Objective:To compare mean retinal nerve fiber layer (RNFL) thickness in patients having pseudo exfoliation (PXF) with normal age matched controls using spectral domain optical coherence tomography (SD-OCT).Methods:This was a case control study conducted at Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi from 12 June 2013 to 12 January 2014. Seventy eyes (Group A - 35 patients with PXF and Group B - 35 healthy age matched subjects) of more than 40 years of age were included in the study. Intraocular pressure (IOP) was measured with Goldmann applanation tonometer (GAT) and peripapillary RNFL thickness was measured in four quadrants with SD-OCT (Topcon 3D OCT-1000 Mark II) in all subjects. Data was analyzed using the SPSS version 14.Results:Mean age of group A (PXF patients) was 65.63 ± 8.47 years and of group B (Healthy subjects) was 64.31 ± 6.51 years (p = 0.470). Both groups were gender matched with male preponderance (p = 0.673). Mean IOP in each group was 13.80 ± 2.59 mm Hg, and 13.49 ± 2.07 mm Hg respectively (p= 0.578). Mean average peripapillary RNFL thickness was 77.46 ± 12.17 µm in group A and 83.96 ± 10.58 µm in group B. Statistically significant differences were detected between two groups for mean average RNFL thickness (p= 0.020) and mean RNFL thickness in inferior quadrant (p=0.014).Conclusion:PXF patients with normal IOP and visual fields have thin RNFL as compared to healthy age matched controls. Therefore routine assessment and follow up of PXF patients with OCT may help in early diagnosis of PXF glaucoma.

Objective: To determine the fetomaternal out comes in placenta Accreta Spectrum (PAS) Study design: Descriptive study: Place and duration: Department of Obstetrics and Gynaecology unit-I1,FJMU /Sir Ganga Ram hospital Lahore. Patient and Methods: During this one years study a total of fifty pregnant women with placenta Accreta Spectrum(PAS) diagnosed on Doppler ultrasound , whether booked or un booked irrespective of number of caesarean scars with or without bleeding per vagina were included in the study. The number of caesarean section, treatment, complications maternal and fetal morbidity and mortality associated with PAS were described. Results: A total of 50 cases of PAS were studied over one year period. 35(70%) patients with placenta Accreta Spectrum (PAS) were unbooked.15(30%) were booked. 25 (50%) patients were the age group between 26-30 years. The average gestational age was between 32-36 weeks. In 35 (70%) type IV placenta previa was found. In 1o(20%) type III placenta previa was detected. In 5(10%) patient with placenta Accreta Spectrum (PAS)had previous once caesarean section while 45 (90% ) patients had two or more caesarean section. In 35 (70%) patients the presentation was bleeding per vagina while 15 (30%) patients were asymptomatic at presentation. In 15 (30%) patients placenta accreta was found while placenta increta and percreta were found in 35 (70%) patients.Total Caesarean hysterectomy done in 35 (70%) patients and Uterine sparing along with internal iliac artery, ligation was carried out in 10(20%). Bladder invasion which needed bladder repair was found in 5(10%) cases. 6(12%) maternal deaths were noted in this study. Mean Intraoperative blood loss was between 3 to 4 litres. Blood transfusion was needed in all 50 (100%) patients.Regarding perinatal out come Out of 50patients Intrauterine growth restriction. Prematurity and neonatal admission to ICU reported in 10(20%), 35(70%), and 15(30%) of the cases respectively. Conclusion: placents accreta spectrum (PAS) is a life threatening haemorrhagic condition associated with high rate of maternal and perinatal morbidity and mortality. Antenatal diagnosis by Doppler ultrasound, multi-disciplinary approach with involvement of senior obstetrician, anaesthetist and haematologist is pivotal to improve feto maternal out come.

Background: The time interval in between pregnancies is viewed as an important and modifiable risk factor for adverse birth outcome. Short interpregnancy interval is associated with a number of adverse outcome for both mother and child, including increased risk of preterm labour, low birth weight baby, and preeclampsia . Objective: To determine the association between adverse perinatal outcome and short inter-pregnancy interval in women presenting in labour Material and Methods: This cohort study was conducted at department of Obstetrics and Gynaecology, unit 1, Lahore General Hospital Lahore for 6 months (from July 12, 2015 to Jan 12, 2016). It was non-probability purposive sampling. Informed consent was obtained. Demographics were noted. Then females were divided into 2 groups, 160 patients in each group, group I with short inter-pregnancy interval (<18 months) and group II with normal interpregnancy interval(≥18 months).Then antenatal record was assessed to measure the gestational age at time of delivery and preterm delivery was labeled if female delivered before 37 completed weeks of gestation. After delivery, baby was assessed for low birth weight i.e<2.5kg. All collected data was entered and analyzed in SPSS version 17.0. Relative Risk was calculated to measure the association between short inter-pregnancy interval and adverse perinatal outcome. RR>1 was considered as significant risk. Results: In my study the mean age of the patients was 29.23±6.24 years and the mean gestational age of the patients was 38.47±2.38 weeks.In this study the preterm deliveries were observed in 67 cases (20.9%) in which 46 (68%) were from short IPI group and 21 (31.3%) were from normal IPI group. Statistically a significant risk of preterm delivery was noted in short IPI group as compared to normal IPI group. i.e RR=2.67. In my study the LBW babies were observed in 46 cases in which all the 46 (100%) were from short IPI group. Statistically a significant risk of LBW babies was noted in short IPI group as compared to normal IPI i.e. RR=2.404. Conclusion: There has been statistically significant risk of adverse perinatal outcome (preterm birth and LBW) in patients with short IPI as compared to patients with normal interpregnancy interval.

Objective: To evaluate the role of Colour Doppler Ultrasound in the management of small forgestational age fetus. SGA or IUGR. Design: Descriptive study. Place & duration of study: Study performed in theDeptt. of Radiology & Deptt. of Gynae. & Obstetrics in Allied Hospital, Faisalabad from August 2005 to July 2006.Material & Methods: This study was carried out on 45 patients admitted through antenatal clinic having suspicion ofcarrying small for gestational age fetus. A brief clinical record including age, parity, nutritional status, intercurrent illness,per-vaginum bleeding, history of drug intake, smoking, past obstetrical history was recorded. Methods involved inscreening SGA fetuses were measurement of Symphyseal Fundal Height chart & Ultrasound biometry, Biophysicalprofile (BPP), Cardiotocography (CTG), Middle cerebral and Umbilical Arteries Doppler studies were performed afteradmission in the management of SGA fetuses. All these information were recorded in a specially designed Performa.Results: Out of 45 SGA fetuses 15(33.3%) were constitutionally small, 20(44.4%) had history of pre-eclampsia,2(4.4%) had cardiac disease, 3(6.6%) had placental abnormalities, 5(11.1%) had multiple gestations. Gestation ofpatients ranged between 30-36 weeks. Umbilical Artery Doppler was used as the primary surveillance tool. Smallfetuses with normal Doppler and anomaly scan were managed on out-patient basis with fortnightly Doppler ultrasound.15 patients (33.3%) with normal end-diastolic flow were delivered at 37 weeks. 20 patients (44.47%) with absent orreversed end-diastolic flow were delivered at 34-35 weeks. 10 patients (22.2%) at 30 weeks gestation with abnormalDoppler study were managed on CTG (Cardiotocography) & biophysical profile over a period ranging between 1-14days. Perinatal mortality was 8.8% (4 cases) mostly due to extreme prematurity. Conclusion: Doppler ultrasound isa very helpful tool in the management of small for gestational age fetuses & it reduces perinatal morbidity & Mortality.

Objective: To assess the outcomes of intravitreal bevacizumab in patients of diabetic maculopathy by anatomical outcomes and best-corrected visual acuity, and to assess the prognostic factors that influence the efficacy of intravitreal bevacizumab. Method: The quasi-experimental study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, from January 2019 to January 2020, and comprised patients with diabetic maculopathy who were administered intravitreal bevacizumab on a monthly basis for three months with further injections administered on an as-needed basis in cases of persistent macular oedema or deterioration of best-corrected visual acuity. The assessment was done pre-injection, and three and six months after the injection. Outcome variables were best-corrected visual acuity and central macular thickness. Data was analysed using SPSS 22. Results: Of the 34 patients, 2(5.9%) were males and 32(94.1%) were females. The overall mean age was 58±10 years. Of the 55 eyes, 27(49.1%) were right and 28(50.9%) were left eyes. After 3 months, the best-corrected visual acuity improved by one line in 20(36.4%) eyes. At 6 months, it improved by one line in 25(45.4%) eyes. After 3 months, the central macular thickness of 48(87.2%) eyes improved anatomically. At 6 months, a further decrease in central macular thickness resulted in 50(90.9%) eyes. The best-corrected visual acuity at 6 months was inversely correlated with central macular thickness and disruption of inner segment/outer segment integrity. Conclusion: Intravitreal bevacizumab injection led to appreciable improvement in best-corrected visual acuity and central macular thickness at 6 months. Disruption of inner segment/outer segment integrity, presence of exudates and cystic changes were noted that lead to poor visual prognosis. Key Words: Intravitreal injection, Bevacizumab, Prognostic factors, Diabetic retinopathy, Optical coherence tomography.