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Objective:Compare the axial lengthand other biometric parameters by two biometric devices. Compare their levelof agreement for these parameters. Study Design:Cross-sectional study. Place and Duration of Study:Armed Forces Institute of Ophthalmology, fromJul 2016 to Apr 2018. Methodology:Study was carried out in Armed forced institute of ophthalmology on 70eyes of 53 patients with Nucleus sclerosisgrade II,III cataract.Patients underwentophthalmic and biometric examination usingoptical biometery devices IOL-Master (Carl Zeiss)and OB-820(WaveLight, Germany).Parameters includedaxial length,keratometric indices and anterior chamber depth.Results were evaluated using BlandAltman analyses for level of agreement, while differences were assessed using the paired samples t test, and correlation was evaluated by interclass correlation coefficient.Results:Mean axial length assessed by OB820 and IOL Master differed significantly in two groups (23.16±1.25 vs 23.53±1.34), with a p-value of 0.018. Bland-Altman analysisconfirmedsignificant differenceamongrangesand 95% limits of agreement for Axial Lengthwith interclass correlation of 0.659. While for other parameters including Keratometery1,2andanterior chamber depthexcellent correlation was found between IOL-master and OB-820 with interclass correlation of 0.960,0.968and0.976respectively. Conclusion:IOL-master and OB-820 shouldn’t be used interchangeably due to lack of agreement in axial length measurementwhich is infact the most importantbiometryparameter.

Objective: To analyze the effect of use of VERION image guided system on surgically induced astigmatism (SIA) in patients undergoing cataract surgery. Study Design: Randomized controlled trial. Place and Duration of Study: The study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Aug 2016 to Dec 2016. Material and Methods: Sixty eyes undergoing cataract surgery with already existing corneal astigmatism of at least 0.5 diopter (D) were included in the study. Cases with already existing ocular pathology or any per operative complication were excluded. Non-probability (purposive) sampling technique was used. Patients were randomly grouped into two groups 1 and 2. Group-1 underwent normal conventional phacoemulsification with no specific predetermined incision site. Group-2 underwent keratometric assessment using VERION image guided system and data was transferred to operating microscope. Steep and flat meridian were displayed on screen and incision were made on steep axis. Pre and 2 week post op keratometric readings were noted on a workup performa for both the groups and compared. All the surgeries were done by the same surgeon. Statistical program for social sciences (SPSS) version 23.0 was used for statistical analysis. Results: Sixty eyes (29 male, 31 female) with mean age of 57.65 ± 7.41 years were studied. Group-1 included 30 eyes with mean age of 56.73 ± 9.16 years. Group-2 also included 30 eyes with mean age of 58.56 ± 5.10 years. Mean pre op astigmatism was 0.93 ± 0.45D and 0.88 ± 0.47 D in group 1 and 2 respectively. Mean...........

Objective: To determine the effect of 23-gauge pars plana vitrectomy on corneal dioptric power through a comparison of difference in pre- and post- surgery keratometry. Study Design: Prospective non-comparative interventional type. Place and Duration of Study: The study was conducted at the Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi from Dec 2016 to Jul 2017. Material and Methods: We studied 33 patients (33 eyes) who underwent 23-gauge vitrectomy with mean age of 46.4 ± 12.8 years. Among them 13 were females and 20 were males. These patients were divided in four groups on the basis of pre-surgical diagnosis. 18 (55%) patients had rhegmatogenous retinal detachment, 9 (27%) had macular holes 3 (9%) with Vitreous hemorrhage and last 3 (9%) had dislocation of intraocular lens. Total vitrectomy was performed in all patients by standard 23G pars plana vitrectomy (PPV) procedure as used with three scleratomies and tunnel shaped incision. Keratometry readings before the surgery and at the end of 1st, 6th and 12th post procedural weeks were recorded in horizontal (K1) and vertical meridian (K2) by utilizing topcon auto kerato-refractometer. Results: The pre-operative dioptric power of cornea in horizontal and vertical meridian (K1 and K2 respectively) was statistically compared with post- operative dioptric power of cornea at the end of 1st, 6th and 12th postopertive weeks. At the end of first post- operative week there was significant difference between pre and post-operative corneal dioptric power with horizontal p-value

Objective: To determine the effect of Intravitreal injection of Bevacizumab on IOP in eyes of different axial lengths. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at AFIO Rawalpindi, from Sep 2013 to Jan 2014. Material and Methods: In this study 55 patients scheduled for intravitreal injection of bevacizumab for the treatment of diabetic macular edema were enrolled. An informed written consent was taken from all the patients. All patients underwent clinical ophthalmic examination including uncorrected distance visual acuity, corrected distance visual acuity, slit lamp bio-microscopy and fundus examination with 90 diopter lens. Axial length was measured before IVB using IOL master. Intra Ocular Pressure (IOP) was measured before and after 1 minute of administration of Intravitreal Bevacizumab (IVB) using Tono-Pen. Result: The mean age of patients was 54.51 ± 7.53 years with minimum age of 43 years and maximum age of 70 years. There were 26 (47.3%) male and 29 (52.7%) female patients. The mean axial length of the examined eyes was 21.12 ± 1.80 with range of 6 mm. Mean IOP before IVB was 13.09 ± 1.62 mmHg. After 1 minute of IVB, mean IOP was 32.8 ± 6.19 mmHg. A good correlation was observed between the axial length and intraocular pressure rise after 1 min i.e. Pearson correlation (r.) = -0.914 (p-value

PURPOSE: The purpose of this study is to compare the safety and efficacy of transepithelial corneal crosslinking (CXL) with epithelium-off crosslinking (epithelium-off CXL) in the treatment of progressive keratoconus in adult Pakistani population. MATERIALS AND METHODS: Sixty-four eyes of 64 consecutive patients of progressive keratoconus were included in this quasi-experimental study. Thirty-two eyes received transepithelial CXL with Peschke TE (0.25% riboflavin (Vitamin B2), 1.2% hydroxypropyl methylcellulose (HPMC), 0.01% benzalkonium chloride) and 32 eyes received epithelium-off CXL with Peschke M (0.1% riboflavin (Vitamin B2) 0.1%, HPMC 1.1%.) The cornea was then exposed to ultraviolet A light at an irradiance of 3 mW/cm2 for 30 min. The primary outcome measure, clinical stabilization of keratoconus was defined as an increase of no more than 1D in Kmaxat 1 year. Other parameters evaluated at baseline and 3, 6, 12, and 18 months postoperatively were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatism (Ast), simulated keratometry, steep keratmetry (steep K), and corneal thickness at thinnest point (pachy thin). RESULTS: Both epithelium-off CXL and transepithelial CXL groups showed a significant reduction in Kmax, steep K, simulated K, corneal pachymetry at all test points (P < 0.05) with significantly greater reductions achieved in epithelium-off CXL group at 18 months follow-up. The mean UDVA, CDVA, SE, Ast significantly improved in both groups (P < 0.05). The mean postoperative UDVA and CDVA between the groups were not significant at 12 months (P = 0.650, 0.018, respectively). Clinical stabilization was achieved in 94% of eyes in epithelium-off CXL and 75% of eyes in transepithelial CXL. In epithelium-off CXL, three eyes exhibited stromal haze resolved by corticosteroid treatment. No complication was documented in transepithelial CXL group. CONCLUSION: Transepithelial CXL is not recommended to be replaced completely by standard epithelium-off CXL due to continued ectatic progression in 25% of cases. However, thin corneas, unfit for standard epithelium-off CXL, can benefit from transepithelial CXL.

In the present study we determined the association of angiotensin converting enzyme (ACE) and plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms with diabetic retinopathy (DR) and its sub-clinical classes in Pakistani type 2 diabetic patients. A total of 353 diabetic subjects including 160 DR and 193 diabetic non retinopathy (DNR) as well as 198 healthy controls were genotyped by allele specific polymerase chain reaction (PCR) for ACE Insertion/Deletion (ID) polymorphism, rs4646994 in intron 16 and PAI-1 4G/5G (deletion/insertion) polymorphism, rs1799768 in promoter region of the gene. To statistically assess the genotype-phenotype association, multivariate logistic regression analysis was applied to the genotype data of DR, DNR and control individuals as well as the subtypes of DR. The ACE genotype ID was found to be significantly associated with DR (p = 0.009, odds ratio (OR) 1.870 [95% confidence interval (CI) = 1.04-3.36]) and its sub-clinical class non-proliferative DR (NPDR) (p = 0.006, OR 2.250 [95% CI = 1.098-4.620]), while PAI polymorphism did not show any association with DR in the current cohort. In conclusion in Pakistani population the ACE ID polymorphism was observed to be significantly associated with DR and NPDR, but not with the severe form of the disease i.e. proliferative DR (PDR).

Objective: To compare post-operative pain relieving effect of topical diclofenac 0.1% versus ketorolac 0.5% in Corneal Collagen Cross Linking (CXL) for patients diagnosed with keratoconus. Methods: This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to (Group-A) and ketorolac 0.5% to (Group-B) 30 minutes in advance of the corneal collagen cross linking (CXL) procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale (VAS) numbers from zero to five where 0 designated no pain & 5 symbolized worst pain. Results: The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 ± 2.93 years (range 20 to 29 years). In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A (diclofenac 0.1%) was 2.57 ± 0.67 while in Group-B (ketorolac 0.4% treated arm) was 3.20 ± 0.61. Conclusion: Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation. [ABSTRACT FROM AUTHOR]