Safety and Efficacy of Subtenon Anesthesia in Anterior Segment Surgeries

Purpose:  The objective of the study was to evaluate the complications of
subtenon anesthesia in patients undergoing anterior segment surgeries
Materials and Methods:  The study was conducted in the department of
ophthalmology, Abbasi Shaheed Hospital, from January 2009 to June 2010. 150
Patients were selected amongst those presenting in outpatient department for
anterior segment surgery using non-probability consecutive sampling technique.
Patients were scheduled for elective ophthalmic procedures with an expected
duration of less than 60 min. Patients with clotting abnormalities, impaired
mental status, uncontrolled glaucoma, were excluded from the study. 2 ml of
2% xylocaine with adrenaline (plain xylocaine where adrenaline was
contraindicated) was injected using  a subtenon cannula in supratemporal
quadrant of the eye ball. We recorded complications including patient
discomfort, inadequate anesthesia, conjunctival chemosis, subconjunctival
haemorrhage, reterobulbar haemorrhage.
Results: A total of 150 patients were operated under subtenon anesthesia.
Majority of the procedures performed were extra capsular cataract extraction
(55.3%) followed by trabaculectomy (24%). Most common complication in our
study was subconjunctival haemorrhage (48%) followed by conjunctival
chemosis (37%). Other complications like inadequate anesthesia were seen in 12
(8%) patients and inadequate akinesia in 18 (12%) patients. A second injection
was required in 12 (8%) patients. Simultaneous use of topical anesthetic was
recorded in 18 (12%) patients. Reterobulbar haemorrhage occurred in a small
percentage (2%) of patients in our study. In addition pupillary constriction after
delivering the nucleus 45 (30%) patients and positive vitreous pressure leading
to raised intra ocular pressure and iris prolapse 3 (2%) patients were also
recorded. 58(39%) patients complained  of pain and discomfort during the
injection.
Conclusion:  Majority of complications encountered in this study were minor
like subconjunctival heamorrhage, conjunctival chemosis, inadequate anesthesia
and akinesia. Major complications like reterobulbar heamorrhage and positive
vitreous pressure leading to raised intraocular pressure during the surgery were
uncommon but present. Subtenon anesthesia though safe is not devoid of
complications.

Outcome of Levator Resection in Congenital Ptosis with Poor Levator Function

Purpose: Purpose of the study is to evaluate the success of levator resection in
congenital ptosis with poor levator function.
Material and Methods: It was a single center, prospective, interventional case
series. The study was carried out at  Department of Ophthalmology, Bahawal
Victoria Hospital, Bahawalpur from March 2008 to November 2010. We selected
50 cases from outdoor department by universal sampling technique. Levator
resection was carried out in all 56 cases (eyes) of congenital Ptosis (with 06
bilateral cases) with poor levator function (less than 4mm) after taking informed
written consent. Patients were subjected to general anesthesia. Data was
collected on special proforma and was analyzed with the help of SPSS.
Results: The study population comprised of 56 eyes of 50 cases of congenital
ptosis. Male to female ratio was 3:1. Two bilateral cases were females and four
were males. Age ranged between 04-32 years (Mean = 14 years). About 75%
patients were between 13 and 24 years. The results were excellent in majority
(67.8%) with complete lid closure. Good results were seen in 17.85% with only
7.14% with fair and poor outcome each. The major cosmetic defect in all cases
was lid lag on extreme downward gaze. The operation is extremely laborious but
fully justified by the good results.
Conclusion: Levator resection in congenital Ptosis with poor levator function is
a viable option for cosmesis especially in unilateral cases

Topical Use of Cyclosporine in the Treatment of Vernal Keratoconjunctivitis

Purpose: To study the efficacy and safety of topical 2% cyclosporine in patients
with vernal keratoconjunctivitis.
Material and Methods: This is a placebo-controlled, clinical trial to evaluate the
effects of topical 2% cyclosporine on patients with vernal keratoconjunctivitis.
Twelve patients were placed in the cyclosporine treatment group and eight
patients were placed in the placebo group.  All patients had a wash out period of
one week in which they were advised not to instill any eye drop. After this period,
patients underwent a detailed ophthalmic  examination with specific note being
made of itching, tearing, photophobia, mucous discharge and foreign body
sensation. Specific signs looked for on  slit lamp biomicroscopic examination
included conjunctival hyperemia, punctuate keratitis, trantas dots, limbal edema
and papillae.
Patients were assigned at random to one of the study groups, either
cyclosporine 2% eye drops or placebo eye drops administered four times daily to
the both eyes.
Patients were examined weekly for a total follow-up period of 6 weeks.
Results: There were 18 males and 2 females in the study. Patients had mean
age of 11.6 years (range 7 to 19 years).  There was a statistically significant
decrease in symptoms and in the conjunctival hyperemia, punctate keratitis, and
Trantas dots in the group of patients treated with cyclosporine. No adverse
effects were noted in the cyclosporine treated group.
Conclusion: Topical cyclosporine appears to be safe and effective for treatment
of vernal keratoconjunctivitis.

Visual Outcome after Primary IOL Implantation for Traumatic Cataract

Purpose: To assess the visual outcome of early cataract extraction with primary
IOL implantation for traumatic cataract caused by penetrating injury.
Material and Methods: A prospective study was carried out on all patients with
traumatic cataract caused by penetrating injury who underwent early cataract
extraction (as surgery carried out within 2 weeks of the injury) with primary IOL
implantation at the Jinnah Post Graduate Medical Center, Karachi between
October 1998 and March 2000. Data was collected on age, gender, preoperative
vision, post-operative vision at 3-6 months, and postoperative complications
responsible for decreased visual acuity.
Results: Sixty eyes in 60 patients were studied. There were 52 males and 8
females. The preoperative visual acuity was poor (≤ 6/60) in all 60 eyes. The
postoperative visual acuity in 30 eyes was good (6-6/-6/12), whereas 26 eyes
had borderline (6/18-6/36) and 4 eyes had poor (≤ 6/60) visual acuity. The
cause of poor visual acuity was mainly corneal opacity and posterior capsular
opacity.
Conclusion: Our study shows that good visual results can be achieved in
traumatic cataract surgery if the posterior segment is not involved and corneal
scar does not block the optical axis.

Use of glaucoma drainage devices in the management of glaucoma associated with aniridia

Use of glaucoma drainage devices in the management of glaucoma associated with aniridia