Purpose:  To assess post-operative cosmetic and functional results of external Dacryocystorhinostomy with Subciliary incision in adults with primary naso lacrimal duct obstruction (NLDO). Study Design:  Quasi experimental study. Place and Duration of Study:  Oculoplasty clinic, Al Ibrahim Eye Hospital, Malir, from July 2016 to September 2017. Material and Methods:  Hundred eyes of hundred patients were included. Inclusion criteria was all the patients between the ages of 20 to 70 years having epiphora with diagnosis of NLDO, chronic Dacryocystitis or Mucocele. Patients having ectropion or entropion of inferior punctum were excluded from the study. DCR with intubation was performed through Sub ciliary incision. Inner canthus was photographed with a Nikon D70S digital camera at 1, 3 and 6 months after surgery. Functional success was determined by subjective improvement in watering and patent drainage passage on syringing. Cosmetic result of the scar was assessed by subjective satisfaction of the patient and grading of the subciliary incision scar according to a four level scale by two ophthalmologists. SPSS version 20.0 was used to analyze the data. Result:  DCR was done on 100 eyes in 100 patients. Functional and cosmetic success was noted in 90 (90%) eyes. 83 patients attained successful functional outcome, which was confirmed on syringing. On objective grading of the scars by ophthalmologist at the final follow up it was observed that 85 patients had invisible scar. Whereas, 2 had moderately visible scar and 3 patients had minimally visible scar. Subjective grading revealed 85 scars to be invisible, 2 moderately visible and 2 minimally visible. Conclusion:  Post-operative cosmetic as well as functional results of subciliary incision in external Dacryocystorhinostomy were found to be highly encouraging.

Objective:To study the outcomes of intravitreal injection of Bevacizumab and laser photocoagulation in the treatment of diabetic macular edema (DME).Methods:Seventy-two eyes of 59 patients with diabetic macular edema were divided into two groups of 41 eyes (Group-A) and 31 eyes (Group-B). Subjects in group-A were treated with three intravitreal injections of Bevacizumab (IVB), and that of group-B with macular photocoagulation. Duration of study was 9 months. Follow up pattern for both groups was1, 2, 3 and 6 months. Best Corrected Visual acuity on log MAR (BCVA) for distance as well as near in each visitwas recorded. Retinal OCT for central macular thickness (CMT) was performed on baseline. SPSS version 20.0 was used to analyze the data.Results:Mean age of the patients was 53.76 ± 8.82 ranging to 36-71 years. Out of 59 patients, 40 (67.8%) were male and 19 (32.2%) female. It was observed that the difference of results among both groups was not significant. Fig.2 documents visual acuity recorded as Improved; Stable and Worse.Conclusion:The improvement in BCVA was significant at 6 months in both treatments. The final improvements in BCVA has been almost similar between both the treatment groups although it was noted that IVB group showed early improvement in BCVA at follow-ups of 1 and 3 months. A long term follow-up is required in these cases to see the effect of both these treatment strategies.

Purpose:  To find out the anatomical and functional outcomes of rectangular three-snip punctoplasty in primary acquired punctal stenosis. Study Design:  Quasi Experimental study. Place and Duration of Study:  Isra Postgraduate Institute of Ophthalmology, Karachi, from July to December 2020. Methods:  Patients of age 50 years and above, from either gender with primary acquired punctal stenosis of any grade (0-5) presenting with epiphora were recruited from Oculoplasty Outpatient department. Punctal stenosis with secondary causes like lesion on or around punctum or lacrimal drainage system and history of surgery or radiotherapy, lower canalicular or common canalicular stenosis were excluded from the study. Punctal stenosis was graded by Kashkouli scale and epiphora by the Munk score. After local anesthesia, two vertical cuts were given in the posterior wall of the punctum and a third cut was given horizontally to connect the vertical cuts. This resulted in a posterior ampullectomy. Syringing and probing was done to assess patency of the lower lacrimal drainage system. The patients were followed up for 6 months to assess for anatomical and functional success. Results:  At the end of six month anatomical success was achieved in 85% cases and functional success in 70% patients. Fifteen percent patients suffered re-stenosis of punctum. Conclusion:  Rectangular punctoplasty is a functionally successful procedure for treating primary acquired punctal stenosis. The anatomy is least distorted and long-term recurrence rate is also low. Key Words:  Epiphora, Primary acquired punctual stenosis, Punctoplasty, Munk score.