We present a case of a 65-year-old Pakistani woman who underwent an uneventful standard left phacoemulsification with posterior chamber intra-ocular lens placement for a mature senile cataract. She was observed to develop post-operative astigmatism secondary to a tilted intra-ocular lens and required repeat surgical intervention to correct the malposition. Per-operatively, the lens was found to be defective with a fixed bend at the haptic-optic junction which necessitated the need for an intra-ocular lens exchange procedure that restored adequate vision. The study highlighted defects in the structural integrity of intra-ocular lenses as an important differential to consider in such cases, and established lens replacement as a successful intervention to improve visual outcome.

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Purpose: The purpose of the study was to illustrate the range of normal values of corneal densitometry using Pentacam Scheimpflug camera. Methodology:Prospective study was conducted at tertiary care Amanat eye hospital. 490 eyes of 490 participants of different age groups were added. All scans were performed in diagnostics room with uniform ambient light, performed by trained ophthalmic technologist. All participants were Pakistani of different ethnic groups. Only one eye of each participant was included to control biasness. T test, One-way ANOVA, pearson correlation coefficient and linear regression model tests were applied for analysis.Results: 490 eyes; 247 right eyes and 243 left eyes were analyzed. Mean age was 41.7±15.27 years (range 20-81 years) with 48.4% male and 51.6% females. based on corneal depth; highest backward scattering of light was observed in anterior (120 µm) layer (20.6±8.52 GSU) than central and posterior layers 13.6±5.17 GSU and 11.7±3.99 GSU respectively. The difference was statistically significant among layers with p< 0.001. Based on corneal surface, minimum backscattering was noted in central 0-6mm zone which increases from central to limbal zone; 0-2mm zone was 13.2±3.81 GSU, 2-6mm zone was 12.6±3.68 GSU, 6-10mm zone was 16.0±8.90 GSU and 10-12mm zone was 22.1±8.26 GSU. The difference was statistically significant with p<0.001. Significant correlation of corneal densitometry and age was observed r= 0.677, p<0.001. Conclusion:Objective assessment of corneal densitometry can be made with Pentacam Scheimpflug. Normative values of corneal density may be used in routine clinical practice and provided a reference for future research.

Purpose:  To compare the intraocular pressure (IOP) during 12 hour day-time phasing with one-time supine position IOP. Study Design:  Prospective, observational. Place and Duration of Study:  Glaucoma clinic of a tertiary eye – care center in Rawalpindi, Pakistan, from September 2020 to February 2021. Methods:  Forty two eyes of 21 participants with primary open angle and normal tension glaucoma were included in the study by convenient sampling technique. Three hourly diurnal Applanation tonometry was performed in sitting position from 9:00 am to 9:00 pm. Mean IOP and standard deviations were calculated. One-time supine position IOP was taken by Perkins tonometer at 9:10 pm. Mean IOP at 9:00 pm in sitting position was compared with the mean IOP in supine position. Results:  There were 15 males (71.42%) and 6 females (28.58%) in the study. Means of sitting position IOP during different times of the day ranged between 16.64 and 18.16 mmHg. The mean of IOP measured at 9:00am, 12:00 pm, 3:00 pm, 6:00 pm and 9:00 pm was 17.62 ± 4.04 mmHg. Mean supine position IOP at 9:10 pm was 22.38 ± 5.92 mmHg. Mean difference between supine and sitting position IOP was 4.75 ± 3.65 mmHg. This was statistically significant p-0.001.Direct comparison between sitting and supine IOP at 9:00 pm and 9:10 pm revealed the values to be 17.88 and 22.38 mmHg respectively (p < 0.001). Conclusion:  One-time supine position IOP gives a higher value than any one – time of IOP recorded during 12-hour diurnal phasing performed in sitting position. Key Words:  Intra ocular pressure, diurnal phasing, Primary open angle glaucoma, Normal tension glaucoma.

Purpose:  To compare the short-term efficacy and safety of intraocular Ranibizumab and Bevacizumab in patients with treatment Naïve macular edema. Study Design:  Quasi experimental study. Place and Duration of Study:  Amanat Eye Hospital, from August 2018 to November 2019. Methods:  Patients with macular edema confirmed with optical coherence tomography (OCT) or leakage on fluorescein angiography were included. Patients with NVE, PDR without macular edema and patients who switched to alternative anti-VEGF compounds prior to the completion of three consecutive monthly injections of their respective anti-VEGF or switched to other treatment options were excluded from the study. A thorough clinical examination was conducted including best corrected visual acuity (BCVA, intraocular pressure (IOP), anterior and posterior segment examination and OCT macula. The patients were then allocated to one of the two study arms (either Bevacizumab or Ranibizumab) based on the doctor’s input and patient affordability. All patients underwent three consecutive injections of the selected molecule at one month intervals. BCVA, CRT and macular volume were then recorded 04 weeks after the third injection. Results:  A statistically significant mean vision gain was observed from baseline in both groups (p < 0.05). However, the change in BCVA was not significantly different between intravitreal Bevacizumab group and intravitreal Ranibizumab group (p > 0.05). Similarly, although there was improvement in CRT and macular volume in both groups but there was no statistically significant difference between the two. Conclusions:  Treatment with intravitreal Bevacizumab and Ranibizumab injections cause statistically similar anatomical and functional results in cases of treatment naïve macular edema. Key Words:  Bevacizumab, Ranibizumab, Macular Edema, Diabetic Retinopathy, Macular Degeneration, Retinal Vein Occlusion.