Sudden prevalence of coronavirus disease-2019 (COVID-19) has badly impeded and collapsed the emerging global trend of economic development by its ongoing pandemic. The novel coronavirus also named severe acute respiratory syndrome virus – 2 (SARS-CoV-2) causes the disease COVID-19 that influences the health management of humans and the world commerce badly. It has affected the human social lives and education in underdeveloped countries and severely impeded industries, organizations, agriculture, etc. Three perceptible types of SARS-CoV-2 strains have been discovered. Each of them has specific receptors, and some of them are common in SARS and SARS-CoV-2. Among them, the ACE2 receptor is believed to be the central receptor of human infectious coronaviruses. It supports mainly to get access, enter into the cell, and causes the basic infection. Similarly, TMPRSS2 is also acting as a portal for a virus to get an approach to the cell and does not support metabolic processes like replication virus. ADAM17, which is a member of disintegrins and metalloproteases and is responsible for cell to cell and cell-array interconnections. These receptors can be important for prevention, vaccine development, and therapies. Several therapies in SARS-CoV-2 infected patients have been tried and suggested. Plasma and stem cell therapy reduce the severity of infection at certain levels in individual patients. In this review, we make an effort to cover all of the said aspects of COVID-19 in a very compressive and brief way. Finally, we shed light on vaccination and therapeutic approaches like plasma therapy and stem therapy and their future perspective with the whole discussion conclusion.

Retinal pigment epithelial detachment (PED) is a common manifestation in several retinal conditions including age-related macular degeneration1. Based on retinal imaging as well as clinical examination, PEDs can be classified as drusenoid, serous or vascular2,3,4. Vascularised PEDs, as the name suggests, are associated with choroidal neovascularization (CNV). Drusenoid and serous PEDs may or may not have an associated CNV. Anti-VEGF therapy has a well proven role in the treatment of vascularized PED5,6. Less well established is the beneficial effect of anti-VEGF therapy in those PEDs where a CNV is not clearly present. Large serous PEDs were excluded from phase 3 clinical trials such as TAP, ANCHOR and MARINA7,8,9 trials . As such these trials cannot be relied upon to provide management strategies for these lesions. Development of a rip in a PED can result in permanent damage to central vision10,11.Such a rip is often spontaneous although intravitreal therapy can also precipitate an RPE rip12,13. It is therefore desirable to reduce the height of a PED in order to minimize the risk of a rip. Furthermore a longstanding PED presumably interferes with the nutrition to the RPE and photoreceptors and thus early flattening of the PED or reducing its height was an important treatment rationale in this study. No universally agreed guidelines exist on the treatment of PEDs not associated with a CNV. One study14 looked specifically at the role of the anti-VEGF agent Ranibizumab (Lucentis) in non-vascularised PEDs but the follow-up period in that study was 12 months. The purpose of this study is to look at the long term effects of 3 Ranibizumab injections given in eyes with non-vascularised PEDs . The effects were monitored for up to 36 months and to date this is the longest follow-up published for this sub-set of treated patients.

Objective: to assess comprehension of local anaesthetic systemic toxicity among clinical practitioners. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Institute, from Dec 2019 to Mar 2020. Methodology: Methodology constituted of a web-based questionnaire. A pilot study carried out at 15-20 participants forquestionnaire validation and reviewed by independent experts for face validity, a final questionnaire comprised of 10 multiple-choice questions in addition to demographic profile. Results: A total of 950 participants participated in the study and data was extracted from their responses. Out of 738 (77.8%) participants declared that they are unaware of local anaesthetic systemic toxicity complication, 26 (2.7%) encountered local anaesthetic systemic toxicity and 185 (19.5%) never experienced. Ninety (9.5%) were aware of the availability and utilization of 'Lipid Emulsion' therapy to treat ‘Local Anaesthetic Systemic Toxicity’ (LAST). Conclusion: Although clinicians have significant awareness level regarding local anaesthetic toxicity but unfortunately compliance with management of this life-threatening complication is deficient.

Objective: To evaluate the success rate of Transcanalicular Diode laser assisted Dacryocystorhinostomy (TC-DCR) in cases of acquired nasolacrimal duct obstruction (NLDO). Methods: This Quasi-Experimental study was conducted in Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi, from July 2018 to April 2019. In this study, 73 patients of chronic dacryocystitis secondary to acquired NLDO were treated by TC-DCR under general anaesthesia. Follow up examination was done after one day, one week and three months. Silicone tubes were removed three months after surgery and syringing of lacrimal system done to confirm patency of lacrimal passages. Success of the procedure was documented as absence of epiphora and patent nasolacrimal duct on syringing. Results: Seventy three patients (males 27; females 46) were included in this study. Mean age of these patients was 51.6±21 years. On completion of this study which was three months after surgery, we found subjective improvement (absence of epiphora) in 86.3% patients and objective improvement (successful irrigation of lacrimal passages) in 93.2% patients. Conclusion: TC- DCR is a minimally invasive technique of doing Dacryocystorhinostomy and imparts more than 90% success rate. It has additional advantages of good cosmetic results, low complication rate and short surgery and convalescence time. doi: https://doi.org/10.12669/pjms.36.4.1906 How to cite this:Awais M, Naqvi SAH, Akram A, Shahid M. Transcanalicular diode laser assisted dacryocystorhinostomy: A breakthrough in the treatment of acquired nasolacrimal duct obstruction. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1906 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Objective: To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Aug 2019 to Jan 2020. Methodology: Thirty-six patients were included and divided into two groups. In group A (n=18), pterygium excision with conjunctival auto-graft was followed by injection of 0.3ml of 7.5mg of Bevacizumab. Patients of Group B (n=18) did not receive any Bevacizumab. All the patients were followed up after 7 days, two weeks, 4weeks and 24 weeks after the start of management. The visual analog score was used for pain assessment, Snellen chart for visual acuity and intraocular pressure was measured with applanation tonometry. Results: After six months the recurrence rate was less in Group-A (n=3, 16.6%, p=0.005) than Group-B (n=4, 22.2%, p=0.01) The recurred pterygium size was also greater in Group-B (mean=0.27 ± 0.28mm, p=0.006) than Group-A (mean=0.11 ± 0.21mm, p=0.006). Patients of Group-A experienced less pain post-surgery. The intraocular pressures were same in both the groups. Visual acuity improvement was seen in the Group-A (n=11, 61%, p=0.008)) than group B (n=4.22%, p=0.008). Conclusion: Administration of Bevacizumab under the conjunctiva after pterygium excision may be useful in averting lesion relapse, less post-op pain, and improved visual acuity.

Objective: To assess the efficacy of oral Doxycycline in reducing the size of pterygium lesions in a Pakistani population Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Sep 2018 and May 2019. Methodology: Sixty patients above 20 years of age were enrolled in the study. Oral Doxycycline 200m/day was given for thirty consecutive days. Photographs of the lesions were taken at the time of recruitment and at the end of the study for assessment of pterygium size. Difference between pre-treatment and post-treatment size was analysed and comparison was made with age, gender and initial lesion size. Results: Twenty-two females and thirty-eight males were examined. The mean age of the participants was 48.8 ± 13.8 years. The mean size of the pterygium lesions before commencing the treatment was 12.24 ± 6.28 mm2. The mean size of the lesions after the treatment was 11.24 ± 5.39 mm2. The mean difference size was 1.00 ± 1.62 mm2 (p <0.001). The relative change in size (i.e. post-treatment size divided by pre-treatment size) was 0.94 ± 0.09 which was found to be statistically significant (p<0.001). There was correlation between larger initial lesion size and greater relative reduction in size (r = -0.42, p = 0.001). Conclusion: The change in the size of pterygium lesions produced by Doxycycline was found to be statistically significant but was not deemed clinically significant. Therefore, oral Doxycycline is not recommended for the treatment of pterygium in our population.

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