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Al-Shifa Journal of Ophthalmology

Vol. 3, No. 1, January-june 2007

Al-Shifa Journal of Ophthalmology
A Journal of
Al-Shifa Trust Eye Hospital, Rawalpindi

Aims and Scope: ASJO, The official journal of Al-Shifa Trust Eye Hospital, Rawalpindi, publishes original reports of research in ophthalmology mostly in the form of clinical studies. Topics may include new diagnostic and surgical techniques, treatment methods, atypical case reports, major and mini-reviews, preventive ophthalmology including health economics and applied research findings.

Al-Shifa Journal of Ophthalmology

Editorial inquiries should be addressed to Prof. Tayyab Afghani, Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Jhelum Road Rawalpindi, Pakistan. Tel: 0092 51 5487820-25, Fax: 0092 51 5487827: Email: info@alshifa-eye.org.pk ;Web site: www.alshifa-eye.org.pk

Contents

Editorial: Cataract Surgery in children-Dilemmas
Tayyab Afghani, MS   

Comparison  of  surgically  induced  astigmatism in  phacoemulsification with  5.5 mm  superior  vs. temporal  incision                                                                  
Shahzad Iftikhar FRCS, Rabia Bashir FCPS,
Badruddin Athar Naeem FCPS, Raja Abrar DOMS,
Rashid Hussain Jaffri MCPS and Ambreen Sarmad FCPS,

100 patients undergoing phacoemulsification were randomly allocated to superior or temporal limbal incision. Temporal incision was associated with significantly less surgically induced astigmatism than superior limbal incision

Comparison of Visual Outcome after Refraction in Keratoconus associated with and without VKC   
Kanwal Batool Dip Optom,  Amtul Aziz DOMS

286 eyes of 170 patients were studied. Each patient underwent complete ocular examination and refraction. Visual outcome after refraction was comparatively worse in keratoconus patients associated with VKC due to photophobia, active conjunctivitis, scaring and vascularization.

Excimer Laser Photorefractive Keratectomy for 3.75 to 6.00 Diopters of Myopia - Six Months Follow Up                 Abdul Moqeet, FCPS

To assess the efficacy and safety of excimer laser photorefractive keratectomy for myopia 44 eyes within range of -3.75 to 6.00 diopters sphere underwent PRK. At one month, three months, and six months after PRK, 45.45%, 63.63%, and 74.31% eyes respectively achieved 6/6 visual acuity without glasses. PRK
appeared to be an effective and safe procedure with good predictability for the correction of moderate myopia.

Simultaneous Bilateral Cataract Surgery in children – A Case Report 
Samina Jahangir FRCS, Mehmood Ali, MBBS

A one year old female child with bilateral congenital cataract underwent simultaneous cataract surgery in a single session in order to reduce the risk of repeated general anesthesia. No per operative complication occurred and satisfactory visual outcome was achieved

Treatment outcome of intubation in congenital nasolacrimal duct obstruction                 
Saemah Nuzhat Zafar FRCS, Ayesha Khan FRCS, Nadia Azad FCPS

Intubation in experienced hands is a successful procedure for treating congenital nasolacrimal duct obstruction mostly after failed probing. 37 eyes were treated with lacrimal intubation using olive tip silicon tube. Success of intubation was seen in 32 out of 37 intubated eyes (86.48%). Tube removal in office is cost effective and safe.

Comparison  of  surgically  induced  astigmatism in  phacoemulsification  with  5.5 mm  superior  vs. temporal  incision

 Shahzad Iftikhar FRCS, Rabia Bashir FCPS, Badruddin Athar Naeem FCPS, Raja Abrar DOMS, Rashid Hussain Jaffri MCPS and Ambreen Sarmad FCPS

Purpose: To compare the effect of superior versus temporal limbal incision on surgically induced astigmatism (SIA) in phacoemulsification with 5.5 mm rigid intraocular lens (IOL)
Duration and Setting: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from January 2006 to December 2006.
Patients and Methods: A total of 100 patients undergoing phacoemulsification with posterior chamber (PC) IOL comprise the study. They were randomly allocated to two groups i.e. Group 1 (superior limbal incision) and Group 2 (temporal limbal incision). 5.5 mm limbal incisions were given in superior and temporal meridians. All surgeries were performed by the same surgeon. All patients had autokeratometry preoperatively and post operatively (4 weeks and 8 weeks). Surgically induced astigmatism was measured by using vector subtraction method ignoring the axis. Statistical analysis was done by using paired sample T test.
Results:  After 8 weeks Group One had 1.41 diopters of SIA and patients of Group Two had mean SIA of 1.03 D. The difference was statistically significant with p value of 0.002.


Conclusion: Temporal incision is associated with significantly less surgically induced astigmatism than superior limbal incision. Al-Shifa Journal of Ophthalmology 2007; 3(1): 9-14 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

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Comparison of Visual Outcome after Refraction in Keratoconus associated with and without VKC

Kanwal Batool Dip.Optom. Amtul Aziz DOMS

Purpose: To compare the visual outcome after refraction in mild, moderate and severe keratoconus associated with and without vernal keratoconjunctivitis (VKC).
Design: Retrospective analysis of patients with keratoconus.
Participants: Patients treated at refraction unit of Cornea Clinic of Al-Shifa Trust Eye Hospital Rawalpindi
Methods: 286 eyes of 170 patients were studied. Each patient underwent complete ocular examination and corneal topography by an ophthalmologist and visual acuity, keratometry and refraction by an optometrist
Results: Majority of patients (94.11%) presented between 8-29 years of age. Mean age was 17.41 years; 5.85% patients presented between 30-45 years of age. 70.58% were male and 29.41% were female.. Out of 286 eyes with keratoconus, 16 eyes had mild keratoconus (K- readings < 48D), 51 eyes had moderate keratoconus (K- readings between 48-54D) and 219 eyes had severe keratoconus (K-readings > 54D). The VKC was associated with 44.75% of patients. Visual outcome was 6/9 or better in 27.69 % (36 eyes) without association of VKC and 8.59 % (11 eyes) in association with VKC


Conclusion: Visual outcome after refraction is comparatively worse in keratoconus patients associated with VKC due to photophobia, active conjunctivitis, scaring and vascularization. Al-Shifa Journal of Ophthalmology 2007; 3(1): 15-19 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

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Excimer Laser Photorefractive Keratectomy for 3.75 to 6.00 Diopters of Myopia- Six Months Follow Up

M Abdul Moqeet, FCPS

Purpose: To assess the efficacy and safety of excimer laser photorefractive keratectomy for myopia in Pakistani population.

Design: Prospective interventional case series
Participants: This study group included 44 eyes within range of -3.75 to 6.00 diopters sphere (DS). Range of the astigmatism was 0.50 to 1.50 diopters cylinder (DC), with an average of 0.93. Nine eyes (20.45%) were lost to follow up after three months. Therefore 35 eyes (79.45%) were examined at final visit scheduled at six months postoperatively.
Methods: All patients presenting at the cornea clinic with moderate myopia and eligible and willing for PRK underwent laser surgery by the same surgeon. The patients were examined at one, three and six months for outcome measures which included visual acuity, incidence of complications, and patient satisfaction.
Results: At one month, three months, and six months after PRK 45.45%, 63.63%, and 74.31% eyes respectively achieved 6/6 visual acuity without glasses. It was found that 23 eyes (52.27%), 24 eyes (54.54%) and 17 eyes (48.57%) had hypermetropia of +1.00 diopters spherical equivalent (DSE) after one month, three months and six months respectively.  None of the eyes had astigmatism more than +1.0 diopters, whereas 02 eyes (05.71%) had -1.0 diopter astigmatism at the end of six months. After six months, eleven eyes (31.33%) still had postoperative corneal haze varying between grades 1 to 3. No vision threatening complication occurred.


Conclusion: PRK appeared to be an effective and safe procedure with good predictability for the correction of moderate myopia. Al-Shifa Journal of Ophthalmology 2007; 3(1): 20-26 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

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Simultaneous Bilateral Cataract Surgery in children – A Case Report

Samina Jahangir, FCPS,  Mahmood Ali, MBBS

Purpose: Feasibility of simultaneous bilateral cataract surgery (SBSC) in children with congenital cataract
Design of study: A case report.
Participants: A one year old female child with bilateral congenital cataract who was brought to outpatient department of Jinnah Hospital Lahore with the complaint of visual inattention. Her general health did not permit repeated general anesthesia and so simultaneous cataract surgery in a single session was planned. No per operative complication occurred and satisfactory visual outcome was achieved.


Discussion: There has been a long standing debate whether simultaneous bilateral cataract surgery especially for congenital cataracts is beneficial or not. The greatest concern in this regard is the rare risk of developing bilateral post operative endophthalmitis. However review of literature shows that in selected cases simultaneous bilateral cataract surgery yielded good postoperative results with no serious post operative complications if strict rules of surgical asepsis are followed. Al-Shifa Journal of Ophthalmology 2007; 3(1): 27-30 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

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Treatment outcome of intubation in congenital nasolacrimal duct obstruction

Saemah Nuzhat Zafar FRCS, Ayesha Khan FRCS, Clinical Fellow in Pediatric Ophthalmology, Nadia Azad FCPS

Purpose: To report results of lacrimal intubation for management of congenital nasolacrimal duct obstruction.
Design: Prospective interventional case series.
Participants and Methods: Twenty nine consecutive patients (37 eyes) with nasolacrimal duct obstruction requiring lacrimal intubation presenting at the Paediatric Ophthalmology Department of Al-Shifa Eye Hospital, were included in the study with informed consent. After detailed history and ophthalmic examination 37 eyes were treated with lacrimal intubation using olive tip silicon tube in the operating room. Patients were followed up at 1 week, 6 weeks and thereafter at varied intervals according to symptoms or complications such as lateral displacement of the tube. Tube was removed after an average of 6.8 months as an office procedure in most of the cases. Complications of the procedure were noted. Success of the procedure, defined as no watering, mucous discharge or increased tear meniscus seen after intubation was noted.
Results: Success of intubation was seen in 32 out of 37 intubated eyes (86.48%). Further success was seen in 2 eyes of 2 patients after removal of the tubing. Three eyes required dacryocystorhinostomy surgery for persisting symptoms with regurgitation of discharge. Operative complications of lacrimal intubation included bleeding from nasal mucosa, difficult retrieval of the tube from the nose due to anatomical reasons and slipping off of the tube from its metal probe, punctal tear, unplanned silicone tubing removal, obstruction encountered during the procedure and lateral displacement of the tube.


Conclusion: Intubation in experienced hands is a successful procedure for treating nasolacrimal duct obstruction mostly after failed probing. Complications of the procedure can be avoided by careful surgery and good pre-operative evaluation. Tube removal in office is cost effective and safe. Al-Shifa Journal of Ophthalmology 2007; 3(1): 31-34 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

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What's New
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Muzaffarabad hospital construction completed more

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Annual address of President Al-Shifa Trust more

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Chairman NAVTEC visits Al-Shifa Trust: A boost to the paramedics training program more

News 4

Institute of Ophthalmology at Sukkur to start working soon more

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Kohat Hospital reaches out to patients despite heavy odds more


News 6

International trainee complete their subspecialty training programs more


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Fund raisers: Chicago, Lahore and Changla Gali more


News 8

Participation in international Conferences more

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Quarterly Progress Report more

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Young Friends of Al-Shifa (YFA) more



Specialties Case Studies Hospitals
  Rawapindi
  Kohat
  Sukkur
  Muzaffrabad
  Quetta
 
 
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(C) 2009 Al-Shifa Trust