PurposeTo present the results of a community-based screening programme for diabetes, diabetic retinopathy (DR) and childhood blindness (CB) in District Hyderabad, PakistanMethodsProspective cross-sectional data collection from January 2014 to December 2015 of screening for diabetes, DR and CB in Hyderabad District. Female health workers were trained to identify high-risk (potential) patients for diabetes and childhood eye disorders to undertake preliminary screening and refer patients to basic health units. The patients were further assessed by medical officers with the support of qualified optometrist, after which they were referred to Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan for management.ResultsA total of 995 244 population was covered in this screening programme during which 2622 children (0–≤15 years) were screened for CB while 16 760 adult patients (>15 years) were screened for diabetes. Random blood glucose level of 3075 patients was >140 mg/dL. Out of these patients, 17% were diagnosed with DR. Refractive error (42%) was the most common cause of childhood visual impairment.ConclusionThe diabetic screening programme detected a high prevalence (17%) of retinopathy in patients with diabetes living in Hyderabad District. The most common cause of childhood visual impairment was refractive error (42%), which was successfully managed due to timely diagnosis. A large number of patients benefited from this community-based screening programme.

Objective: To assess impact of duration of macular detachment on visual outcome after scleral buckling for retinal detachment with macula off. Methods: Prospective, descriptive case series was conducted at Ophthalmology Department Dow University of Health Sciences, Civil Hospital Karachi and Al Noor Eye Clinic Karachi from May 2012 to June 2013. Five groups were made according to period of macular detachment. Best corrected Visual acuity (BCVA) was main outcome measure. P value < 0.001 was considered significant. Results: Mean duration of macula off was 17.0±4.0 (SD) days. Mean pre-operative VA in patients with immediate, early, intermediate, delayed or late group were 2/60, 2/60, Counting figure (CF) 3 meters (m), CF2 m and Hand Movement (HM) respectively. Only 48.48% patients of those repaired within 7 to15 days had significantly better (P < 0.001) BCVA (6/9-6/18) than the other groups. Only 19.35% patients of intermediate group achieved BCVA 6/18-6/24 (P < 0.001) which was comparatively better than the delayed and late group. Conclusions: Scleral buckle surgery for macular-off Rhegmatogenous Retinal Detachment has good post-operative visual outcomes if repaired within two weeks.

Objective: To estimate the relationship between serum level 25-hydroxyvitamin (25 (OH) D) and diabetic retinopathy (DR) in type 2 diabetic elders. Study Design: Prospective, Observational study. Setting: Institute of Ophthalmology, Liaquat University of Medical & Health Sciences Jamshoro. Period: July 2020 to September 2021. Material & Methods: After completing the clinical examination, all participants were sent to the laboratory to investigate the blood level of Vitamin D (Vita D), glycated hemoglobin, glucose fasting/random; and urea and creatinine. For statistical analysis, the Statistical Package for Social Sciences (SPSS) version 20 was used. The serum level of 25 (OH) D was assessed with logistic regression analysis to evaluate the relationship with diabetic retinopathy. Results: Collected blood variables indicated that the mean level of Vita D was lower in subjects with proliferative Diabetic Retinopathy (PDR) and Non-PDR (NPDR) as compared to No DR (NDR) (14.10 ± 1.20, 21.10 ± 1.91, 23.29 ± 2.10

Aim: To assess the role of fundus fluorescein angiography (FFA) for early detection of diabetic maculopathy. Study Design: Prospective Cross-sectional study. Place and Duration: Department of Ophthalmology, unit II Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Hyderabad between March 2020 to March 2021. Methodology: Diabetic patients above the age of 20 years were screened by visual acuity recording, fundus, slit-lamp examination, and Fundus fluorescein angiography. Complete ophthalmic detail was obtained from each participant using pre-designed Proforma. Outcomes of the study were recorded. Results: A total of 100 subjects having 200 eyes were observed in the study. There were 53(53%) males and 47(47%) females with a mean age of 54±21.22 years. FFA was done in 124(62%) eyes. Diabetic maculopathy with diabetic retinopathy was higher in moderate nonproliferative diabetic retinopathy (NPDR) 53(42.7%) followed by proliferative diabetic retinopathy (PDR) 22(17.7%), severe NPDR 20(16.1%), and mild NPDR 08(6.5%). Most of the subjects 79(63.7%) had the diffuse type of leakage followed by focal 33(26.6%) and mixed type of leakage. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and Central Macular Thickness (CMT) were improved at the 3rd and 6th-month follow-up visit as compared to baseline visit. Conclusion: Fundus fluorescein angiography (FFA), a diagnostic method of diabetic retinopathy is reliable, more accurate, and precise. Our study recommends that diabetic patients should be regularly screened through FFA to save the precious vision of the diabetic population.

Purpose:  To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes. Study Design:  Quasi experimental study. Place and Duration of Study:  Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018 Methods:  Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve < 0.05 was accepted as statistically significant. Results:  The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P < 0.001). The decrease in macular edema thickness was more in group II than group I (P < 0.001). Conclusion:  Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up. Key Words:  Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

Aim: To determine the frequency of refractive errors in school-age children. Study Design: Cross-sectional study. Place and duration: Two Government and two Private schools of Hyderabad Sindh, screened by the institute of ophthalmology at Liaquat University of Medical and Health Sciences Jamshoro, from January 2021 to June 2021. Methodology: Schools and students were selected by stratified random method; a total of four hundred students were screened in four schools. From class one to class ten, 10 students were selected from each class. Prior written permission was obtained from parents. External ocular examination, visual acuity, pinhole test, autorefraction, and fundus examination were done and recorded on proforma along with the information regarding age, sex, family history, and parent’s education. The data was entered and analyzed by SPSS version 22. Results: In government schools 27 students out of 200 had refractive errors, myopia was present in 15 (55.55%) students, hypermetropia in 7 (25.93%) students and astigmatism in 5 (18.52%) students, while in private schools 25 students had refractive errors. Myopia was present in 16 (64%) students, hypermetropia in 7 (28%) students and astigmatism in 2 (8%) students. Myopia and astigmatism were more prevalent in female sex being 8.1% and 2% respectively, while in males it was 6.4% and 1.4% cases. In this study, no significant refractive error difference was found between government and private sector schools. Conclusion: In our study, the prevalence of refractive errors was 13% (52) out of 400 students. Refractive errors are the most common and easily treatable causes of decreased vision in school-aged children. It is recommended that visual acuity be checked prior to admission to school because refractive errors can be easily corrected with glasses. If it is treated in time, the child can be prevented from amblyopia and squint.