Objective: Present study aims to compare the efficacy of single dose triamcinolone acetonide suspension in suprachoroidal space and intravitreal bevacizumab in primary diabetic macular edema patients. Study design: Prospective observational study Study duration and settings: Study was conducted at department of ophthalmology, Eye Unit III, Mayo hospital Lahore (KEMU) from March 2020 to August 2020. Material and methods: The WHO calculator was used to estimate a sample size of 136 patients (66 patients in each group). Non-probability sequential sampling was used to identify patients.. Intravitreal bevacizumab injections (2.5 mg/0.1 mL) were given to patients in Group A, and triamcinolone acetonide was given to patients in Group B, all at random. After one and three months, patients were reassessed. Results: Total 135 patients were included in study. There were 71(52.2%) male and 65(47.8%) female. Mean age of patients was 41.1±6.9SD. BCVA improved 5 letters after 3 month was significantly high in TA group as compared to IVB (P=0.002). Moreover, CSF decreased at least 10% from baseline after one and three months was comparatively high in TA group (p=0.01 and p=0.04 respectively). Among all the patients in IVB group, 29.5% showed efficacy while in group TA, 37.5% showed efficacy (p=0.03) Conclusion: Triamcinolone acetonide is an efficient drug for management of diabetic macular edema. Triamcinolone had long standing effect as compared to intravitreal bevacizumab on structural and functional outcome of the patients with primary diabetic macular odema. Both interventions are associated with limited complications. Keywords: Triamcinolone acetonide, Diabetic macular edema, Intravitral bevacizumab

BackgroundOver one billion people worldwide live with avoidable blindness or vision impairment. Eye Health Programmes tackle this by providing screening, primary eye care, refractive correction, and referral to hospital eye services. One point where patients can be lost in the treatment journey is adherence to hospital referral.ContextPeek Vision's software solutions have been used in Pakistan with the goal of increasing eye health programme coverage and effectiveness. This involved collaboration between health system stakeholders, international partners, local community leaders, social organizers and “Lady Health Workers”.ResultsFrom the beginning of the programmes in November 2018, to the end of December 2021, 393,759 people have been screened, 26% of whom (n = 101,236) needed refractive services or secondary eye care, and so were referred onwards to the triage centers or hospital services. Except for a short period affected heavily by COVID-19 pandemic, the programmes reached an increasing number of people over time: screening coverage improved from 774 people per month to over 28,300 people per month. Gathering and discussing data regularly with stakeholders and implementers has enabled continuous improvement to service delivery. The quality of screening and adherence to hospital visits, gender balance differences and waiting time to hospital visits were also improved. Overall attendance to hospital appointments improved in 2020 compared to 2019 from 45% (95% CI: 42–48%) to 78% (95% CI: 76–80%) in women, and from 48% (95% CI: 45–52%) to 70% (95% CI: 68–73%) in men. These patients also accessed treatment more quickly: 30-day hospital referral adherence improved from 12% in 2019 to 66% in 2020. This approach helped to utilize refractive services more efficiently, reducing false positive referrals to triage from 10.6 to 5.9%. Hospital-based services were also utilized more efficiently, as primary eye care services and refractive services were mainly delivered at the primary healthcare level.DiscussionDespite various challenges, we demonstrate how data-driven decisions can lead to health programme systems changes, including patient counseling and appointment reminders, which can effectively improve adherence to referral, allowing programmes to better meet their community's needs.

Objective: Objective of our study was to determine accuracy of IOL Master and A scan acoustic biometry in silicon filled eyes in terms mean difference of axial length pre-operatively and mean post-operative refractive error Study design: Comparative cross sectional study Study settings and duration: Study was conducted at department of Ophthalmology (Eye Unit III) Mayo hospital Lahore (KEMU) from November 2019 to April 2020. Material and methods: WHO calculator was used for calculation of patient sample (N=34). Patients were randomly divide in two groups Group I underwent preoperative axial length (AXL) measurement by using IOL Master and by acoustic a-scan ultrasound in Siliconized mode. Results: Total 34 patients were included in study. There were 18(52.9%) male and 16(47.1%) female. Mean age of patients was 44.2±6.4 years. Patients undergone biometry with Master IOL showed better visual acuity (Log Mar) (0.25±0.7, 0.63±0.09, p=0.000), less post-operative refractive error (0.22±0.02, 0.72±0.17, p=0.000) as compared to those in which A scan acoustic biometry was done. A significant difference in post-operative axial length was reported (p=0.04) Conclusion: IOL master is more accurate and reliable method of IOL power calculation resulting in better visual outcomes and less post-operative refractive error as compared to A scan acoustic biometry in silicon filled eyes. Keywords: A scan Acoustic biometry, Axial length, IOL Master

Purpose: To determine frequency of post-operative macular edema in diabetic retinopathy patients having received preoperative intravitreal bevacizumab, after phacoemulsification cataract surgery while compared with the controls. Study Design: Quasi experimental trial Place and Duration of Study: Department of ophthalmology eye unit 3, KEMU /Mayo hospital, Lahore from March 2020 to August 2020. Methods: A total of 60 patients were included in the study and randomly divided into two groups. Patients of study group were given 1.25mg bevacizumab injection by IV route two weeks priority to surgery while nothing was administered in the control group. Before one week of surgery ocular examination and OCT were perfumed and it was repeated after every month of performance of surgery. Allocation of patients was even not known to the researcher to avoid biasness. Components of monthly examination were best correct visual acuity, slit lamp examination and central macular thickness quantification with OCT. Standard cataract surgery was performed in all the patients (phacoemulsification and implantation of monofocal intraocular lens (IOL)). Post-operatively, all patients were given standard treatment i.e moxifloxacin-dexamethasone). Follow up of all the patients was made for consecutive three months on monthly basis to assess outcome variables i.e macular edema was observed keeping in view central macular thickness. Results: In patients of study group, 16.66% had developed macular edema while in control group it was observed in 46% patients. While comparing macular edema between side of eye, study group had 02 (13.33%) patients belonging to right eye while 03(20.0%) had left eye. However, in control group it was 08 (53.33%) and 06 (40.0%) for right and left eyes respectively. Group A had 230.23 ± 32.16 µm central macular thickness while it was 274.21 ± 25.34 µm in group B. Conclusion: In macular edema prophylaxis using preoperative intravitreal bevacizumab is efficacious in comparison with the controls in patients with mild-moderate edema. Keywords: NPDR, Macular edema, Intravitreal Bevacizumab, Phacoemulsification Surgery, Diabetic Retinopathy.