Objective: To compare the efficacy between Ahmed glaucoma valve surgery and Trabeculectomy with Mitomycin-c in pediatric glaucoma. Study design and setting: Quasi-experimental study was conducted at Pediatric Ophthalmology Department, ISRA Post graduate Institute of Ophthalmology/ Al-Ibrahim Eye Hospital, Karachi. Duration of study was February to August 2016. Methodology: Samples were divided into two groups. Group A Trabeculectomy with Mitomycin-C and Group B with Ahmed Glaucoma valve surgery. Inclusion criteria were children (above 2 years and less than 15 years of age) visiting Pediatric Ophthalmology OPD irrespective of gender, glaucoma diagnosed with the duration of symptoms > 4 weeks. Exclusion criteria were patient with repeat surgery for glaucoma, combined ocular surgery i.e penetrating keratoplasty or cataract, Preoperative keratitis, uveitis or conjunctivitis, as determined by slit-lamp examination. Paired sample t-test was applied to compare the pre and post IOP examination findings. P-value = 0.05 considered as statistically significant. Results: A total of 110 patients were recruited in this study in which 97 patients were analyzed. Mean age of Group A was 6.73±2.7 and mean age of Group B was 7.05±2.3. Mean pre-operative IOP in “Group A” was found to be 31.59±5.4 and post-operative IOP was reduced to 17.95±4.8 with statistically significant P-value <0.0001. In “Group B” Mean preoperative IOP was 30.60±5.3 and post-operative IOP was 18.43±3.8 with statistically significant P-value <0.0001. Conclusion: A significant difference found between efficacy of Ahmed glaucoma valve surgery and Trabeculectomy with Mitomycin-C in pediatric glaucoma after 4th week of surgery.

Objectives: To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi. Methods: An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient’s BCVA was found to be 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment. Results: A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week. Conclusions: The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%. doi: https://doi.org/10.12669/pjms.37.7.4428 How to cite this:Ahsan S, Memon MS, Bukhari S, Mahmood T, Fahim MF, Haseeb U, et al. Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4428 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.

Objective:To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract.Method:We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed.Results:Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1st daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period.Conclusion:The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.

Capture-Recapture sampling methods are being used to estimate the population size of an unknown population. These methods are widely used for determining the population size of animals and birds. Literature shows that these methods were purely used by ecologist in the past. But now-a-days, these methods are also used to determine the chronic diseases, for example, cancer patients, HIV Aid patients, etc. Not only this, many studies had conducted to determine the road accidents ratios on different points. This study covered two examples; one was the total number of female drivers at Bahauddin Zakariya University, Multan and the second example was about the total number of male smokers at Bahauddin Zakariya University, Multan. On these two examples, the basic capture-recapture sampling methods were used which involved Lincoln Peterson Index, Chapman Estimate and Schnable Estimate. Then an artificial data with known population was created and same methods were used for analysis. In the end, the results of artificial data and two examples were compared with each other through analysis on excel sheet.

Objective: The aim of study is the determination of   prevalence of asymptomatic bacteriuria during antenatal period in PUMHSW, with prevalence of antenatal asymptomatic bacteriuria in neighboring countries. Methodology: This study is Cross Sectional-Prospective, and conducted at the Department of Pathology Peoples University of Medical & Health Sciences (PUMHS) for Women Nawabshah (Shaheed Benazir Abad). All the samples (417) were obtained from the pregnant women attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah.All mid-stream clean catch collected urine sample in sterile container processed for urine detailed report (physical, chemical and microscopic examination).All the demographic details were entered and analyzed by SPSS 20.More than 8 international as well as national databases were searched  to  the year 2020, consisting of  google, Pub-med, Science direct, Web of Science, Medline. The data obtained were analyzed and their results reported with a random-effects model with confidence level 95%. Result: Out of 417 patients the mean age of the pregnant female was 29.32± 5.74 years.There were females with mean parity of 2.66 ±2.42 and mean gestational age was25.84± 11.80.Age when compared with asymptomatic bacteriuria revealed statistically significant value p value 0.000 with an increased incidence seen among age group of 26-30yrs n=33(44%).  The total prevalence of asymptomatic bacteriuria (ASB) was 83(19.9%).Age when compared with asymptomatic bacteriuria revealed statistically significant value p value 0.000 with an increased incidence seen among age group of 26-30yrs. Conclusion: Asymptomatic bacteriuria during pregnancy is increasingly found in younger age women, with increasing gestational age. Therefore urine cultures during antenatal period should be done to diagnose asymptomatic bacteriuria in order to make preventative planning and control of asymptomatic bacteriuria among pregnant women.

Objectives: To observe patterns of Pediatric eye diseases over five years 2015-19, to improve management of ophthalmic pediatric units in the developing countries. Methods: It was an observational, cross-sectional study carried out in a tertiary eye care Hospital, Karachi. Records of the children under 16 years of age from 2015 to 2019 were retrieved. Inclusion criteria included complete records with age, gender of the children, symptoms, examination, investigation if necessary, and diagnosis. All incomplete records were excluded. Results: A total of 35348 records with 55.17% boys and 44.82% girls were analyzed. Similar gender difference was reflected in disease frequency. Seven percent of the children did not have detectable ocular pathology. Conjunctivitis, refractive errors and squint were the three most common ocular morbidities observed in decreasing order of frequency as 32.67%, 20.08% and 14.7% respectively. Cataract was present in 4.51%, Corneal disease in 4.11%, Retinal pathology in 1.04%, Glaucoma in 0.49% cases; but Retinoblastoma was present in 55 cases and ROP in 4 cases only. Almost 60% of the children had simple ocular problems like conjunctivitis, refractive error and absence of any pathology. Conclusion: Majority of the children attending pediatric ophthalmology had simple problems manageable at primary health facility level. Strengthening of the primary health care facility will reduce considerable burden of pediatric unit at the tertiary level. Optometrists and orthoptists are important members of the team for refraction and squint management. doi: https://doi.org/10.12669/pjms.38.6.5441 How to cite this:Bukhari S, Azam S, Ahsan S, Mahmood T, Memon MS, Haseeb U, et al. Five years’ retrospective analysis of childhood ocular morbidities; A priority setting guidelines for pediatric eye clinic. Pak J Med Sci. 2022;38(6):---------.  doi: https://doi.org/10.12669/pjms.38.6.5441 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.

Objective: To find out the validity of hand-held fundus camera by optometrist using slit lamp 90D biomicroscopy as reference standard for screening of diabetes retinopathy. Method: The observational cross-sectional study was conducted at the diabetic clinic of Al-Ibrahim Eye Hospital, Karachi, from August 2020 to May 2021, and comprised diabetics of either gender aged >16 years visiting the outpatient department. Un-dilated fundus photograph of both eyes were taken with non-mydriatic fundus camera. Pupils were then mid-dilated with one drop of tropicamide 1% before capturing retinal images by handheld fundus camera by another optometrist. Both the optometrists identified and recorded the presence and absence of diabetic retinopathy. Subsequently, a retinal specialist examined the fundus with slit lamp 90 D biomicroscopy. Data was analysed using SPSS 23. Results: Of the 500 subjects, 291(58.2%) were males and 209(41.8%) were females. The overall mean age was 54.49±9.16 years (range: 16-83 years). Of the 1000 eyes, fundus was not readable in 130(13%) by hand-held fundus camera, 296(29.6%) eyes by non-mydriatic fundus camera and 76(7.6%) eyes by slit lamp. Sensitivity and specificity of hand-held fundus camera compared to non-mydriatic fundus camera was 89.86% and 80.36%, respectively. In comparison with slit lamp, the sensitivity was 91.71% and specificity was 71.10%. Kappa statistic for diabetic retinopathy detection by hand-held fundus camera versus non-mydriatic fundus camera was 0.705, indicating substantial agreement. Kappa statistic for diabetic retinopathy detection with hand-held fundus camera versus slit lamp (standard) was 0.609, indicating good agreement. Conclusion: Handheld fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy. Key Words: Retinal screening, Hand-held fundus camera, Optometrist, Sensitivity, Specificity.

Purpose:  To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma. Study Design:  Interventional case series. Place and Duration of Study:  Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019. Methods:  Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age > 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated. Results:  A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg. Conclusion:  Phacoemulsification produces a useful decrease in IOP in glaucoma patients. Key Word:  Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.