Single nucleotide polymorphism, Type 2 Diabetes mellitus.

Changes in Corneal Biomechanical Properties after Laser-Assisted in situ Keratomileusis and Photorefractive Keratectomy in Myopia.

To compare changes in corneal biomechanical properties after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in low and moderate myopia by Ocular Response Analyzer. Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, between September 2020 and April 2022. Myopic correction was done in forty-six eyes of twenty-three patients by PRK, and forty-seven eyes of twenty-four patients by LASIK. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using Ocular Response Analyzer (ORA), pre-operatively, and then 1, 3, and 6 months, postoperatively. The relationship between the amount of myopia treated and biomechanical properties was also studied. CRF and CH were decreased significantly after LASIK and PRK. A significantly larger decrease in CRF was observed after LASIK as compared to PRK at 6 months (Mann-Whitney U test: CRF, p = 0.02); however, decrease in CH was not statistically significant between LASIK and PRK at 6 months period (Mann-Whitney U test: CH, p = 0.388). A significant correlation was observed between the changes in biomechanical properties and extent of myopic correction after LASIK and PRK. Biomechanical strength of the cornea was significantly reduced by PRK and LASIK, which was also dependent on the spherical equivalent (SEQ) of myopic correction. A significantly larger change in CRF was observed after LASIK as compared to post PRK. Myopia, Laser in situ keratomileusis, Photorefractive keratectomy, Cornea, Biomechanics.

Analysis of intraocular pressure in healthy individuals and type 2 diabetes patients with and without diabetic retinopathy: A comparative study.

Objective: To compare intraocular pressure between normal subjects and Type 2 diabetics with and without diabetic retinopathy. Study Design: Comparative study. Setting: Sindh Institute of Ophthalmology & Visual Sciences Hyderabad Sindh Pakistan. Period: June 2021 to December 2021. Material & Methods: The ages ranged from 45 to 75 years old. The blood glucose level, intraocular pressure, and indirect ophthalmoscopy were measured between 9:00 am and 11:00 am with an iCare tonometer and an ophthalmoscope. The data were analyzed in SPSS 23.0. Results: A total of 112 participants were included. The average intraocular pressure (IOP) in both eyes of individuals with type 2 diabetes and no diabetic retinopathy is slightly higher than in the non-diabetic population, but the difference is not statistically significant (p>0.05). Group A was composed of 16 males (50.0%) and 16 females (50.0%), while group B had 13 males (40.6%) and 19 females (59.3%). In group C, there were 19 males (59.3%) and 13 females (40.6%), and in group D, 7 males (43.7%) and 9 females (56.2%). All female participants were in the post-menopausal phase. Conclusion: In the study, researchers found that the intraocular pressure of diabetics was higher than non-diabetics. Diabetes progression reduced intraocular pressure in non-proliferative diabetic retinopathy and increased it in proliferative diabetic retinopathy relative to the former, but the difference was not statistically significant.

Comparison of Efficacy of Warm Compresses Versus Loteprednol-Tobramycin Combination Therapy in the Management of Posterior Blepharitis

Objectives: to compare the efficacy of warm compresses to add-on therapy with Loteprednol-Tobramycin in patients withposterior Blepharitis.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun 2020 to Jul 2021.
 Methodology: Pre-diagnosed posterior blepharitis patients using warm compresses (Group-A) and add-on antibiotic steroid therapy (Group-B) were included in the study. A detailed history and ophthalmic examination evaluated tear breakup time, tear film height, intra-ocular pressure measurement, meibomian gland function, structure, and meibum appearance. In addition, the patient's symptoms were noted through the ocular surface disease index questionnaire. 
 Results: The study sample had seventy-one males (56%) and 55 females (43.6%) with mean age of 35.33±12.24 years. The clinical parameters in the two groups were almost alike at enrollment. There was a significant improvement in the clinical parameters in both groups. With slightly better improvement among Group-B (using Loteprednol-Tobramycin), Only two individuals did not report an increase in IOP at six weeks of treatment in Group-B. (p=0.53).
 Conclusion: Lid hygiene with warm compresses is an effective alternative with no side effects, provided if appropriately practised; however, add-on therapies may further improve MGD and Blepharitis.Keywords: Blepharitis, Meibomian gland dysfunction, Warm compresses.

Infective Etiologies in Patients with Bilateral Congenital Cataract

Objective: To determine the frequency of positive Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis serology in patients with bilateral congenital cataract and their correlation with different type of cataracts and age groups.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022.
 Methodology: Data was collected by a single investigator on Microsoft Excel sheet including patient’s age, gender, mode of delivery, consanguinity of parents, and type of congenital cataract, results of TORCH Screening and Presence or absence of amblyopia. TORCHS screening comprised of serum IgM and IgG levels for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis. 
 Results: A total of 134 patients reported to our institute with bilateral congenital cataract during the study period. Out of them 56 patients had positive results of TORCH screening (41.7%) Out of total 56 patients with bilateral congenital cataract testing positive for TORCH, 30(53.6%) were male while 26(46.4%) were female. Age range was from 1-17 months (9.2±4.2 months).Lamellar cataract was the most common cataract type in our study sample 16(28.6%).
 Conclusion: In patients with bilateral congenital cataract positive TORCHS serology was most frequent. Serum Rubella IgM followed by Rubella IgG was positive in most cases. Most common age of presentation in our study was from 4-7 months. Furthermore, lamellar cataract followed by nuclear cataract was the commonest cataract type.

Comparison Between Efficacy and Safety of Oral Azithromycin (250mg) vs Oral Doxycycline (100mg) in Treatment of Meibomian Gland Dysfunction (MGD)

Objective: To compare the efficacy and safety of oral Azithromycin with oral Doxycycline in patients with Meibomian Gland Dysfunction.
 Study Design: Quasi-experimental study.
 Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Apr 2021 to Apr 2022.
 Methodology: The sample population comprised 172 subjects, including 86 cases in the oral Doxycycline-Group and 86 oralAzithromycin-Group. Meibomian Gland Dysfunction was diagnosed by a consultant ophthalmologist by slit-lampexamination. Schirmer-I test and Tear Break Up Time were performed. Signs and symptoms of Meibomian Gland Dysfunction were assessed before treatment and at six months follow-up.
 Results: The study recruited equal numbers of cases and controls. Symptoms scores for burning sensation (2.04±0.5 vs 1.9±0.7) and foreign body sensation (1.8±0.6 vs 1.5±0.8) were significantly higher in patients taking Doxycycline as compared to the Azithromycin-Group (p<0.05). On comparing the signs score between the two Groups, it was seen that total scores (pretreatment and post-treatment) were more significant in the Doxycycline-Group (p<0.05). Treatment with Doxycycline yielded more significant complications, such as diarrhoea (39.5%), nausea (46.5%), and cramps (48.8%). Headache was more associated with Azithromycin treatment (3.4%), whereas Rash (1.1%) and blurring of vision (1.1%) were seen in the Doxycycline-Group.
 Conclusion: Meibomian Gland Dysfunction leads to tear film instability and direct damage to the ocular surface epithelium. This study supports the clinical efficacy and safety of oral Azithromycin and Doxycycline therapy for managing refractory or severe Meibomian gland disease.

The Impact of A Successful Pterygium Excision on Corneal Astigmatism and Topography

Objective: To determine the impact of successful excision of pterygium on corneal astigmatism and topography.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb 2021 to Jul 2021.
 Methodology: All 52 patients of pterygium who underwent surgical excision of the pterygium during the study period were included. The size of pterygium was measured in millimeters. Pre-operative automated keratometry and corneal topography was done, and changes in astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity were measured postoperatively on the 7th day. Paired sample t-test was applied between pre- and post-operative astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity.
 Results: The mean age of participants was 42.02±13.3 years, with 22(42.3%) females and 30(57.7%) males. The male to female ratio is 1.36:1. The highest frequency of cases was noted in the age group, 31-50 years (42%), followed by 18-20 years (21%). Pterygium size was 2.25 to 4.10 mm, with a mean of 3.16±0.54mm. Pain and photophobia were noted in 5 cases. Pre- and postoperative comparison of astigmatism and corneal topography revealed a significant reduction in Surface Asymmetry Index and Surface Regularity Index values (p-value<0.001). Uncorrected Visual Acuity (p=0.002) and Best Corrected Visual Acuity also improved significantly after surgery (p=0.006).
 Conclusions: This study concluded that pterygium excision brings a significant decrease in astigmatism and reversible corneal topography changes.

The Effect of Artificial Tear Treatment on Central Corneal Thickness in Dry Eyes

Objective: To evaluate the role of artificial tear treatment on central corneal thickness in patients with dry eyes coming to a tertiary care eye hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Tertiary Care Eye Center, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Nov 2022. Methodology: The study included central corneal thickness of 210 eyes (n=210) of 110 patients with dry eye disease measured before and after treatment with continuous use of artificial tear drops one month apart, patients were diagnosed on the presence of symptoms such as burning, dryness, pain, irritation, grittiness followed by slit lamp examination for marginal tear meniscus(<0.25mm) or absent, tear film BUT of <10 seconds , Schrimer test 2 of <6mm after 5 minutes and ocular surface staining score of >1 with fluorescein. Central corneal thickness was measured using corneal topography (Galleli G6 Ziemer). Results: A total of two hundred and twenty eyes of 110 individuals having dry eyes were included in our study. Median CCT before treatment with artificial tears was 522(75)µm while median CCT after 1 month treatment with artificial tears was 547(22.25)µm this showed a percentage increase of 3.79% in central corneal thickness after one month treatment with artificial tears (p-value <0.001) therefore treatment with artificial tears was significantly associated with an increase in central corneal thickness in dry eye disease. Conclusion: Central corneal thickness is substantially related to dry eyes.

Comparison of Higher Order Aberrations between Wavefront Optimized Photorefractive Keratectomy and Laser in situ Keratomileusis in Myopic Patients.

To compare the higher order aberrations (HOA) between wavefront optimized (WFO) laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in myopic patients. Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from December 2021 to December 2022. Forty-four patients underwent wavefront optimized PRK and fifty-seven patients underwent wavefront optimized LASIK. All variables were recorded before the procedure and at 1, 3, 6, and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), root mean square (RMS) of HOAs, spherical aberration (SA), and coma aberration (CA). A total of 101 eyes of 51 patients were considered in the final analysis. Patients were divided into two groups. Group A comprised of 44 (43.6%) eyes of 22 patients who underwent PRK while group B comprised of 57 (56.4%) eyes of 29 patients who underwent LASIK. UCVA significantly improved postoperatively at 3 and 6 months in both PRK and LASIK groups (p<0.001 for both groups). In this study, the increase in root mean square (RMS) of higher order aberrations from baseline value was 77% after PRK and 28% after LASIK, similar ratio was observed in spherical aberration (SA). The trend of rise in Coma aberrations was more in LASIK group 66.49%as compared to 46.2% in PRK group. Both Wavefront Optimized PRK and LASIK are safe and have elicited comparable results of post-procedure visual recovery. There was a marked increase in RMS of HOAs in PRK group as compared to WFO LASIK group while coma aberration increased more in LASIK as compared to PRK postoperatively. LASIK, PRK, RMSh, HOAs, Spherical aberration, Coma, Myopia.

Correlation Between Corneal Keratometry, Central Corneal Thickness and Anterior Chamber Depth as Measured by Wavelight OB 820 Biometer and Wavelight Oculyzer II in Preoperative Cataract Surgery Patients.

To compare and correlate corneal keratometry (K), central corneal thickness (CCT), and anterior chamber depth (ACD) using a partial coherence interferometry device and a Scheimpflug camera system device in patients planned for cataract surgery. Comparative cross-sectional study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, from December 2021 to June 2022. Patients planned for cataract surgery underwent measurement of central corneal thickness (CCT), anterior chamber depth (ACD), and keratometric values (K) by Wavelight OB 820 biometer and Allergo Oculyzer II, preoperatively. Correlation and inter-device agreement were assessed between two devices. There were 115 patients with a mean age of 64.23 ± 9.26 years. All anterior segment parameters showed excellent agreement and high degree of correlation between the two optical devices. Correlation coefficient (r) for central corneal thickness was r = 0.958 (p<0.001) while correlation coefficient for anterior chamber depth was r = 0.965 (p<0.001), r = 0.966 (p<0.001) for flat K, and r = .0969 (p<0.001) for steep keratometry, respectively. Ophthalmic parameters assessed by both devices were comparable and are recommended to be used in the clinical practice of keratorefractive and cataract surgeries interchangeably. ACD, CCT, Keratometry, Cataract, OB 820 biometer, Oculyzer II.

Comparison of Intraocular Pressure Measurement by Goldmann Applanation Tonometer, Air Puff Tonometer and Tonopen in Vitrectomized Eyes

Objective: To compare Goldmann applanation tonometer, air puff tonometer, and tonopen measured IOP Readings in vitrectomized eyes filled with temponading oils and gasses. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan, from Aug 2021 to Feb2022. Methodology: A total of 50 eyes were included in our study. Intraocular pressure was measured by an experienced ophthalmologist between 10am to 4pm on the 7th postoperative day by three devices, Goldmann applanation tonometer (GAT), air puff tonometer, and tonopen. Pearson’s correlation and paired samples t-test was applied to determine correlation and any significant difference between the mean of intraocular pressure measured by three different devices. Results: Out of the 50 people included in study 31(62%) were males and 19(38%) were females. The mean age of study participants was 50.10±11.61 years. Mean intraocular (IOP) pressure measured by the GAT applanation tonometer was 14.59±1.13 mmHg. Mean IOP as calculated by the airpuff tonometer was 15.93±1.88 mmHg, whereas mean IOP as calculated by tonopen was 15.85±1.86 mmHg. All three instrument values showed significant difference as p-value &lt; 0.001. Conclusions: The air puff tonometer overestimates IOP as compared to GAT. Tonopen and air puff tonometer produce IOP measurements that are similar and consistent to each other but not to GAT

Spasm of Near Synkinetic Reflex: Outcomes of a Comprehensive Management Protocol

Objective: To find out the frequency of spasm of near reflex presenting to our clinic and outline the management outcomes. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022. Methodology: A patient who was suspected to have spasm of near reflex underwent subjective and objective refraction and detailed orthoptic evaluation. Dry and cycloplegic retinoscopy was obtained along with post-mydriatic refraction achieved after 3 days of Cycloplegic. Spasm of near reflex was categorized as mild if it resolves on administration of a weaker cycloplegic drug like cyclopentolate, moderate if administration of stronger cycloplegic i.e., atropine/homatropine is required or severe if long term home therapy of atropine 0.5% once daily is required. Results: Our study included 236 patients with suspected spasm of near reflex, among which it was confirmed in 200 only. Of the 200 patients with confirmed spasm of near reflex, there were 74 mild cases (37%), with no spasm of near reflex during their post-cycloplegic visit. Eighty-eight patients (44%) had moderate spasm of near reflex that was relieved by the post atropine examination. Whereas, 38 patients (19%) had severe spasm of near reflex, requiring long-term atropine 0.5% management. Conclusion: Spasm of near reflex is often a diagnostic dilemma which is otherwise not very difficult to treat. Most of such cases were found to be mild to moderate having good visual outcomes to once or twice application of moderate (Cyclopentolate 1%) to stronger acting Cycloplegic eye drops (Atropine 1%).

Agreement between Subjective and Objective Parameters Using Meibography for Assessment of Dry Eye Syndrome

Objective: To determine the agreement between subjective and objective parameters using meibography. Study Design: Cross-sectional observational study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan from August 2021 till February 2022. Methodology: 100 patients were included in the study. Non-contact infra-red meibography was performed on each patient. Subjective assessment was done using the four-grade and five-grade scales while objective assessment was done by applying computerized grading. Results: A total of one hundred (n=100) patients participated in the study. Out of total, 60% patients were male and 40% were females, with a mean age 42.25±14.9 years. There was statistically significant difference was seen Session I OII vs Session II OII as p-value &lt;0.001 in Grade-4, Session-I OIII vs Session-II OIII as p-value &lt;0.001 in Grade-5. There was not statistically significant difference seen in Computerized Grading (100-grade scale) as p-value &gt;0.05. Correlations between observers was best with the 5-grade scale followed by the computerized 100-grade scale and 4-grade scale. Conclusions: We found that the reliability of the 5-grade scale was poorer to that of the 4-grade scales. We also concluded that computerized grading offers a better intra and inter-observer assessment.

Assessment of Endothelial Cell Count Changes Post-Yttrium Aluminium Garnet Laser for Posterior Capsular Opacification

Objective: The study aimed to assess the effect of Neodymium : Yttrium Aluminium Garnet laser (ND:YAG laser) on endothelial cell count loss and anterior segment elements. Study Design: Quasi-experimental. Place and Duration Of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from Jul 2021 to Feb 2022. Methodology: A total of 60 patients with a history of posterior capsular opacities planned for Neodymium: Yttrium Aluminium Garnet laser posterior capsulotomy were included. Specular microscopy was done pre and post-laser to study and parameters such as central corneal thickness, endothelial cell count, intra-ocular pressure was noted. Data were analyzed by using the Statistical Package for the Social Sciences version 23 software Result: After four weeks of Neodymium : Yttrium Aluminium Garnet laser, there was no significant change in the intraocular pressure (p=0.334), however, the visual acuity improved from 0.6±0.3-0.05±0.1 (p&lt;0.001) along with a decrease in endothelial cell count 2101±485-1919±427 (p&lt;0.001) and central corneal thickness 0.504±0.03-0.502± 0.03 (p=0.010). A similar trend of changes in the parameters was observed for lower (1.0-1.2MJ) and higher energy (2.1-2.5MJ) in the sample for posterior capsulotomy. Conclusion: Our study concluded that the corneal structural changes occur post-Neodymium: Yttrium Aluminium Garnet posterior capsulotomy, including changes in endothelial cell count. However, there is no significant disturbance in the intraocular pressure after the procedure.

Spectrum of Etiologies and Clinical Presentation of Patients with Extraocular Motility Disorders Presenting to a Neuro-Ophthalmology Clinic

Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study.

Frequency and Antibiotic Susceptibility of Bacteria Isolated in Patients with Blepharitis

Objective: To determine the frequency and antibiotic susceptibility of bacteria isolated in patients with blepharitis. StudyDesign: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Oct 2021. Methdology: 160 cases of blepharitis, during a period of 2 years, who were not using topical or systemic antibiotics were recruited in this cross-sectional study. After detailed history and slit-lamp examination of eyelids and tears film each patient underwent sample collection under aseptic conditions, from the eyelid margin. The samples were inoculated in a culture of blood agar and chocolate agar (Biomeriux) , Then the susceptibility of the identified bacteria to common systemic and topical antibiotics were tested using the disc diffusion method (Rosco Neo-Sensitab). Results: In 160 patients,118(73.7%) were males and 42(26.3%) were females. According to type of blepharitis, 98(61.3%) had posterior blepharitis and 62(38.7%) had anterior blepharitis.Culture of eyelid sample of 77(48.1%) patients showed growth of coagulase-negative staphylococcus Coagulase-negative staphylococcus (CoNS) show greater resistance towards Penicillin 77(100%), Ciprofloxacin 55(72.5%) and Erythromycin 33(42.8%) however more susceptibility was shown towards Linezolid (CoNS). 71(45%) had Staphylococcus aureus isolated from their culture. 77(100%),Vancomycin 77(100%), Gentamycin 66(85.8%), Chloramphenicol 56(74.5%) and Cotrimoxazole 55(72.5%).Staphylococcus aureus show greater resistance towards Penicillin 72(100%),Ciprofloxacin 41(56.9%) and Tetracyclins 30(41.6%) however more susceptibility was found towards Gentamycin 72(100%), Linezolid 72(100%),Vancomycin 72(100%) and Chloramphenicol 61(84.7%). Conclusion: Coagulase-negative staphylococcus (CoNS) and Staphylococcus aureus have been the main isolated organisms in blepharitis. These bacteria have been shown to be resistant to Penicillin,