Objective:To determine the Efficacy of Corneal Crosslinkage (CXL), using Corneal Topography, in eyes with progressive Keratoconus.Methods:This randomized control trial was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from October 2013 to April 2014. A total of 60 eyes of 30 patients were included who presented with bilateral progressive Keratoconus. Each eye of the patient was randomized either to a treatment group (Group-A) or control untreated group (Group-B) of 30 eyes each. A written informed consent was obtained from each patient, following which corneal crosslinkage (CXL) with topical riboflavin eye drops was performed. Follow up visit was done at three months post operatively, Corneal topography was repeated and recorded.Results:The mean age of the patients was 23.13±7.62 years (range 13 to 39 years). There were 26 males and 34 females patients. The mean simK value at the start of study was 50.94±4.84 diopters in Group-A and 49.73±5.24 diopters in Group-B. At three months follow-up, the mean simK value was significantly lower in Group-A (48.28±4.47) as compared to Group-B (51.11±4.85). Keratoconus improved/ remained stable in 34 (56.7%) eyes while progressive disease was noted in 26 (43.3%) eyes. When compared between the groups, the frequency of efficacy was significantly higher in Group-A (86.7% vs. 26.7%; p=.000) as compared to Group-B.Conclusion:Corneal Crosslinking was found effective in causing regression or halting the progression of disease in patients with progressive Keratoconus at three months follow-up, however, the efficacy of corneal crosslinking was unaffected by patient’s age and gender.
Objective:To determine the etiology and severity of various forms of ocular war injuries in patients presenting at an Army Hospital in Pakistan.Methods:This cross sectional study was conducted at the Department of Ophthalmology, Combined Military Hospital, Peshawar over four years period from June 2012 through March 2016, Two hundred ten consecutive soldiers who presented with ocular war injuries were included for analysis after taking written informed consent. A predesigned proforma was used to record patient’s demographic details along with the cause, side, type and severity of injury, ocular trauma score was also recorded at presentation.Results:The mean age of the patients was 29.34±5.35 years. All of them were males. Left side was more frequently involved (n=126, 60.0%) and the most frequent underlying cause was IED blast injury (n=114, 54.3%). Closed globe injuries were more frequent and were recorded in 120 (57.1%) patients. Upon assigning Ocular Trauma Score, Grade-V (28.6%) injuries were the most frequent followed by Grade-I (25.7%), Grade III (25.7%), Grade II (11.4%) and Grade IV (8.6%). When stratified for the type of injury, OTS Grade I injuries were highest (60.0%) among patients with open globe injuries, hence poorer prognosis, while OTS Grade V injuries were highest (50.0%) among patients with closed globe injuries (p=0.000).Conclusion:IED blast injuries are most frequently encountered ocular war injuries often involving soldiers in the age group 20-30 years. These open globe injuries had worst clinical presentation to begin with and poorer prognosis than closed globe injuries.
To assess the role of conventional plain X-rays in managing fish bone impaction in throat, after eating commonly consumed species of fish in Pakistan. METHODS:This cross-sectional descriptive study was conducted at Combined Military Hospital Muzaffarabad, Pakistan. X-ray of bones from eight different species of commonly eaten fish were taken (in-vitro) and then compared to X-ray of same bone kept in oral cavity of a volunteer (in-vivo), in order to assess the effect of soft tissue and bony super imposition on radio opacity of fish bone and its clinical impact. The radiographs were taken using Siemens 500 MAS machine with an exposure of 65 kV for adults. Both the in vitro and in vivo radiographs were reviewed by thirty doctors of varied echelons ranging from interns to consultants of varying specialties (ENT, Radiology, Internal medicine, general surgery). RESULTS:Bones of seven fish species were 100% identified on in-vitro film while one fish type (drum fish) was identified by 93.3% (n=28/30) observers. Whereas, in-vivo identification of same bones ranged from 0.00% to a maximum of 33.33%. On in-vivo films, the maximally visualized fish bones were Mahseer and Butter fish (n=10/30; 33.3% each) followed by Catla/Indian carp, Eel, Pomfret and Cobia (n=5/30; 16.6% each). Croaker /drum fish could not be visualized by any observer on in-vivo films.CONCLUSION: Conventional plain X-rays alone cannot be relied upon for diagnosing fish bone impaction in upper aero-digestive tract.
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