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.
Objective: Glaucoma is a multifaceted eye disease which is classified as physical damage of retinal ganglion cells which may effect in loss of vision and permanent blindness. While physical damage of glaucoma can be clinically evaluated the optic nerve head and peripapillary retinal nerve fiber layer (RNFL). Our objective is to evaluate the mean RNFL thickness in all types of glaucoma. Methodology: This prospective and cross sectional study was conducted in Glaucoma Clinic of Al Ibrahim Eye Hospital (AIEH), Karachi, for the period from May 2019 to October 2019, after ethical approval from Institutional Research Committee. A total of 64 glaucoma patients were chosen by using non-probability purposive sampling technique. The participant comprised, no known eye disease, no visual impairment, IOP below 22 mmHg, and no obvious retinal disease or defect were included while individuals having a history of ocular diseases or pathology with residual visual impairment, retinal diseases, amblyopia, and history of intraocular surgery or laser therapy were excluded from the study. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 64 patients of both genders with mean age of 55.54±15.58 years. The mean intraocular pressure of right eye and left eye was 16.46±8.06 and 16.75±7.82 mmHg, respectively. The mean RNFL thickness in superior, inferior, temporal and nasal quadrant of the right eye was measured 68.23±25.44, 66.79±27.50, 51.75±12.58 and 47.73±18.82 microns, respectively while the mean RNFL thickness in superior, inferior, temporal and nasal quadrant of the left eye was measured 76.01±22.72, 67.42±21.25, 54.37±13.0 and 49.62±11.57 microns, respectively. Conclusion: Our study showed that analysis of retinal nerve fiber layer thickness with optical coherence tomography is the best tool for the diagnosis of glaucoma. It has also been observed in our study that frequency of changes in retinal nerve fiber layer thickness was mostly found in primary open angle glaucoma patients
Purpose: To see the effect of soft contact lens wears on tear breakup time. Study Design: Descriptive Observational study. Place and Duration of Study: College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Mayo Hospital, Lahore. From January to March 2016. Material and Methods: Students of King Edward Medical University Lahore wearing soft contact lens for more than 3 months with no known ocular pathology were selected by non-probability convenient sampling technique. Subjects with history of using any eye drops, history of oral drugs, which could cause dry eye and individuals any ocular disease, were excluded from the study. Tear film BUT was tested by using Fluorescein sodium dye and examinig under cobalt blue filter of slit lamp.SPSS version 20 is used to analyze the data. Results: There were 30 participants with mean age of 24.5 ± 5 years. All were females. Sixty percent were wearing corrective lenses, and 40% were wearing cosmetic lenses. Out of 30 patients wearing contact lenses, only 6.67% had marginal tear film BUT and none of the patients has shown dry eyes. Individuals using contact lenses for 9 – 12 years had decreased BUT as compared to subjects using lenses for 3 – 6 months. 33.33% of extended lens wearers had reduced BUT as compared to disposable and daily wearers of contact lenses. Discomfort with contact lenses was observed in only 4 patients. Conclusion: As the duration of contact lens wear increases, the tear film break up time decreases. Individuals using extended wear contact lenses are more prone to develop decreased TFBUT.
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.
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