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Objective: To compare the frequency of Pseudo-Exfoliation Syndrome (PXS) in patients undergoing cataract surgery in different regional hospitals in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Three Tertiary Care Hospitals of Karachi, Rawalakot and Skardu Pakistan, from Sep 2017 to May 2020. Methodology: Patients aged 45 years and more undergoing age-related cataract surgery were evaluated for Pseudo-Exfoliation Syndrome. Initially, each patient underwent a complete outpatient ophthalmological workup. Demographic details like age and gender were noted. All the patients were screened for hypertension and diabetes mellitus. In addition, patients were screened for pseudo-exfoliation syndrome. Congenital, developmental, secondary and traumatic cataracts were excluded. Results: A total of 1882 patients were included in the study. Pseudo-exfoliation was carried out in 249(13.23%) patients. In Hospital-A, 23(3.23%); in Hospital-B, 145(14.92%) and Hospital-C, 81(40.70%) of the patients had pseudo-exfoliation. The frequency of pseudo-exfoliation syndrome was significantly more in Hospital-C and then in Hospital-B and least in Hospital- A (p<0.01). Conclusion: Pseudo-exfoliation syndrome was significantly more common in Skardu and then in Rawalakot and least in Malir, which in the same order have more latitude away from the equator, have less average annual temperature and are situated at higher altitudes. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of depression in low vision and normal vision patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Eye Department, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Dec 2017 to May 2019. Methodology: Patients with low vision and normal vision were evaluated for depression. Initially, each patient underwent a complete Outpatient ophthalmological workup. Then, the patients were assigned to the low vision and normal vision groups, and after informed consent, each patient was to complete Patient Health Questionnaire-9 (PHQ-9). Result: Two hundred and sixty-nine patients with low vision and 275 patients with normal vision were included in the study. One hundred and eighty-two (67.66%) patients with low vision and 71(25.82%) patients with normal vision were found to have significant depression (PHQ-9 score>5). Depression was significantly more prevalent in the Low Vision-Group (p=<0.01). Conclusion: Significantly high level of depression in the Low Vision-Group needs to be taken care of in ophthalmology departments. The ophthalmologist should not look into the eyes but treat the patients as human beings. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of dry eye among children during the COVID-19 pandemic. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Hafeez Hospital, Islamabad Pakistan, from Mar to Aug 2021. Methodology: Children aged 7-15 years reporting to the PNS Hafeez Hospital, OPD were included in the study. A proforma was used to record the demographics and screen time of the children. In addition, an ophthalmic examination was conducted to assess the dry eye status of the children using the Schirmer-II test. Results: Seventy-three children participated in the study. Their mean age was 11.08±2.42 years. There were 40(54.8%) boys and 33 (45.2%) girls. These children had a mean daily screen time of 7.23±2.77hours. Children with dry eye had a greater amount of screen time (8.75±2.11hours) as compared to those with normal tear function (6.05±2.66 hours; p<0.001). In addition, the screen time of children with dry eyes was significantly greater than those with normal tear functions (p=0.001). Conclusion: Children with dry eyes were reported to have more screen time and more online classes than their counterparts with normal tear functions. Authorities should consider resuming face-to-face sessions for all school children. [ABSTRACT FROM AUTHOR]

Objectives: To study the impact of applying topical Chlorhexidine compared with Methylated spirit on umbilical cord sloughing time in neonates. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Department, KRL Hospital, Islamabad Pakistan from Oct 2018 to Mar 2019. Methodology: A total of 100 neonates were enrolled in each Group, i.e., Chlorhexidine and Methylated spirit. After taking informed consent from the parents, the treatment was applied twice daily for five days. Parents had telephonic interviews about the signs of umbilical cord infection on day two following enrollment in the study, and then babies were examined for signs of omphalitis during each hospital visit on days-7, 14 and 21. Umbilical cord sloughing time was noted. Results: Both Groups were independent (statistically insignificant) with respect to neonatal birth weight, gestational age, neonatal sex, mode of delivery and type of feed with p-values of 0.258 and 0.17, 0.066, 0.304 and 0.143, respectively. The result showed that the mean rank of cord sloughing time with the Methylated spirit was significantly less than Chlorhexidine, with the p-value of 0.001. Conclusion: Based on our results, we concluded that the application of Methylated spirit on the umbilical cord shortens the sloughing time compared to Chlorhexidine, but both treatments have comparable efficacy in preventing omphalitis. [ABSTRACT FROM AUTHOR]

Objective: To study the abnormality of alanine aminotransferase (ALT) in enteric fever among children and test the association between raised alanine aminotransferase and antibiotic resistance. Study Design: Prospective longitudinal study. Place and Duration of Study: Paediatric Department, KRL Hospital, Islamabad, from Oct 2018 to Mar 2020. Methodology: A total of 100 patients were enrolled as per inclusion criteria. Detailed clinical history was taken, and a physical examination was done. In addition, laboratory tests, i.e., complete blood count, liver function tests and blood culture, were performed to validate the inclusion and exclusion criteria and to collect the data of required variables mentioned in a structured proforma. Results: Out of 100 culture-proven typhoid fever patients, 57% were male and 43% female. The average age was 7.79 ± 3.3 years. Raised alanine aminotransferase (>45 U/l) was observed in 60%. The alanine aminotransferase was raised in at least 51% of the population having typhoid fever with a p-value of 0.035. The results also showed that the proportion of extensive drug-resistant (XDR) typhoid was more significant in patients with raised alanine aminotransferase than in patients with normal alanine aminotransferase with a p-value of 0.003. Conclusion: Based on our study, we concluded that high alanine aminotransferase is related to enteric fever. We also observed that those having raised alanine aminotransferase have more chances of extensively drug-resistant typhoid. [ABSTRACT FROM AUTHOR]

Objective: To compare the success rate of nasal endoscopic assisted probing and simple probing in congenital nasolacrimal duct obstruction. Study Design: Quasi-experimental study. Place and Duration of Study: Eye department, Combined Military Hospital, Malir Cantt, Karachi, from Feb 2018 to Jun 2019. Methodology: A total of 100 children were randomly divided into two groups. Each child in both groups underwent probing of the nasolacrimal duct. In one group, simple probing was performed, and patency was confirmed with metal on metal touch. In the second group, a nasal endoscope was employed to visualize probe passage through the opening of the nasolacrimal duct in the inferior meatus. In fracture of the inferior turbinate was performed in every case when a nasal endoscope was utilized. In the simple probing group, in fracture was performed if the inferior meatus was narrow. The rate of epiphora resolution was recorded in both groups at 1-month postoperatively. Results: The success rate of epiphora resolution was 96% (48 out of 50) in the nasal endoscopic assisted probing-group and 82% (41 out of 50) in the simple probing-group (p=0.02). The simple probing-group had a 40% (20 out of 50) significant nasal bleed, and in the nasal endoscopic-group, the significant nasal bleed was 20% (10 out of 50) (p=0.02). Conclusion: Nasal endoscopic assisted probing of the nasolacrimal duct has a higher success rate than simple probing in congenital nasolacrimal duct obstruction. [ABSTRACT FROM AUTHOR]

Objective: To assess any association between the cooperation of patients during biometry and cataract surgery by phacoemulsification in order to predict the type of anesthesia for the subject surgery. Study Design: Cross-sectional study. Place and Duration of Study: Eye Department, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2019. Methodology: A total of 332 patients requiring cataract surgery by phacoemulsification were recruited from the Eye department of Combined Military Hospital Multan. Patient cooperation level was measured during A-scan biometry. The cooperation level of same patient, assessed during biometry was used to plan the type of anesthesia to be administered during cataract surgery by phacoemulsification. Results: There were 209 male and 122 female patients with the mean age of 65.14 ± 0.57 years. A significant association was found between the cooperation of patient during biometry and cataract surgery by phacoemulsification appointments (p=0.02). A significant proportion of the patients 162 (81.4%) maintained their good cooperation during surgery. Out of the 133 patients, exhibiting poor cooperation during biometry procedure, 88 (66.3%) showed an improvement in their status by having good cooperation in surgery procedure. Conclusion: In the light of favorable clinical observation, the cooperation of the patients at the biometry procedure may be considered as a significant predictor of the type of anesthesia to be administered during cataract surgery by phacoemulsification. [ABSTRACT FROM AUTHOR]

Objective: To assess any association between the type of cataract and the central corneal thickness at pre-operative and postoperative three-day and one-month appointments after phacoemulsification surgery. Study Design: Prospective, comparative study. Place and Duration of Study: Eye Department Combined Military Hospital Multan, from Jun 2020 to Apr 2021. Methodology: A total of 89 patients requiring cataract surgery by phacoemulsification were recruited. Age and gender were recorded for each patient. Patient’s type of cataract based on maturity was recorded before the surgery. Phacoemulsification cataract surgery using ‘divide and conquer’ technique was carried out. Patients’ central corneal thickness was measured at the pre-operative, three-day post-operative and one-month post-operative appointment using traditional non-contact tonopachymeter. Results: There were 49 (55.1%) male and 40 (44.9%) female patients with a mean age of 62.15 ± 12.40 years. No significant association was found between the type of cataract and central corneal thickness at the three-time intervals (p=0.14). Central corneal thickness significantly increased from 0.48 ± 0.04 mm pre-operatively to 0.51 ± 0.04 mm at the three-day post-operative appointment (p<0.001). It then reduced to 0.49 ± 0.04 mm at the one-month appointment (p=0.01). Conclusion: The type of cataract is not associated with the variation in central corneal thickness due to cataract surgery. Central corneal thickness significantly increases from the pre-operative to right after the cataract surgery. However, it returns to preoperative levels after a one-month period. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of sodium hyaluronate, hydroxypropyl methylcellulose/dextran and polypropylene/polyethylene glycol based commercial artificial tear products using the noninvasive tear film breakup time. Study Design: Quasi experimental Study. Place and Duration of Study: Study was conducted at the Eye department of Combined Military Hospital Malir Cantt Karachi, from Sep 2017 to Nov 2017. Methodology: Three different types of commercially available artificial tears were evaluated on 30 eyes of 30 patients, having all types of dry eyes diseases. The noninvasive tear film breakup time was measured before and then at 15, 30 and 45 mins after instillation of the artificial tear using keratometer. The active ingredients in these eye drops were sodium hyaluronate, polyethylene glycol/propylene glycol and hydroxypropyl methylcellulose/ dextran 70. Results: Among the three artificial tears only Sodium hyaluronate eye drops caused a statistically significant increase in noninvasive tear film break up time at 45 mins post instillation. Polyethylene glycol/propylene eye drops extended tear film breakup time upto 30 mins. Comparison of the difference in extension of the breakup time was statistically insignificant between sodium hyaluronate and polyethylene glycol/polypropylene at 15 and 30 mins post instillation. Conclusion: Sodium hyaluronate eye drops were effective in prolonging the noninvasive tear film breakup time upto 45 mins postinstillation while polypropylene/polyethylene glycol were effective upto 30 mins in all types of dry eye diseases. [ABSTRACT FROM AUTHOR]

Objective: To compare outcome of pterygium excision with conjunctival autograft using sutures versus conjunctival limbal autograft using autologous blood. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital (CMH) Rawalakot, from Jul 2017 to Jul 2018. Material and Methods: After getting approval from hospital ethical committee 140 patients with primary pterygium were included in the study. The demographic details were noted and patients were randomized by lottery method in two groups (group A & B). Both groups were operated under topical anesthesia (Alcain). Group A underwent lamellar pterygium excision followed by limbal conjunctival autograft secured with nylon 10/0 sutures. Group B underwent limbal conjunctival autograft using autologous blood (non-glue, suture less), 2-3 drops of patients own blood below graft acted as adhesive when left there for 15 to 20 minutes. Patients were followed up at 2 weeks, 2 month and 6 months postoperatively to see recurrence. All the readings were carried out and noted by single person in order to minimize study bias. Results: A total of 140 patients (70 in each group) were included in the study with a mean age of 32.88 ± 5.82 years in group A and 32.97 ± 4.69 years in group-B. Regarding gender distribution, 51.43% in group-A and 48.57% in group-B were males. Comparison of outcome of pterygium excision with conjunctival autograft using sutures vs conjunctival limbal autograft using autologous blood showed that 15.71% in group-A and 5.71% in group-B had recurrence of pterygium. Conclusion: We concluded that the recurrence was significantly lower after pterygium excision when comparing conjunctival limbal autograft using autologous blood (non-glue, suture less) with conjunctival autograft using sutures. [ABSTRACT FROM AUTHOR]