The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Determinants Of Visual Outcomes After Small Incision Cataract Surgery In Pati...Dr. Jagannath Boramani
Authors : Presenting author- Dr. Kumud Jeswani Co authors: Dr. Kuldeep Dole, Dr. Shruti Shah, Dr. Nilesh Kakade. PMBA ‘S H .V . Desai Eye Hospital, PUNE.
:Extraocular foreign bodies (EOFBs) are a common presentation to the emergency
department (ED). Given that inadequate management can result in severe complications including visual
impairment, ED clinicians may be overly cautious and often schedule patient reviews in the ED even
where it is unnecessary, placing a burden on hospital resources.
Diode Laser Treatment for Retinopathy of Prematurity – Our Experience in Bulg...inventionjournals
Purpose: To present early structural outcomes in patients with ROP treated with indirect diode laser photocoagulation at Pediatric Eye Unit, Eye Clinic, University Hospital "Alexandrovska", Sofia, Bulgaria for a period of five years. Patients and Methods: A 5 year retrospective study (August 2011 – December 2016) was conducted. 54 children (102 eyes) with ROP, requiring treatment were included. All children were treated with indirect diode laser photocoagulation (810 nm). Retinal status before and after treatment were documented with RetCam imaging system. Results: 54 (102 eyes) prematurely born babies are included - 33 (61.1%) boys and 21 (38.9%) girls. The mean gestational age was 26.8 weeks (± 1.93 g.w.), and the mean birth weight - 920 g (± 274.7g). Zone I ROP was observed in 9 (8.8%) eyes, and Zone II ROP - in 93 (91.2%) eyes. Favorable structural result was achieved in 89 (87.3%) eyes. In 13 (12.7%) eyes was observed unfavorable structural result, from which seven eyes were with retinal detachment. Conclusion: Widespread introduction of mandatory screening programs and conducting timely and effective treatment of ROP is a key element in reducing cases of preventable childhood blindness worldwide.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Determinants Of Visual Outcomes After Small Incision Cataract Surgery In Pati...Dr. Jagannath Boramani
Authors : Presenting author- Dr. Kumud Jeswani Co authors: Dr. Kuldeep Dole, Dr. Shruti Shah, Dr. Nilesh Kakade. PMBA ‘S H .V . Desai Eye Hospital, PUNE.
:Extraocular foreign bodies (EOFBs) are a common presentation to the emergency
department (ED). Given that inadequate management can result in severe complications including visual
impairment, ED clinicians may be overly cautious and often schedule patient reviews in the ED even
where it is unnecessary, placing a burden on hospital resources.
Diode Laser Treatment for Retinopathy of Prematurity – Our Experience in Bulg...inventionjournals
Purpose: To present early structural outcomes in patients with ROP treated with indirect diode laser photocoagulation at Pediatric Eye Unit, Eye Clinic, University Hospital "Alexandrovska", Sofia, Bulgaria for a period of five years. Patients and Methods: A 5 year retrospective study (August 2011 – December 2016) was conducted. 54 children (102 eyes) with ROP, requiring treatment were included. All children were treated with indirect diode laser photocoagulation (810 nm). Retinal status before and after treatment were documented with RetCam imaging system. Results: 54 (102 eyes) prematurely born babies are included - 33 (61.1%) boys and 21 (38.9%) girls. The mean gestational age was 26.8 weeks (± 1.93 g.w.), and the mean birth weight - 920 g (± 274.7g). Zone I ROP was observed in 9 (8.8%) eyes, and Zone II ROP - in 93 (91.2%) eyes. Favorable structural result was achieved in 89 (87.3%) eyes. In 13 (12.7%) eyes was observed unfavorable structural result, from which seven eyes were with retinal detachment. Conclusion: Widespread introduction of mandatory screening programs and conducting timely and effective treatment of ROP is a key element in reducing cases of preventable childhood blindness worldwide.
Incidence of Glaucoma & Diabetic Retinopathy in Patients with Diabetes Mellit...QUESTJOURNAL
Background: Vision is a means of communication of man with the external world. The impact of visual loss due to various ocular morbidities has profound implications for the person affected and the society as a whole. Diabetes has become one of the world’s most important public health problems & WHO indicate that 19% of world’s diabetic population lives in India. Diabetes related microvascular complications cause visual disability even in younger age group individuals. Aim: To estimate the magnitude of Glaucoma and diabetic retinopathy in diabetic patients in our institution. To create awareness about avoidable blindness in diabetic patients.To enlighten and thereby motivate the patient for further evaluation and follow up. Materials and methods: The study is a hospital- based , non- interventional, cross-sectional study. The ocular disorders are evaluated in 500 consecutive diabetic patients attending ophthalmology out patient department of Kanyakumari medical college hospital. Estimation of visual acuity, slit lamp examination, intraocular pressure, retinoscopy & fundus examination, visual field analysis , gonioscopy are done to detail the defective vision. Result analysis Data is analysed using SPSS. The common manifestations are cataract- 346 (69%), diabetic retinopathy- 94 patients (18.8%), glaucoma– 34 (6.8%). Patients with cataract are well managed by cataract extraction techniques. Prime importance is to create awareness and also diagnose the early changes of retinopathy and glaucoma.Treatment of glaucoma if instituted early will go a long way in preventing avoidable blindness Therefore periodic visual screening along with control of hyperglycemia and associated risk factors is needed to ensure good quality of vision.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
APPLY MACHINE LEARNING METHODS TO PREDICT FAILURE OF GLAUCOMA DRAINAGEIJDKP
The purpose of this retrospective study is to measure machine learning models' ability to predict glaucoma
drainage device failure based on demographic information and preoperative measurements. The medical
records of 165 patients were used. Potential predictors included the patients' race, age, sex, preoperative
intraocular pressure (IOP), preoperative visual acuity, number of IOP-lowering medications, and number
and type of previous ophthalmic surgeries. Failure was defined as final IOP greater than 18 mm Hg,
reduction in intraocular pressure less than 20% from baseline, or need for reoperation unrelated to normal
implant maintenance. Five classifiers were compared: logistic regression, artificial neural network,
random forest, decision tree, and support vector machine. Recursive feature elimination was used to shrink
the number of predictors and grid search was used to choose hyperparameters. To prevent leakage, nested
cross-validation was used throughout. With a small amount of data, the best classfier was logistic
regression, but with more data, the best classifier was the random forest.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
COMPATIBILITY OF PROGRESSIVE GLASSES IN RELATION TO AGE, REFRACTIVE ERROR AND OCCUPATION OF PATIENT:
Journal: Sabargam International Journal of Research in Multidiscipline
ISSN: 2456-4672 Volume I, Issue II, Jan 2017
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Profile of secondary glaucoma cases in a tertiary eye care centre.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Incidence of Glaucoma & Diabetic Retinopathy in Patients with Diabetes Mellit...QUESTJOURNAL
Background: Vision is a means of communication of man with the external world. The impact of visual loss due to various ocular morbidities has profound implications for the person affected and the society as a whole. Diabetes has become one of the world’s most important public health problems & WHO indicate that 19% of world’s diabetic population lives in India. Diabetes related microvascular complications cause visual disability even in younger age group individuals. Aim: To estimate the magnitude of Glaucoma and diabetic retinopathy in diabetic patients in our institution. To create awareness about avoidable blindness in diabetic patients.To enlighten and thereby motivate the patient for further evaluation and follow up. Materials and methods: The study is a hospital- based , non- interventional, cross-sectional study. The ocular disorders are evaluated in 500 consecutive diabetic patients attending ophthalmology out patient department of Kanyakumari medical college hospital. Estimation of visual acuity, slit lamp examination, intraocular pressure, retinoscopy & fundus examination, visual field analysis , gonioscopy are done to detail the defective vision. Result analysis Data is analysed using SPSS. The common manifestations are cataract- 346 (69%), diabetic retinopathy- 94 patients (18.8%), glaucoma– 34 (6.8%). Patients with cataract are well managed by cataract extraction techniques. Prime importance is to create awareness and also diagnose the early changes of retinopathy and glaucoma.Treatment of glaucoma if instituted early will go a long way in preventing avoidable blindness Therefore periodic visual screening along with control of hyperglycemia and associated risk factors is needed to ensure good quality of vision.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
APPLY MACHINE LEARNING METHODS TO PREDICT FAILURE OF GLAUCOMA DRAINAGEIJDKP
The purpose of this retrospective study is to measure machine learning models' ability to predict glaucoma
drainage device failure based on demographic information and preoperative measurements. The medical
records of 165 patients were used. Potential predictors included the patients' race, age, sex, preoperative
intraocular pressure (IOP), preoperative visual acuity, number of IOP-lowering medications, and number
and type of previous ophthalmic surgeries. Failure was defined as final IOP greater than 18 mm Hg,
reduction in intraocular pressure less than 20% from baseline, or need for reoperation unrelated to normal
implant maintenance. Five classifiers were compared: logistic regression, artificial neural network,
random forest, decision tree, and support vector machine. Recursive feature elimination was used to shrink
the number of predictors and grid search was used to choose hyperparameters. To prevent leakage, nested
cross-validation was used throughout. With a small amount of data, the best classfier was logistic
regression, but with more data, the best classifier was the random forest.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
COMPATIBILITY OF PROGRESSIVE GLASSES IN RELATION TO AGE, REFRACTIVE ERROR AND OCCUPATION OF PATIENT:
Journal: Sabargam International Journal of Research in Multidiscipline
ISSN: 2456-4672 Volume I, Issue II, Jan 2017
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Profile of secondary glaucoma cases in a tertiary eye care centre.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
penetrating ocular trauma,
case series of 60 patient 1 year study,
classification of ocular injury, types & classification of eye injury (BETT Classification ),
investigations
management
Clinical study of fundal changes in high myopiaiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Optometry Times practical chair side advice VOL 12,NO.6 JUNE 2020Mero Eye
Optometry Times practical chairside advice VOL 12,nO.6 jUNE 2020
Contact Lenses
PATIENTS AREN’T HEARING
CONTACT LENS CARE INFORMATION
By Ernie Bowling, OD, FAAO
Doctors and staff need to better communicate
recommendations to contact lens wearers 5
11 THINGS MY PATIENT WISHED HER
PREVIOUS OD HAD TOLD HER
By Crystal M. Brimer, OD, FAAO
Patients clearly want more, not less, information and
data from their eyecare providers 9
Ocular Surface Disease
LACTOFERRIN LEVELS CAN
DIAGNOSE DRY EYE DISEASE
By Jeffrey Anshel, OD, FAAO
New test allows distinction between causes of
symptoms 11
PROPER DOCUMENTATION HELPS
ASSURE PRIOR AUTHORIZATIONS
By Vin T. Dang, OD, FAAO
Newer dry eye medications require approval, and
charting helps prove the need 12
Technology
SWEPT-SOURCE AND MULTIMODAL
OCT TECHNOLOGIES OFFER
CLINICAL ADVANTAGES
By Kerry Salsberg, OD
The expenditure of embracing new technologies is
worthwhile 15
TELEHEALTH SUCCESS HINGES ON
BETTER TOOLS
By Sandeep Jain, MD, FCCP, FAASM
Communication and respect for everyone’s time
needed, as well 20
Glaucoma
PEDIATRIC GLAUCOMA: TYPES,
TESTS AND TREATMENTS
By Stacy Potwin, OD, and Michael Chaglasian, OD
The different concerns in pediatric glaucoma
compared with adults 1
CONTRAST SESITIVITY MANIFESTS
IN GLAUCOMA PATIENT WITH NO
CATARACTS
By Benjamin P. Casella, OD, FAAO
A comment from a patient prompts a doctor’s change
in testing and discussion 21
Refractive
10 THINGS I WISH I KNEW EARLIER
ABOUT VISION THERAPY
By Marc B. Taub, OD, MS, FAAO, FCOVD, FNAP
How to take on the challenge of providing therapy to
improve vision
Retina
OCT, OCTA SHOWS PROMISE IN
SCREENING FOR DR
By Kyra Dorgeloh, OD; Lucy Zhu, OD; Nitish Mehta, MD; and Thomas A.
Wong, OD
This imaging technique provides depth-resolved
images of retinal vasculature 1
RESOLVED COTTON-WOOL SPOT
LEAVES RNFL DEFECT IN ITS WAKE
By Leo Semes, OD, FAAO
Imaging reveals diabetic retinopathy, cotton wool spot,
and RNFL defect 30
Other
WHAT A PRACTICE OWNER WOULD
ADVISE HER YOUNGER SELF
By Dori M. Carlson, OD
An OD looks back 30 years of running a practice and
recommends developing CEO skills 26
April 2019 . Cataracts secondary to intraocular diseases are complicated cata...Vinitkumar MJ
DEMOGRAPHIC PROFILES AND AETIOLOGY OF COMPLICATED CATARACTS: A HOSPITAL BASED STUDY.
Aim: To study demographic profiles and aetiology of complicated cataracts in patients presenting to the Out-Patient Department of B. P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS).
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Visual outcomes of cataract surgery an observational study
1. Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1775
INTRODUCTION
Cataract is the gradual cloudiness of the
transparent ocular lens. It is regarded as a single
largest cause of reversible blindness worldwide.
Nearly 45% of global blindness is attributed to
cataract, accounting 15 million out of 33.6 million
cases of the global blindness.1
Every year nearly
one million people worldwide became blind
due to cataract expected to raise further due to
population growth and longer life expectancy.2
The burden of vision loss in Pakistan had
been on the rise since 1990 and is estimated to
increase at a steady rate by 2025. Pakistan ranked
third, among south Asian countries, after India
and Bangladesh in the prevalence of blindness
and vision impairment. Presbyopia, refractory
disorder and cataract contributed >90% cases of
blindness and severe vision loss. Nearly >50%
of these cases in the country were attributed to
cataract.2
Correspondence:
Dr. Muhammad Saleh Memon FRCS(Eden).
Director Research, Al Ibrahim Eye Hospital,
Isra Postgraduate Institute of Ophthalmology,
Karachi, Pakistan.
E-mail: salehmemon@yahoo.com
* Received for Publication: March 17, 2021
* Revision Received: June 8, 2021
* Revision Accepted: July 5, 2021
Original Article
Visual outcomes of cataract surgery: An observational study
of ten years from a tertiary eye care hospital in Pakistan
Shahid Ahsan1
, Muhammad Saleh Memon2
, Sadia Bukhari3
, Tauseef Mahmood4
,
Muhammad Faisal Fahim5
, Uzma Haseeb6
, Muhammad Arslan7
ABSTRACT
Objectives: To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye
care hospital, Karachi.
Methods: An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital
(AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was
retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when
patient’s BCVA was found to be 6/18. Visual assessments of the patients were done on day 01, one week
and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual
impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment.
Results: A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals,
cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of
operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578
(53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%),
patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had
moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the
commonest cause (33.56%) at sixth week.
Conclusions: The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18)
of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.
KEYWORDS: Cataract Extraction, Ophthalmic diseases burden, Visual Acuity, Phacoemulsification.
doi: https://doi.org/10.12669/pjms.37.7.4428
How to cite this:
Ahsan S, Memon MS, Bukhari S, Mahmood T, Fahim MF, Haseeb U, et al. Visual outcomes of cataract surgery: An observational
study of ten years from a tertiary eye care hospital in Pakistan. Pak J Med Sci. 2021;37(7):1775-1781.
doi: https://doi.org/10.12669/pjms.37.7.4428
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2. Shahid Ahsan et al.
Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1776
Cataract is primarily an aging phenomenon that
cannot be prevented. However, vision impairment
by cataract can be restored by surgery. Though
cataract surgery is the commonest procedure
performed by the ophthalmic surgeons,
substantial variations in cataract surgery rate
(CSR) between countries were observed. Cataract
surgery rate is used as a proxy indicator of access
to cataract services in a country.2
In 2004, WHO
mapped Pakistan with other countries of Eastern
Mediterranean Region having 2000-3000 CSR.
A dramatic rise in CSR over in the last 14 years
in the country was observed touching to >5000
cases in 2018. This rise in rate of cataract surgery
is likely be due to increased access to eye care
facilities, increased aging population and reduced
thresholds of visual impairment (from 6/60 to
6/12) as an indication for surgery. For example,
in Australia reduction in visual impairment
threshold from 6/60 to 6/12 as an indication
for cataract surgery resulted in nearly fivefold
increase in number of people eligible for cataract
surgery.3
Moreover, with introduction of new
techniques and technologies for cataract raises
the demand and patient’s expectations for better
vision. These facts raise the concerns about the
quality of outcomes and concept of surgical audit.
In order to achieve good results, it is imperative
that surgeons and eye care centers should audit
their performance regularly.4
Present study has followed the new
recommendations.5
In this study, authors audited
the 10 years results of cataract surgery at Al-
Ibrahim Eye Hospital, Karachi, which is tertiary
level eye care center draining sub urban and rural
area of Karachi and surrounding districts of Sindh
and Baluchistan.
METHODS
It was an observational study with retrospective
data retrieved from HIMS for the year 2010-
2019 carried out at Al Ibrahim Eye Hospital, a
tertiary eye care center, Karachi. Data of all adults
(above 16 years) undergoing cataract surgery
by Extra-capsular cataract extraction (ECCE),
phacoemulsification with IOL (Phaco + IOL)
implant and Intra capsular cataract extraction
(ICCE) with or without IOL were included in
the study. Missing records, dropped follow-
ups, cataract surgery combined with other
ocular surgery like trabeculectomy, vitrectomy,
keratoplasty, complicated and secondary cataract
were excluded.
All patients visiting the out patient’s department
of Al Ibrahim Eye Hospital for ophthalmic
consultation, underwent detail ophthalmic
examination like Best corrected visual acuity
(BCVA), Slit lamp examination, IOP and Fundus
examination. Presence of opacity in the lens was
labelled as cataract. B-scan was performed in
patients whose fundus was not visible with 90 D
fundus examination. Surgery was advised when
patient’s BCVA found to be < 6/18 or patient
was not satisfied with his present vision. Pre-
operative investigation included Hepatitis B, C,
HIV and Random Blood Sugar level. Keratometry
and biometry was done to determine IOL number.
The choice of procedure was based on type and
grade of cataract. Extracapsular extraction was
done in mature and hyper mature cataracts where
phacoemulsification was problematic. IOL was
implanted in both procedures. Post-operatively
topical antibiotics and steroids were prescribed
to all patients. First follow-up was scheduled the
next day of surgery. Subsequent follow-up was
at 1st
week and 6th
week after surgery. BCVA was
recorded at all visits. Visual acuity (BCVA) was
graded according to new recommendations where
visual outcome is categorized into 4 grades: good
6/6 to 6/12, minimal visual impairment 6/18,
moderate visual impairment < 6/18 to 6/60 and
severe visual impairment < 6/60.
WHO recommends following categories and
levels to be achieved:6
Category Visual range
Available
correction
Best corrected
VA
Good 6/6 -----6/18 >85% >90%
Borderline <6/18 …..6/60 < 10% <5%
Poor <6/60 <5% <5%
Almost all national studies7-13
followed this
classification to report surgical outcome. As the
cutoff point for surgery has been revised from
6/60 to 6/18 or even 6/12,14
the visual outcomes
need to be revised. The new recommendations5
consider 6/6 – 6/12 as good, 6/18 as mild
visual impairment, < 6/18 to 6/60 as moderate
visual impairment and < 6/60 as severe visual
impairment.
Statistical Analysis: Data was retrieved from
Hospital Information Management System (HIMS)
and exported to SPSS version 23.0. Mean and
Standard deviation was calculated for continuous
variable like age. Frequencies and percentages
3. Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1777
were reported for categorical variables like age
groups, gender, type of surgery, categories for
visual acuity and causes of reduced BCVA. Chi-
square test was applied to see the significance.
P-value ≤ 0.05 considered to be statistically
significant.
Ethical Approval: (Ref: REC/IPIO/2020/031,
Dated: September 16, 2020).
RESULTS
During the year 2010-2019, total of 1,027,840
patients visited Al-Ibrahim Eye Hospital with
different eye problems. Among them 88443
(8.6%) individuals were labelled as cataract, Fig.1.
Number of cataracts which met the criteria of
surgery were 58371 and the number of cataracts
operated were 38616. Details shown in Fig.2.
Age of patients ranged from 16 to more than
60 years. Mean age of patients operated was
54.96±14.22 years. An increasing frequency of
age group was seen from 46 to 60 years. Gender
distribution was observed as male 20578 (53.29%)
and female 18038 (46.71%). Phacoemulsification
with PC IOL (Phaco + PC IOL) was done in 33990
(88.02%) and Extracapsular Cataract extraction
with Posterior Chamber Intraocular Lens (ECCE
+ PC IOL) was done in 3684 (9.54%) patients.
Remaining individuals 942 (2.4%) had Intra
capsular cataract extraction (ICCE) with or without
IOL (Table-I).
Results at 6 week follow up: Total number
completing follow up of 6 weeks were 19301 (50%)
Those with “good vision” were 3561 (18.4%), with
mild visual impairment were 12242 (63.43%), with
moderate visual impairment were 13.86% and
those with sever vision impairment were 4.26%
(Table-II).
Drop outs were 9.84% (3801) patients on 1st
postoperative day, 27.41% (10588) on 2nd
follow
up at one week and 50% (19315) at 6th
week. At 6
Visual outcomes of cataract surgery
Fig.1: People attending Outpatient
department (2010-2019).
Table-I: Demographic Characteristics of patients.
Age Group
Frequency (%)
(n=38616)
16-30 7.35%
31-45 13.27%
46-60 49.14%
>60 30.24%
Gender
Male 20578 (53.29%)
Female 18038 (46.71%)
Type of Surgery
(PHACO + PC IOL)
Phacoemulsification plus Posterior
Chamber Intraocular Lens
33990 (88.02%)
(ECCE + PC IOL) Extracapsular
Cataract extraction plus Posterior
Chamber Intraocular Lens
3684 (9.54%)
Others 942 (2.44%)
Fig.2: Cataract Burden and Coverage from 2010 to 2019. Fig.3: Causes of BCVA <6/18 at Sixth Week Follow-up.
4. Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1778
week follow up, 18.27 % of the Phaco IOL had “
good vision”, 65.04% had mild visual impairment,
13.03% had moderate and only 3.64% had severe
visual impairment. Respective results with ECCE
IOL were 19.2%, 55.7%, 17.78% and 7.18%. Severe
visual impairment with Phaco is 3.64%, which is
well within recommended level of < 5%; but 7.18%
with severe visual impairment in ECCE IOL is
more than desirable (Table-III).
Causes of BCVA< 6/18 at 6th
week follow-up is
shown in (Fig.3): Main causes of reduced vision
were related to cornea (33.56%) and refractive
errors (27.96%), while others were due to associated
causes like glaucoma (24.04%) and retinal diseases
(14.44%).
DISCUSSION
Cataract surgery is one of the most frequently
performed surgical procedure worldwide. There is
no guideline from international organization about
visual acuity threshold for cataract surgery. Ideally
any patient who has symptoms of cataract should
offer surgery. Priority however should be given to
the people who are blind from un-operated cataract
as this segment of patient benefitted at most from
surgery. This trend is however changed in current
era because patients’ needs and the results that
they expect to obtain from surgery have changed.
Thus patients in early stages of the development
of cataract and with visual acuity of 6/6 to 6/12
opted to undergo cataract surgery often to correct
the refractive error rather than to reverse visual
impairment. National studies from Pakistan also
reported significant proportion of patient undergo
cataract surgery at good VA of 6/6- 6/18. A
study from Aga Khan reported7
57.9% of patients
that underwent cataract surgery had good pre-
operative VA of 6/6-6/18. In the present study
23.01% had pre-operative VA of > 6/18 , 6.93%
patients with VA (6/6- 6/12) and 16.08% patient
had mild impairment (VA 6/18). Seventy-seven
percent (77%) patients, had moderate and severe
preoperative visual impairment (VA <6/18).
Presence of higher frequency of poor preoperative
VA is an indication of inadequate provision of
cataract surgical services. In contrast induction
of patients with better VA resulted in rise in CSR
without having the influence on reduction of
Shahid Ahsan et al.
Table-II: Visual Acuity from Baseline (pre-operative) to Sixth Week Post-Operative.
Visual Acuity
Pre-Operative 1st day Post-Op 1st Week Post-Op 6th week Post-Op
Frequency Percent Frequency Percent Frequency Percent Frequency Percent
6/6 – 6/12
(Good Vision)
2678 6.93 4281 12.3 4936 17.61 3561 18.45
6/18 (Mild Vision
Impairment)
6211 16.08 17120 49.17 14747 52.62 12242 63.43
< 6/18 – 6/60 (Moderate
Vision Impairment)
18002 46.62 10233 29.39 6734 24.03 2676 13.86
< 6/60 (Severe Vision
Impairment)
11725 30.36 3181 9.14 1611 5.75 822 4.26
Total 38616 100 34815 100 28028 100 19301 100
Table-III: Type of Surgery and Visual Outcomes at Sixth Week Follow-up.
BCVA Categories
Type of Surgery
P-value
ECCE + PC IOL
n=3356 (17. 38%)
Phaco + PC IOL
n=15945 (82.6%)
6/6 - 6/12 (Good Vision) 647 (19.2%) 2914 (18.2%)
0.347
6/18 (Mild Vision Impairment) 1871 (55.7%) 10371 (65%)
< 6/18 - 6/60 (Moderate Vision Impairment) 597 (17.8%) 2079 (13.03%)
< 6/60 (Severe Vision Impairment) 241 (7.1%) 581 (3.6%)
Total 3356 15945
5. blindness. This is particularly observed in low-
and middle-income countries where despite of
increased cataract surgical rate prevalence of
blindness is also on rise. According to a report of
WHO15
nearly two decades earlier most people
in India and Kenya had VA of < 3/60 before
undergoing cataract surgery. Though recently
there is dramatic increase in the number of cataract
operations, it had no impact on the number of
people who are blind from cataract.
As regards gender, in developed countries,
females accounted for 59%-66% of all cataract
surgeries.16
Whereas in developing countries
gender bias is known to exist with more men
than women had cataract surgery. Since women
have higher incidence of cataract and longer life
expectancy, in order to have equal access to care
for cataract nearly 60-70% of the individuals
undergoing cataract surgery must comprise of
women.17,18
In present study similar gender pattern was
observed with more men compared to women
(56.46% vs 43.54%) undergone cataract surgery,
which is 12.92% lower in women. Various studies
from Pakistan reported Cataract surgical coverage
(CSC) of 69.9 – 72.2% among men while reported
CSC for women was 39.6 – 60.2%. Studies also
reported gross gender inequity in terms of CSC from
other countries of South Asia. Like in India CSC
was found to be 27% higher in men than women.
Nearly 2/3rd
of the global burden of blindness was
found in women, a higher rate of cataract surgery
in female populations should be emphasized in
cataract programs.16
Reporting the outcome of cataract surgery is
important in order to establish the bench mark and
to audit the performance of an institute. Nearly
19755 (33.9%) individuals advised for surgery did
not avail intervention. It remains to be explored why
33.9% people with cataract did not avail surgery
although being non-profit organization, surgery
is offered at very subsidized rate. These patients
availed the free consultation; but did not avail the
intervention. Second observation in this study was
patient dropout rate in follow ups after cataract
surgery. Our findings indicated that people seek
and receive cataract surgery but miss out on regular
follow-up consultations. Most likely reason of both
these occurrences is financial constraint. Though
being charitable institute services in this center is
offered at very subsidize rate, for the very poor
segment of people it remains out of pocket. People
were too poor to afford even subsidized cost and
come for follow up. There exists strong relationship
of poverty with cataract surgical rate (CSR), and
postoperative visual acuity.8
Study on “relationship
of output, outcomes of cataract surgery and national
indices of socioeconomic development” has shown
that good vision outcomes was lowest in Pakistan
(6%) and highest in Malaysia (86%), however
author did not cite the source of this information.19
Over the period of ten years, change in the
operation procedure was observed from ECCE
(17.38%) to Phacoemulsification (82.6%). ECCE
has been replaced by Phaco surgery except in very
hard cataracts. Our main worry is moderate vision
impairment (<6/18 to 6/60) of 13.03% with Phaco
surgery.
Our results are comparable with national
and afro Asian countries. Most of these studies
followed the old recommendations where “good
vision” includes 6/6 to 6/18, border line 6/24-
Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1779
Visual outcomes of cataract surgery
6. Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1780
Shahid Ahsan et al.
6/60 and poor vision <6/60. In our study if 6/18
is considered as “good vision”, the number will
be 81.88% with Phaco and 74.9% with ECCE IOL.
ReportfromuniversitycollegehospitalinIBADAN
showed “Good vision” in 78.8%, borderline vision
in 17.4%, and severe visual impairment in 3.8%
after cataract surgery.20
A study from Bangladesh
also showed that at final follow-up visit (6 to 8
weeks), best corrected visual acuity (BCVA) was
good (≥6/18) in 68.5%, borderline in 20.1% and
poor in 11.5%.21
Rapid assessment of cataract surgical services
in Malakand district showed good, borderline
and poor visual acuity of 40.5%, 22% and 14.3%
respectively.9
Malikandcolleagues10
demonstrated
that visual outcome after 8 weeks post operatively
good visual outcome in 90% or more of operated
eyes. A study from a private sector reported15
overall, 93.3% of the operated eyes had good visual
outcome, while 4.4% and 2.2% had borderline and
poor outcomes. Marie Adelaide Leprosy Centre
Karachi,11
reported “best” corrected visual acuity
in 97.2%, borderline in 2.2% and poor in 0.6%
patients at >12 weeks follow up with 565 (38.7%)
drop out patients. Report from Eye Unit of the
Lady Reading Hospital, Peshawar, reported good
Visual outcome in 88.3%, borderline in 8.3% and
poor in 3.3% patients.12
Present study is the largest
postoperative result reported nationally. Though
the study has certain limitations, the outcomes
of high volume of cataract surgeries reported in
this study made it creditable to compare with
the outcomes of cataract surgeries conducted
nationally and in neighboring countries.
Like any surgical procedure, cataract surgery is
also liable to complications. These complications
result in poor visual outcomes and are dependent
on many preoperative, intraoperative and
postoperative factors. Corneal damage during
surgery is the most common cause of postoperative
moderate as well as severe vision impairment.
This is common in the learning phase of Phaco
emulsification. The second common reason for
unfavorable visual outcome was due to refractive
errors resulting from the surgery.13
Limitations of the Study: Though present study
is the largest study reporting post-operative
outcomes of cataract, study demands carful
interpretation. Deposition of data in HMIS is not
real time. Data entry operator transferred data
from hard copy to the data bank at a convenient
time. This may result in erroneous entry which
is rectified by randomly cross checking and
matching the hard file entry with data bank.
Nearly 33.9% people attended the hospital and
diagnosed with cataract did not avail surgery
in our center. Moreover, postoperative patient’s
dropouts reached to 50% (19315) at 6th
week. We
are completely unaware of the visual status of
these patients. Another important aspect of this
study is variability of the operating surgeon from
trainee ophthalmologist to senior surgeon over 10
years.
CONCLUSION
The institution achieved WHO recommended
criteria of “good visual outcome” (6/6 to 6/18)
of 81.83% which is near to recommended ≥ 90%
and severe visual impairment of 4.26%.
Acknowledgment: We are thankful to the
Sightsavers UK and Christoffel-Blindenmission
(CBM) for their support in subsidization of patients.
Grant Support & Financial Disclosures: None.
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7. Pak J Med Sci November - December 2021 Vol. 37 No. 7 www.pjms.org.pk 1781
Authors:
1. Dr. Shahid Ahsan, MPhil (Bio), MPhil (NCD), PhD fellow
Department of Biochemistry,
Jinnah Medical & Dental College,
Karachi, Pakistan
2. Dr. Muhammad Saleh Memon, FRCS(Eden)
Department of Research,
3. Dr. Sadia Bukhari (MS Ophth)
Department of Ophthalmology,
4. Mr. Tauseef Mahmood, M.Sc. (Statistics)
Department of Research,
5. Mr. Muhammad Faisal Fahim, M.Sc. (Statistics)
Department of Physical Therapy,
Bahria University Medical & Dental College,
Karachi, Pakistan.
6. Dr. Uzma Haseeb (FCPS)
Department of Ophthalmology,
7. Mr. Muhammad Arslan (MCSW)
Department of Research & Excellence,
Al-Tibri Medical College,
Karachi, Pakistan.
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Isra Postgraduate Institute of Ophthalmology,
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Authors’ Contribution:
MSM manuscript writing & final review.
SA manuscript writing, critical review & literature
search.
SB did final review of the article.
TM did data collection, summarizing of data &
editing of manuscript
MFF did Statistical analysis and result write up.
UH review from clinical point of view as an
ophthalmologist
MA design of study and comments on review
article.
Visual outcomes of cataract surgery