Purpose:  To find out the outcomes of suprachoroidal Triamcinolone injection in refractory diabetic macular edema. Study Design:  Quasi experimental study. Place and Duration of Study:  Al-Ehsan Eye Hospital, Lahore from Jan 2020 to 31st Dec 2020. Methods:  Sixty-five patients with refractory diabetic macular edema were included. Patients underwent complete ocular history and examination. To document baseline macular edema, SD-OCT was done. The recruited patients received 0.1ml of suprachoroidal Triamcinolone injection (40mg/ml) using a 30 gauge syringe. Follow up was performed at one week, one month and third month after injection. At each follow up, best corrected visual acuity, central macular thickness and retinal nerve fiber thickness were documented. Data was analysed using SPSS version 36.0. Comparison of BCVA, central macular thickness and retinal nerve fibre layer thickness (RNFL) before and after injection was analyzed by paired sample t-test with p value of ≤ 0.05 as significant. Results:  Out of 65 patients, 29 (44.62%) were females. Mean age of patients was 54 ± 8.4 years (range 40 to 80 years). Central macular thickness after suprachoroidal Triamcinolone injection changed from 556.2 ± 10.9 to 313.6 ± 7.2 ųm. Change in visual acuity was 0.9 ± 0.01 to 0.6 ± 0.02. Pre-treatment and post-treatment visual acuities demonstrated a substantial change after undergoing treatment along with decrease in central macular thickness with p value ˂ 0.001. Conclusion:  Suprachoroidal Triamcinolone injection results in anatomical as well as functional improvement in diabetic patients with refractory macular edema.

Purpose:  To compare the results of peri-lesional Triamcinolone Acetonide (TA) with incision and curettage in the treatment of primary chalazia. Study Design:  Quasi experimental study. Place and Duration of Study:  Eye department of District Head Quarter/Teaching Hospital, Gujranwala, from June 2018 to May 2019. Methods:  One hundred and twenty patients with primary chalazion, either gender and age between 10–30 years, were enrolled in this study. They were equally divided into two groups. In group A, incision and curettage was done. In group B, perilesional TA (40 mg/ml) was given.  Followup was done at 5th day, 14th day, 1 month and 3 months. Lesion resolution or recurrence and complications were recorded. IOP monitoring was also carried out at each followup. Results:  Mean age was 18.0 ± 2.14 years with range of 10–30 years. There were 45.0% females and 55.0% males. No statistically significant difference was found in age, gender and complication rates between the two groups. Complete resolution was seen in 95.0% in group A and 88.3% cases in group B. The difference between the two groups was not statistically significant regarding small and medium sized chalazia. In case of large chalazia, 23 out of 24 patients in group A and 19 out of 23 patients in group B showed complete resolution and the difference in success rate of two groups was statistically significant (p = 0.014). Conclusion:  Incision and curettage and perilesional TA injection are equally effective in treating small and medium primary chalazia. While for large chalazia, Incision and curettage offered superior results. Key words: Chalazion, incision and curettage, triamcinolone Acetonide,

Objectives: To evaluate the short-term and sustained intraocular pressure changes after intravitreal bevacizumab in patients with diabetic retinopathy. Method: The quasi-experimental study was conducted at the District Headquarter Teaching Hospital, Gujranwala, Pakistan, from January to December 2020, and comprised diabetic patients of either gender aged 18-60 years with indication for intravitreal bevacizumab. Intraocular pressure was measured at 5, 10 and 30 minutes for short-term elevation, and the patients were followed up weekly for one month to record any sustained elevation in intraocular pressure. Data was analysed using SPSS 25. Results: Of the 42 patients, 20(47.61%) were male and 22(52.38%) were female. The overall mean age was 52.4±5.7 years. Intraocular pressure increased significantly in the short term post-injection (p<0.001), while the difference was not significant in the weekly check-ups (p=0.264). Conclusion: There was short-term rise in intraocular pressure after intravitreal bevacizumab, but no sustained elevation was noted over the following month. Key Words: Vascular endothelial growth factor, Bevacizumab, Intraocular pressure, Diabetic retinopathy.

Purpose: To compare the efficacy of nepafenac 0.3% with nepafenac 0.1% to control postoperative pain and conjunctival redness after cataract surgery. Study Design: Randomized control trial Place and Duration: Ophthalmology Department, DHQ Teaching Hospital, Gujranwala from November 2020 to January 2021. Materials and Methods: A prospective review of 70 patients operated for age-related cataract was done. Patients were divided into two equal groups. Group A patients were given Ilevro eye drops (nepafenac 0.3%) once a day and group B patients were instilled Nevanac eye drops (nepafenac 0.1%) thrice a day. All patients were scored for ocular pain and conjunctival redness on basis of pre-defined scales on one day before surgery and on 1st, 7th and 14th postoperative day. Results from both groups were analyzed and compared using SPSS v 25.0. Results: Out of 70 patients, 35 were put in group A and 35 into group B. Overall 37 (52.8%) patients were male and 33 (47.2%) were female. Patients above 40 years of age were 33 (94.3%) in group A and 35 (100%) in group B. Patients having pain score ≥5 were 30 (85.7%) in group A and 25 (71.4%) in group B on 1st postoperative day, with ≥3 were 1 (2.8%) in group A and 33 (94.2%) in group B at 7th postoperative day and zero on 14th postoperative day. Patients with conjunctival redness ≥2 were 31 (88.6%) in group A and 29 (82.9%) in group B on 1st postoperative day, with ≥1 were 18 (51.3%) in group A and 28 (79.9%) in group B on 7th postoperative day while four (11.4%) in group A and one (2.8%) in group B on 14th postoperative day.   Conclusion: Effect of once daily nepafenac 0.3% on postoperative pain and conjunctival redness was found to be sub-rated against thrice daily nepafenac 0.1% on 1st postoperative day. However, this effect became equal and then slightly superior to that of nepafenac 0.1% on 7th and 14th postoperative days. Key Words: Cataract Surgery, Nepafenac, Postoperative Pain, Conjunctival Redness

Purpose:  To determine the factors that cause delay in Dacryocystorhinostomy in patients with chronic dacryocystitis. Study Design:  Cross sectional survey. Place and Duration of Study:  Ophthalmology Department DHQ Teaching Hospital Gujranwala from February 2021 to May 2021 Methods:  Sixty five ophthalmologists were included in this study. Questionnaire was designed on Google Forms and it composed of four parts. First part included the title and purpose of this study. Second part included professional information regarding qualification and place of practice. Third part included 18 questions that were divided in three sub-sections in terms of factors related to the patient (5 questions), ophthalmologist (9 questions), and health resources provided (4 questions). Responses were recorded in yes/no answers.  Last part comprised of blank space for remarks. The electronic link of questionnaire was shared with the participants of ophthalmology educational groups on WhatsApp, Facebook and E-mail. Data was analyzed using SPSS 23.00 software and results were derived based on questionnaire. Results:  Out of 65 ophthalmologists, 48 (72.7%) agreed that patients suffered from delay in surgical management. Among the hospital related factors, 45 (69.23%) ophthalmologists believe that busy Out patient department accounted for most of the delay. Among patient related factors, 51 (78.46%) ophthalmologists were of the view that patients took the disease lightly as it was not vision-threating. Forty one ophthalmologists (63.07%) reported that there was lack of surgical exposure during training years to learn DCR. Conclusion:  There are various patient related, surgeon related and hospital related factors which play a significant role in delay of surgical management of chronic dacryocystitis. Key Words:  Dacryocystitis, Dacryocystorhinostomy, Epiphora.