Objectives: To assess the awareness of diabetic patients about diabetic retinopathy. Method: The cross-sectional study was conducted at the Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan, from April 2018 to April 2019, and comprised diabetic patients of either gender aged 21-80 years. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic, diabetes and diabetic retinopathy characteristics. Fundoscopic examination was done, and the presence and stage of diabetic retinopathy were documented. Data was analysed using SPSS 20. Results: Of the 132 subjects, 9(6.8%) were male and 123(93.2%) were females. The majority 64(48.5%) was aged 61-80 years. Overall, 74(56.1%) patients were aware that diabetes could affect their eyes, 57(43.2%) were never diagnosed with diabetic retinopathy, 76(57.6%)  had gained information about diabetic retinopathyfrom ophthalmologists, 61(46.2%) and 29(22%) respondents reported that eyes should be examined ‘only when vision is affected’ and ‘every 6 months’ respectively, 98(74.2%) said the biggest barrier in getting eyes examined earlier was ‘lack of knowledge’, 23(17.4%) believed surgery was done for diabetic retinopathy treatment and 33(25%) believed that surgery, laser and injections all can be used.  Significant relationship of diabetic retinopathy was found with duration of diabetes and the general health status (p<0.05). Conclusion: Though more than half the patients were aware that diabetes could affect the eyes, awareness of diabetic retinopathy and its consequences was low. Key Words: Awareness, Diabetes mellitus, Diabetic retinopathy, Continuous...

Purpose:  To determine the immediate effect of intravitreal Bevacizumab on intraocular pressure (IOP) in eyes with retinal vascular disorders. Study Design:  Interventional case series. Place and Duration of Study:  Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, from January 2019to July 2019. Methods:  One hundred and thirty one patients were included in this study using non probability consecutive sampling. IOP was measured before intravitreal injection (baseline) and at 5 and 30 minutes post-injection. Descriptive statistics were obtained using SPSS version 21.0. Results:  One hundred and thirty one eyes of 131 patients were observed for IOP change after intra vitreal injection of Bevacizumab. Among them 23 (18%) were males and 108 (82.4%) were females. Mean age was 57.57 ± 13.09 years. Mean IOP at baseline was 16.16 ± 2.52 mmHg. At 5 minutes after injection, 108 eyes (82.4%) had raised IOP, maximum IOP recorded was 44 mmHg. There was a statistically significant correlation between IOP at baseline and 5 minutes with p = 0.005 (≤0.05). At 30 minutes, 94 eyes (71.7%) had IOP fallen back to normal. Statistically, an insignificant correlation was present between IOP at baseline and 30 minutes (p = 0.081) post-injection. IOP rise was not significantly correlated to gender, age, hypertension and asthma at any interval (p value > 0.05). However, IOP rise was significantly correlated in diabetic patients at 30 minutes. Conclusion:  IOP elevation has been observed after intravitreal bevacizumab in immediate post-injection period which warrants the monitoring of IOP in this critical period to avoid serious blinding complications. Key Words:  Bevacizumab, Vascular endothelial growth factor, Intraocular pressure, Goldmann applanation tonometer.

Objective: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. Methods: The is a prospective cohort study carried out from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital (FFH) Rawalpindi. A total of 65 eyes of 65 patients of corneal ulcer meeting the inclusion criteria were evaluated and corneal scrapes were sent for microbiological assessment.  Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity (BCVA), treatment and complications. Results: Out of 65 eyes of 65 patients, 40 (61.5%) were females and 25 (38.4%) were males. Most common local risk factor was ocular surgery (29.2%) followed by ocular trauma (23.1%). Diabetes was present in 44.6% of the cases. Culture results after corneal scrapings were positive for 39 (60%) of the total samples, while 26 (40%) had no growth. Bacterial growth was present in 51.3% of eyes, fungal in 28.2% while 20.5% of the eyes were infected with polymicrobial organisms. Most common pathogens were Pseudomonas (25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up period 40 cases (61.5%) showed improvement. Conclusion: This study concluded that isolated Pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are very much needed in developing countries to avoid blindness due to keratitis. Keywords: Infective keratitis, risk factors, corneal ulcer, culture sensitivity.

Objective:To compare the prophylactic use of antibiotic with placebo to prevent post intra-vitreal endophthalmitis and other complications.Methods:A prospective, cohort study was conducted at Ophthalmology Department, Fauji Foundation Hospital (FFH), from June 2016 to July 2017. A total of 1082 eyes of 673 patients were enrolled in this study. Patients were selected at non-random and divided into two groups. In Group-I, non – exposed, placebo eye drops were given after intravitreal bevacizumab injections and in Group-II, exposed, ofloxacin eye drops were given after intravitreal bevacizumab injections.Results:Total 1082 eyes were given intravitreal bevacizumab injection in 673 patients. No patients in Group-I, non – exposed, receiving placebo eye drops developed post intra vitreal endophthalmitis, whereas only 01 (0.1%) patient developed post intravitreal endophthalmitis in Group-II, exposed, receiving ofloxacin eye drops. In inferential statistics the P- value was also statistically insignificant [x2 (1, N=1082) =0.95, P>0.05]Conclusion:This study showed that topical antibiotic, as a prophylaxis after intravitreal injections has no role in the prevention of post intravitreal endophthalmitis and other complications.

PURPOSE: To determine the safety of multiple doses preparation of bevacizumab from single vial in minor theatre in reducing the frequency of endophthalmitis. STUDY DESIGN: Retrospective exposure study PLACE AND DURATION OF STUDY: Department of Ophthalmology, Fauji Foundation Hospital (FFH), Rawalpindi from June 2016 to March 2018. MATERIAL AND METHODS: 1690 eyes belonging to 1001 patients was included using computer logs of patients receiving intravitreal bevacizumab (IVB). In FFH, we allocate three consecutive days every month in order to administer IVB. Approximately 50 patients were typically given IVB over three-days period.1-2 ml (depending upon the number of patients) of bevacizumab was withdrawn in a 3 cc syringe.1 cc insulin syringe with 29 G needle was taken and, 0.05 ml (1.25 mg) bevacizumab was injected from behind using the 3 cc syringe, resulting in preparation of 10-20 injections of IVB. The bevacizumab vial was then stored at 4 degrees Celsius. RESULTS: Total 1690 eyes belonging to 1001 patients were analyzed. The occurrence of endophthalmitis was 2/1690 (0.12%) corresponding to a 95% CI of 0.03%-0.43%, which does not represent an increase in cases as compared to endophthalmitis resulting from using a compounding pharmacy. CONCLUSION: Whereas, a priori, it seems reasonable to assume that aliquot preparation and storage of bevacizumab for intravitreal use particularly by a compounding pharmacy is safer. We, however, show that our preparation of IVB from single vial technique using proper sterilization is equally safe. Due to the reduced cost of our technique, we recommend it, particularly in the developing world.