Al Shifa Ophthalmic Research Centre

Al Shifa Ophthalmic Research Centre with its latest equipment is another rare facility available at PIO for applied and basic research in ophthalmology. The research work is being carried out since 1992. However AORC was commissioned in 1999 with the generous support of donors. The centre aims to provide facilities for ophthalmic research leading to M. Phil and PhD. Professor S. Darougar, Dr. Qasim Mehdi and Professor Pablo Gold Schmidt leading research scholars are advisors to the centre. It has three full time research fellows, who are working on various projects, which will lead to M-Phil and later to PhD.

The centre has four state of the art research equipments namely Specular Microscope, Corneal Topography, Retina Tomogram and Electrodiagnostic equipment. It also has Internet and E-mail facilities along with the backup support of the Library.

Library:
The medical library contains over 3,500 ophthalmic books and over 3,000 journals. In addition, it provides CD-ROM facilities for research. The library provides material for doctors, nurses, optometrist and ophthalmic paramedics. Library has a large collection slides (over 10,000) donated by Prof S. Darougar on a vide spectrum of Ophthalmic diseases. It also has a useful collection of Video Cassettes, which can be viewed in the Audio Video area.
The library has a regular subscription to over 20 national and international journals.

Pakistan Institute of Ophthalmology is also a member of Higher Education Commission(HEC). To access the digital library please follow the link

http://www.digitallibrary.edu.pk/alshifa_trust_hosp.html

Research Articles

Role of ERG in diagnosis of medical retinal problems

Prevention of Diabetes related blindness

Spectrum of eye problems in school children

Miners’ Nystagmus

Causes of childhood blindness-Survey of Schools for the Blind

Miners’ Nystagmus

Preschool Vision Screening-An Analysis of 16,592 Preschoolers.

Causes of Childhood Blindness and Severe Visual Impairment-Survey of the Blind Children from a Rural Population and Schools for the Blind in an Urban Area

Awareness of Vitamin A deficiency in Pakistan

Etiology of blindness in an Afghan refugee community in Pakistan.

Phototherapeutic Keratectomy ---An alternative to Keratoplasty in selective case.

Results of Photorefractive Keratectomy in 228 eyes for low, moderate and high myopia at Al-Shifa Trust Eye Hospital.

Experience of 220 Keratoplasties at Al-Shifa Trust Eye Hospital, Rawalpindi.

Role of Corneal Topography in Diagnosis of Eye Diseases.

A laser device to measure the human cornea in vivo

Comparison of indigenous microbial flora of the eye to that found in conjunctival & corneal infections

Management of macular edema in patients of diabetes

Study of Excimer laser photo refractive keratectomy for myopia

Spectrum of Vertical deviation found in patients of squints

Antimicrobial Sensitivity Pattern Of Pre-Operative Cases At Al-Shifa Trust Eye Hospital Rawalpindi.

Role Of Intravitreal Triamcinolone Acetonide Injection In Treating Refractory Diabetic Macular Edema.

Ophthalmoplegic Migraine; A case report and review of literature

Role of Intravitreal triamcinolone acetonide injection in treating refractory diabetic macular edama

Diabetic vitreouse hemorrhage and its management

Management of rhegmatogenous retinal detachment in aphakics

Intraocular lens implants for traumatic cataracts in children

Management of postoperative astigmatism following cataract surgery

Management of bacterial and fungal keratities

Study of results and complications in Radial Keratotomy

Role of ERG in diagnosis of medical retinapl problems

In the differential diagnosis of medical retinal problems, especially in children difficulties are encountered in arriving at a diagnosis where the disease is not manifested fully. In this situation ERG plays an important role not only in diagnosis but also in follow-up and prognosis of the disease.
ERG (full field light-evoked electroretinogram) is the record of a diffuse electrical response generated by neural and no neuronal cells within the retina and pigment epithelium in response to light.
Originally received: May 3, 2004
Revised: July 5, 2004
Accepted: November 01, 2004
Correspondence to Amtual Aziz
Department of Research, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
It has three components, an initial negative deflection” a” wave, subsequent positive component termed as “b” wave and a final prolonged positive component referred as “c” wave.
Case Report:
A girl aged 8 yrs visited Pediatric Ophthalmology Department of Al-Shifa Trust Eye Hospital, Rawalpindi with history of nigh blindness and defective vision.
Family history ware positive in 4 out of 10 siblings. One examination she was found to be myopic. Her vision was 6 /12 in both eyes which improved to 6/9 after correction.
Anterior segment was normal. On preliminary examination no gross changes in fundus could be found except generalized granularity & myopic degeneration. She was labeled as a case of Congenital Stationary Night Blindness and was advised to have ERG.
Full field standard ERG revealed that Rod response as well as Cone response was markedly reduced. All the effected members of the family were examined who underwent ERG as well. All effected members had markedly reduced.

Examination of the four affected family members

Discussion
In patients with Cone dystrophy, rod responses are entirely normal or only minimally affected in the early stages. Rod and Cone response. Finally the a diagnosis of Cone-Rod Dystrophy was made.
With time, rod as well as cone responses can show additional impairment. Some autosomal recessive and, less frequently, autosomal dominant forms can, however manifest appreciable rod ERG amplitude reduction even at the time of diagnosis.
Such patients are best described as having a Cone-rod dystrophy. Cone-rod dystrophy patients infrequently complain of poor night vision. Usually the fundus examination then show retinal attenuation and midperipheral as well as peripheral pigment clumping in addition to a macular lesion. Optic disc atrophy has been reported in these patients.

Title Prevention of Diabetes related blindness
Author Dr. Tayyab Afghani
Published International Seminar on Diabetes-related blindness at Al-Shifa Trust eye Hospital, Dec 1998.

Abstract: The study represent preliminary result of screening of rural populations for potentially weight-threatening diabetes. All patients presenting at the camp above 40 years of age were screened for diabetes through urine and blood examination. The patients with +ve urine sugar and a blood sugar random reading of 140mg/dl were defined as diabetic and examined for diabetic retinopathy. Those with retinopathy were referred to Al-Shifa diabetic clinic, while others were given counseling. Diabetes was found in 5% of rural population. 10% of the discovered diabetic population were having diabetic retinopathy.

Title Spectrum of eye problems in school children
Author Dr. Tayyab Afghani
Published Islamabd Internation congress of Ophthalmology, sep. 1996

Abstract: The study consists of screening results of about one million school children from Rawalpindi and Islamabad. Amongst the potentially sight-threatening conditions, uncorrected refractive error was identified 5% of the students. Other important ocular problems identified were allergic conjunctivitis (10%) and Blepharitis (7%).

Title Miners’ Nystagmus
Author Dr. Tayyab Afghani
Published Islamabd Internation congress of Ophthalmology, sep. 1996

Abstract: Occupational Eye health is an important terms of reference for Al-Shifa prevention of blindness programme. 200 workers were examined from different coalmines of Dandot/Choa Saiden Shan to find out the status of eye health and safety measures of mine workers. It was discovered that 2.6% of them had Miners’ Nystagmus. It was related with duration and type of the job as well as with the ambient light at workstations.

Title "Causes of childhood blindness-Survey of Schools for the Blind”
Author Dr. Tayyab Afghani
Published Lahore International Congress of Ophthalmology, Dec 1995

Abstract: the study consists of survey of Schools for the blind from Rawalpindi and Islamabad. Three schools were examined with a total of 75 pupils. Hereditary diseases including congenital anomalies were the causes of blindness in 45 % of cases. Neglected or mistreated congenital cataract and glaucoma were responsible for blindness in another 20% and 12% of children respectively. Consanguinity was an important possible contributing factor for such a large proportion of congenital blindness. Recommendations for ameliorating situation through genetic counseling, public awareness and inter-disciplinary coordination were also given.

Title Miners’ Nystagmus
Author Dr. Tayyab Afghani
Published Pakistan Journal of Ophthalmology vol:35 No.2 1996

Abstract:Miner’s nystagmus is an acquired occupational disease of nervous System with special manifestation in the ocular motor apparatus occurring in coal miners. We examined 141 mine worker at Dandot Coal Mines. All had been underground workers for a long time. We diagnosed 4 mine workers with characteristic features of miner’s nystagmus ( an incidence of 2.85%). Poor illumination and cramped postural conditions were the most important underlying factors.

Title Preschool Vision Screening-An Analysis of 16,592 Preschoolers.
Author: Dr. Tayyab Afghani
Published Pakistan Journal of Ophthalmology vol:14 No.2, 1998

Abstract: Amblyopia and strabismus require treatment early in life for best visual results at present many such children are treated late or not at all. Mass screening at preschool age appears the only viable solution to this problem. We carried out village –to- village screening of 16, 592 preschool children in a rural area. Anterior segment examination and rapid retinoscopy, together with visual acuity checking with Snellen test types, where possible, were utilized as screening tools. The coverage rate was more than 80%. The results show that 22% of these children had some sort of ocular problem, while 3.27% suffered from potentially blinding conditions like amblyopia, refractive errors, squint etc. Comparative analysis shows that there is significant under-detection of amblyopia and squint in this group. At the moment, preschool screening methods does not seem to produce desired results. In order to assess this matter, various vision screening methods appropriate for preschoolers or infant base on current evidence are reviewed.

Title Causes of Childhood Blindness and Severe Visual Impairment-Survey of the Blind Children from a Rural Population and Schools for the Blind in an Urban Area
Author Dr. Tayyab Afghani
Published Pakistan Journal of Ophthalmology Vol. 16 No.1 Jan, 2000
Abstract

Objective: To investigate the causes of childhood blindness and severe visual impairment (SVI /BL) in Pakistan using specific WHO/PBL from
Design and setting: Cross-sectional survey of children attending 3 schools for the blind in an urban area and registered non-blind school children from a rural area. Main outcome measures: Proportion of blind children with blindness from different causes and number of children in need of surgical medical or low vision services.
Results: The lens, the retina and the whole globe were involved in 24%,23% and 22% of children respectively. Hereditary etiology was the most common and was identified in 47 % of children followed by 44 % of children in whom no underlying cause could be identified. Cataract and glaucoma were the major diseases of unknown origin. Hereditary diseases were more common in the urban population .54% of causes were avoidable, out of which 37% were treatable and 17% were preventable.
Conclusion: Diseases of the retina and the lens are the commonest causes of childhood blindness and SVI in Pakistan. Heredity plays the major role. More specialized curative services are needed in rural areas, while more low-vision services are needed in urban area. There are significant variations between the urban and the rural populations. Blind school study is a reasonable measure to study the causes of childhood blindness in general population.

Title Awareness of Vitamin A deficiency in Pakistan
Author Dr. Tayyab Afghani
Published Sight and Life Newsletter 1/2000

Abstact
Vitamin A deficiency is a public health problem in Pakistan especially in pre school children who were dying and becoming blind for no fault of theirs. Outreach programmes were conducted in rural areas and to our utter disbelief, in a span of three months within a radius of 60 miles we came across 80 cases of acute vitamin A deficiency in preschool children presenting with night blindness of recent onset. At different occasions this great problem was projected at the national level and finally it has been recognized and 25 million children received Vitamin A drops on the National Polio Day.

Title Etiology of blindness in an Afghan refugee community in Pakistan.
Author Dr. Haroon Rashid Awan & Tariq Ihsan.
Published Pakistan Journal of Ophthalmology Vol:35 No.2, 1996

Abstract:
The prevalence and etiology of visual loss and of disease were determined in a resident Afghan refuge community in Northern Pakistan. A 30-cluster random sample survey of 1156 persons was conducted representing the non-migrant Afghan refugee population. The survey revealed that 2.0 % of the population is blind and another 6.9 % are visually impaired according to the World Health Organization definition. The most common causes of blindness include cataract, uncorrected refractive error, retinal dystrophy / degeneration, and glaucoma. Corneal opacities, cataract, uncorrected refractive errors, optic atrophy, phthisis and amblyopia are also important causes of unilateral visual loss. Active trachoma (TF,TI) was found in 4% of all children under 10 years of age.

Title: Phototherapeutic Keratectomy ---An alternative to Keratoplasty in selective case.

Author/Presenter: Prof. Wajid Ali Khan
Presented at Lahore Ophthalmo 1999

Abstract

We treated 28 eyes of 19 patients with superficial corneal pathology with Excimer Laser phototherapeutic Keratectomy .13 patients were male and 6 female. Age ranged between 7 to 81 years Maximum follow up was 36 months. Indications for PTK were superficial Granular Dystrophy (14 eyes) Band Keratopthy (4) Recurrent Corneal Erosion (6) Spheroidal degeneration (2) and Macular dystrophy in 2 eyes. All patients were treated with Summit Omnimed Excimer Laser with 193 nm wavelength. Optical Zone was 65 mm and 50 300 pulses were used. All eyes had epithelial debridement manually and laser was applied after covering the surface with a thin layer of viscoelastic. Eyes were covered for 2 days. Results showed that 70% cases attained visual acuvity of 6/18 or better. Best results were seen in cases of Superficial granualar dystrophy and Bank Keratopathy. Eyes with Spheroidal degeneration and Macular dystrophy although improved but not to great extent .2 eyes with Superficial Granular dystrophy showed decreased visual acuity due to recurrence of the disease after one year.

Title: Results of Photorefractive Keratectomy in 228 eyes for low, moderate and high myopia at Al-Shifa Trust Eye Hospital.
Author/Presenter: Prof. Wajid Ali Khan
Presented at Lahore Ophthalmo
Abstract
228 eyes were treated at Al-Shifa Trust Hospital with Excimer Laser Photorefractive Keratectomy for myopia. Out of these 120 eyes were of male patients and 108 were of female patients. Myopia was divided in three groups. “A” group ranged between -1.50 to -6.0 DS. “B” group between -6.25 to -10 DS and “C” group from -10.25 DS and “C” group from -10.25 DS on ward. In group “A” out of 142 eyes 120 eyes had unaided visual acuity of 6/6 to 6/9 at six months. In group “B” out of 38 eyes 21 eyes had unaided visual acuity of 6/6 to 6/9 at six months. In group “C” 11 eyes out of 48 had unaided visual acuity of 6/6 to 6/9 at six months. The major complications were under correction corneal haze and glare. There were more cases of corneal haze in high degrees of myopia.

Title: Experience of 220 Keratoplasties at Al-Shifa Trust Eye Hospital, Rawalpindi.
Author/Presenter: Prof. Wajid Ali Khan
Presented at Lahore Ophthalmo
Abstract
Results of 220 penetrating Keratoplasties performed at Al-Shifa Trust Eye Hospital Rawalpindi were discussed. Main indications for Keratoplasties were Keratoconus, corneal scars, Aphakic Bullous Keratopathy, Pseudophakic Bullous Keratopathy, corneal Dystrophies and re-grafts. Out of 220 eyes 137 eyes were of male patients and 83 eyes of female patients. Over 80% patients were between ages of 10 years to 40 years. Pre operatively best corrected vision in 134 eye was between 6/60 to counting fingers and in 80 eyes less than counting fingers. 63% eye had best corrected visual acuity of 6/6 to 6/18 any time after the operation. Common complications were post operative astigmatism, graft rejection and suture related infections

Title: Role of Corneal Topography in Diagnosis of Eye Diseases.
Author/Presenter: Dr. Amtual-Aziz
Presented at: Lahore Ophthalmo 2000
Abstract:
In this paper advantages of Computerized Corneal Topography were compared to other methods for assessment of corneal curvature. Principle of C.C.T. discussed; the use of Corneal Topography in the diagnosis of various corneal pathologies, and its role in planning and predicting the outcome of keratorefractive surgery, to improve the results of anterior segment surgery and in contact lens fitting was highlighted. Results of Corneal topographies done at Al-Shifa Trust Hospital, Rawalpindi were also presented.

Title: A laser device to measure the human cornea in vivo
Author: Dr. Wajid Ali Khan & M. M.S. Gilani
Published: Laser microflab-Icaleo’ 99 volume 88
Abstract: To see the detail consult the Journal

Title: Comparison of indigenous microbial flora of the eye to that found in conjunctival & corneal infections

Author Dr. Shehla Rubab(Consultant) Al-Shifa Trust Eye Hospital

Abstract:
Bacterial and fungal infections are an important but a complex group of ocular disease. All the samples were inoculated on blood & chocolate agar and Sabourad’s agar. The yield was tested for sensitivity for different antibiotics. The common organisms found in control group were Staph. Epidermidis, Staph. Aureus, Strept. Pnuemoniae & Diphtheroides spp. The common gorganisms found in infective cases were Staph aureus (22.8%), Strept. Pneumoniae(25%), Staph. Epidermidis (22.2%) and Strept. Pyogenes (9.6%) in cases of conjectivitis. In cases of keratitis the common organisms were Strept pneumonae (25%), Staph. Aureus (17.5), Haemophilus spp (12.5%) and pseudomonas (10%). In Control groups 70% of the Strept. Epidermis and Staph. Auresus were sensitive to gentimicin,chloramphenical and cephradin. In the cases group over 80% of Staph aureus showed sensitivity against gentamicin, chloramphenical and cephradine. About 80% of pneumococci were sensitive to chloramphenicol, cephradine and erythromycin.

Title: Management of macular edema in patients of diabetes
Author Dr. Nadeem Ishaq(Consultant) Al-Shifa Trust Eye Hospital

Abstract
Macular edema isa common finding in patients with diabetic retinopathy. It is more common in IDDM patients than in NIDDM patients. Fundus fluorescien angiography plays an important role in the decision for the type of laser application required. Grid laser for diffuse edemas and modified grid or focal laser gives the best results.

(Ophthalmic Research Manual Al-Shifa Trust Eye Hospital Rawalpindi Pakistan)

Title: Study of Excimer laser photo refractive keratectomy for myopia
Author Dr. Abdul Moqeet Khan(Consultant) Al-Shifa Trust Eye Hospital

Abstract
A study of patients under going photo refractive keratectomy for correction of myopia was done. The cases selected were between -1.00 and -7.00 diopters.
The correction of myopia was achieved in about 75% cases with in + / - 1.00 diopter of emmetropia. Major complications in the study were corneal haze and under or over correction. There was an observation of early hyperopic shift and late regression, especially noted in patients of higher degree of myopia.
(Ophthalmic Research Manual Al-Shifa Trust Eye Hospital Rawalpindi Pakistan)

Title: Spectrum of Vertical deviation found in patients of squints
Author Dr. Muhammad Abbas (Consultant) Al-Shifa Trust Eye Hospital

Abstract
Strabismus is mainly a disease of childhood that involves the problem of misalignment of the eye along with the challenging amblyopia therapy. A study of 924 patients was carried out to fine the incidence of vertical deviation. A total of 11.40 % had vertical deviation. Mostly were associated with horizontal squints (83%) and the rest were pure vertical deviations (17%). The conditions most commonly encountered included inferior oblique over action, ptosis, DVD,DEP, Duane’s syndrome and A & V patterns. Amblyopia was present in about one quarter of the patients.

(Ophthalmic Research Manual Al-Shifa Trust Eye Hospital Rawalpindi Pakistan)

Antimicrobial Sensitivity Pattern Of Pre-Operative Cases At Al-Shifa Trust Eye Hospital Rawalpindi.

Tania Rab M.Sc (Biological Sciences), M. Phil (Microbiology), Tayyab Afghani MBBS, Ms (ophthalmology) Mussarrat Aziz B.Sc Nursing

Purpose: To review the distribution and shifting trends of bacterial culture specimens in preoperative cases in an eye hospital and to assess the sensitivity pattern of isolated organisms to the treatment regimen utilized.

Design of Study: Retrospective analysis of record of 2, 050 hospital indoor pre-operative patients.

Participants: 2,050 hospital patients admitted during two period for intra-ocular surgery without any symptom of ocular infection.
Methodology: Conjunctival swabs for microbiological examination were take from patient’s eye to be operated. The samples were examined by gram staining and cultured on Blood Agar, Chocolate Agar, Brain Heart infusion broth, and thioglycolate broth, and thioglycolate broth. Cultures were maintained for 7 days. Antibiotic susceptibility of these isolates was determined for various ocular antibiotics using the Disk Diffusion susceptibility Test.
Results: Ocular surface infection was documented in 23 % of otherwise non-symptomatic pre-operative admitted patients. 75% were attributable to gram-positive, while 25% were due to gram-negative. No fungal growth was observed. Amongst the gram positive, Staph aureus had the highest prevalence of 41% followed by Strept pneumoniae of 11.5 %. Gram-negative bacteria predominantly isolated were Pseudomonas aeruginosa, which represented 6% . Antimicrobial susceptibility results revealed variable degrees of susceptibility in the isolates from our preoperative cases. The over all gram-positive strains demonstrated highest sensitivity to Keflaz (82%) and then to Ciprofloxacin (56%). The gram-negative bacteria presented with highest sensitivity to Ofloxacin (85%) followed by ciprofloxacin (74%).
Conclusion: Several preoperative risk factors can predispose to an infection. Their early recognition may prevent a disastrous outcome. However, in some cases the infection seems impossible to foresee. Therefore, a careful patient selection and special attention to asepsis are mandatory.
Al-Shifa Journal of Ophthalmology 2005; 1; 45-52 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.

Role Of Intravitreal Triamcinolone Acetonide Injection In Treating Refractory Diabetic Macular Edema.
Nadeem Ishaq, MBBS,MCPS,FCPS

Purpose: To study the effect of intravitreal triamcinolone in patients with diffuse macular edema refractory to laser treatment.
Study Design: Prospective interventional case series
Intervention: Intravitreal triamcinolone injection
Participants: 54 eyes of 42 patients with diffuse diabetic macular edema refractory to laser treatment were enrolled in this study. 10 Patients had bilateral intravitreal Kenacort. A injection but at the different times. 47 eyes of 43 patients had regular follow up.
Methodology: Intravitreal injection of triamcinolone acetonide 4 mg in 0.1 ml was given through a 27-g needle in the inferotemporal pars plana 3.5 mm posterior to the limbus under topical anesthesia. After the injection, IOP, indirect ophthalmoscopy, fundus examination was carried out to evaluate the perfusion of the central retinal artery and the intravitreal location of the triamcinolone.
Results: Improvement in visual acuity was found in 39[82 %] patients. The mean improvement of acuity was1,2,4,2 Snellen lines at the 6 wks, 8wks, 12wks, and 24 wks follow-up interval respectively. Intraocular pressure increase was observed in 21 [44%] eyes. At 12 wks follow-up only 2 eyes had persistence of high IOP up to 32 mm Hg and received combination therapy of topical prostaglandin analog and beta blockers. Two eye exhibited cataract progression at six months. Re-injection was perform after six months in 13[27%] of 47 because of recurrence of diabetic macular edema.
Conclusion: Intravitreal triamcinolone is a promising therapy for patients with diabetic macular edema refractory to laser treatment. It is effective in improving vision, reducing macular thickness and inducing re-absorption of hard exudates.
Al-Shifa Journal of Ophthalmology 2005; 1:30-33 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.

Ophthalmoplegic Migraine; A case report and review of literature
Tayyab Afghani, MBBS,MCOPS, MS(Pak),DCEH(London), FIACLE(Australia)

Purpose
To highlight the presentation and management of a case of ophthalmoplegic migraine and mini review of the subject.
Study Design: Case report.
Participant:
A 12 years old boy presenting with painful unilateral, recurrent ptosis.
Discussion: The incidence of childhood migraine in general has been estimated at between 2% and 5.7 %. The ophthalmoplegic migraine is quite rare and constitutes 0.16 % of childhood migraine. Third nerve involvement is most common. A typical clinical syndrome emerges in a child or young adult with periodic headache associated with ophthalmoplegia involving all functions of the third nerve, beginning at the height of an attack of cephalgia, which is primarily unilateral and in the orbital region; the paresis lasts for days to weeks following the cessation of headache; recovery is gradual and tends to be less complete after repeated attacks. MRI may show enhancement of third nerve. Systemic steroids have shown prmising results. The present case report is quite typical of those reported elsewhere: Al-Shifa Journal of Ophthalmology 2005; 1: 10-16 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.

Role of Intravitreal triamcinolone acetonide injection in treating refractory diabetic macular edama
Purpose:
To study the effect of intravitreal triamcinolone in patients with diffuse macular edema refractory to laser treatment.
Study Design:
Prospective interventional case series.
Intervention: Intravitreal triamcinolone injection
Participants: 54 eyes of 42 patients with diffuse diabetic macular edema refractory to laser treatment wee enrolled in this study. 10 patients had bilateral intravitreal Kenacort. A injection but at the different times. 47 eyes of 43 patients had regular follow up.
Methodology:
Intravitreal injection of triamcinolone acetonide 4 mg in 0.1 ml was given through a 27-g needle in the inferotemporal pars plana 3.5 mm posterior to the limbus under topical anesthesia.
After the injection, IOP, indirect ophthalmoscopy, fundus examination was carried out to evaluate the perfusion of the central retinal artery and the intravitreal location of the triamcinolone.
Results: Improvement in visual acuit was found in 39[82%] patients. The mean improvement of acuity was 1,2,4,2 Snellen lines at the 6wks,8wks, 12wks, and 24 wks follow-up intervals respectively. Intraocular pressure increase was observed in 21[44%] eyes. At 12 wks follow-up only 2 eyes had persistence of high IOP up to 32 mm Hg and received combination therapy of topical prostaglandin analog and beta blockers. Two eye exhibited cataract progression at six months. Re-injection was performed after six months in 13[27%] of 47 because of recurrence of diabetic macular edema.
Conclusion: Intravitreal triamcinolone is a promising therapy for patients with diabetic macular edema refractory to laser treatment. It is effective in improving vision, reducing macular thickness and inducing re-absorption of hard exudates. Al-Shifa Journal of Ophthalmology 2005; 1: 30-33 © Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.

Title Diabetic vitreouse hemorrhage and its management
Author Dr. Shehryar Altaf

Abstract: Vitreous hemorrhage is an important sequel of diabetic retinopathy. The incidence of vitreous hemorrhage is almost the same in IDDM and NIDDM. Ultrasound plays an important role in the diagnosis. In simple / uncomplicated diabetic vitreous hemorrhage the treatment modalities include retinal photocoagulation, pars plana vitrectomy and retinal cryopexy. In patients with dense vitreous hemorrhage 80% of the eyes had vision of <1/60 and rest had < 6 /60. Post operatively around 25% had vision of 6/18-6/6. Only 25% had vision of around 6/60. the patients undergoing laser therapy had stable vision and improvement in around 60% of patients. Results of vitrectomy are comparable in both the types of diabetes but shows better results in the IDDM type.

Title Management of rhegmatogenous retinal detachment in aphakics
Author Dr. Mehboob Fazal
Abstract: Aphakic and psuedophakic retinal detachment can be managed by using different treatment modalities, which include external buckling and vitrectomy with internal tamponade. All the patients were randomly selected for either an external buckle procedure or a primary vitrectomy with or without silicone oil. Comparison between these two modalities in the management of the retinal detachment has shown that there is no significant difference regarding anatomical and function outcome.

Title Intraocular lens implants for traumatic cataracts in children
Author Dr. Tariq Mehmood

Abstract Ocular trauma in childhood usually occurs while playing. The study was carried out including 40 patients of childhood ocular trauma. The trauma was mainly sustained because of stones, firecrackers, thorns, syringe needles and wood. The surgery were carried out within one week in most of the cases (72%) the rest being operated within one year. Excellent postoperative vision was seen in about 76% of cases. The most common encountered postoperative complication was posterior capsular thickening, which was treated with YAG capsulotomy or surgical capsulotomy. It is better to have an IOL implant done as primary procedure in cases of traumatic cataract where it is possible.

Title Management of postoperative astigmatism following cataract surgery
Author Dr. Khawaja Ahmed Rizwan Waheed

Abstract Post operative astigmatism can cause a decreased visual acuity and symptoms like diplopia, asthenopia and meridional distortion. A number of variables effect the astigmatism after cataract surgery. It was found out that a continuous running suture in form of a shoelace with 10/0 elastic monofilament nylon suture gives the best and quickest visual recovery with least amount of post operative astigmatism.

Title Management of bacterial and fungal keratities
Author Dr. Azhar Mehmood

Abstract A study of corneal infections reporting to the out patients and inpatients of Al-Shifa Trust hospital was carried out. A significant number of all the patients had bacterial keratitis (90%) and rest had either fungal or acanthaemoebal keratitis. The most common bacterial infections were Staphylococcal and Streptococcal. The fungal infections were mainly Aspergilus. The most effective medications were ciprofloxacin and aminoglycocide. Antigungal used was ketoconazole.

Title Study of results and complications in Radial Keratotomy
Author Dr. Mubashir Jalis

Abstract Radial keratotomy is one of the modalities of refractive surgery used to correct myopia. A study of 61 patients undergoing radial keratotomy in both eyes with refractive error ranging from -3.00 to -6.00 diopters. About 35 eyes had unaided vision of below CF. 59 eyes had vision of around 6 /60 and only 10 eyes had vision of around 6 /36. About 59 eyes had final refraction of -1.00 or less. Rest had an under correction of -2.00 or over correction of +1.00 diopters. Mean optical zone and post operative intraocular pressure had effect on the final outcome. Common operative and post operative complications included fluctuating vision, glare, ocular discomfort, astigmatism, under and over correction and IOP rise.

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