This study aims to determine the effect of corneal cross-linkage (CXL) on intraocular pressure (IOP) in keratoconus patients. Methods: A quasi-experimental study was carried out at the Cornea Clinic of Al Ibrahim Eye Hospital Malir, Karachi. A total of 60 eyes of 36 subjects with progressive keratoconus with the age range of 15 to 31 years were fulfilling the criteria of the study. Subjects were selected with convenient sampling and subjects with a previous history of CXL were excluded from the study. A complete history of the patient, clinical examination with slit-lamp biomicroscopy, and visual acuity (VA) with Snellen chart were recorded. Intraocular pressure (IOP) measurements of each subject were recorded with Goldman Applanation Tonometer (GAT) before and immediately after 15 minutes of CXL and on the 2nd day of CXL, 1month, and 3 months after CXL. SPSS version 22 was used to analyze the data. Results: The average preoperative measured intraocular pressure (IOP) was 20.22 +/- 3.97 mmHg. There was a statistically significant decrease in IOP measurements 18.96 +/- 3.73 mmHg on the same day after the corneal cross linkage procedure with (P 0.001) while there was no statistically significant change in intraocular pressure (IOP) measurements was observed on the 2nd day, 1 month and 3 months after CXL. The postoperative mean of IOP measurements was 19.61 +/- 3.47 mmHg on the 2nd day, 19.67 +/- 3.14 mmHg on 1 month, and 19.33 +/- 3.64 mmHg at 3 months respectively. Conclusion: This study shows that reductions in intraocular pressure (IOP) measurements were observed on the immediate response of corneal cross-linkage (CXL) on the same day. This change might be due to immediate alteration in the biomechanics of the cornea during corneal cross-linkage. These changes return to the normal position later because no change was seen on different follow-ups of patients after CXL in eyes with keratoconus.
Significance: Intermittent exotropia is intermittently manifest squint at distance and latent exophoria at near. Most of the time, the eyes seems to be aligned with normal binocular single vision is maintained because its exodeviation is intermittently controlled by fusional mechanisms. Purpose: To evaluate the effect of vision therapy on fusional vergences in intermittent exotropia. Methods: This hospital-based, Quasi-Experimental study was carried out at the Orthoptics clinic of Al-Ibrahim Eye Hospital from August 2020 to July 2021. Non- probability, purposive sampling was used. This study involved the 40 subjects who were diagnosed with Intermittent Exotropia of age ranges 10 to 25 years, of both genders. A detailed history was evaluated. Orthoptics assessment included visual acuity, cover test, near the point of accommodation and convergence at a distance, and near and fusional vergences of positive and negative with prisms were measured. All subjects underwent vision therapies for 2 months. SPSS version 20.0 was used to analyze the data. Results: A total of 40 subjects with a mean age of 16.53±2.96 were included in this study. Out of 40 subjects, 22 subjects were females and 18 subjects were males. Subjects who received dot card therapy and executives bifocals therapy showed a significant change in the angle of deviation at distance and near (P=.001), followed by reduced the near point of convergence (P=.001), and increased the positive fusional vergences at distance and near (P=.001). There was no significant improvement seen in near point of accommodation (P=.16) with both therapies. Negative fusional vergences showed non-significant as (near: P=.14, distance: P=.05) with executives bifocals and (P=.26) with dot cards. Conclusions: This study showed that vision therapies with dot card and executive bifocals therapy have significantly improved the angle of deviation, positive fusional vergences, and near point of convergence in intermittent exotropia subjects.
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