Purpose:  To determine the frequency of myopia among children and to find out the role of smart phone usage and outdoor activities in myopia development and progression. Study Design:  Descriptive cross-sectional study. Place and Duration of Study:  Ophthalmology department DHQ-UTH Gujranwala, from January 2019 to June 2019. Methods:  After approval from the hospital ethical committee and informed consent from each participant, a descriptive cross-sectional study was carried out with a sample size of 250 patients. Patients of either gender between 4 – 14 years of age using smart phones for ≥ 2 hours daily and found to have refractive error were included in this study. Routine ophthalmic examination was carried out, data was recorded on proforma, and daily usage of smart phones and weekly outdoor activity in hours along with school grade, family history and previous history of using refractive glasses was also determined and documented. Data was analyzed using SPSS v.20 Results:  250 patients were included in this study, out of which 142 (56.8%) were male and 108 (43.2%) were female. Mean age was 10.1 ± 2.45 years. Mean outdoor activity was 0.95 ± 0.98 hours per week while mean daily smart phone usage was 2.89 ± 0.93 hours. Pearson correlation coefficient for daily smart phone usage and UCVA was +0.297 (0.3) which showed a positive moderate association between two variables while the value obtained for UCVA and weekly outdoor activity was – 0.51 that depicted a negative strong association. Conclusions:  In conclusion, myopia occurrence is higher among smart phone users showing a moderate positive correlation while outdoor activities reduce myopia prevalence and progression depicting strong negative correlation. Key Words:  Refractive Errors, Myopia, Visual acuity, Smartphone.

Purpose: To determine the efficacy of 0.03% dermatological tacrolimus ointment in patients with refractory vernal keratoconjunctivitis Study Design: Quasi-experimental study Study Place and Duration: Eye Department, DHQ-Teaching Hospital, Gujranwala, Pakistan from April 2018 to March 2019 Material and Methods: After approval from hospital ethical committee and obtaining written informed consent from each patient/guardian, patients of either gender between 4-16 years of age with VKC not responding to conventional treatment for more than 8 weeks or having steroid-induced complications were included in this study. Dermatological tacrolimus ointment 0.03% started to be placed in inferior fornix in BD frequency along with topical lubricants. Patients were followed up on a regular schedule. Individual symptoms score was assessed from the questionnaire and signs score from observer’s clinical assessment. Data were analyzed using SPSS v23.0. P-value <0.05 was considered as statistically significant. Results: 40 eyes of 20 patients were included in this study. Out of which 4(20%) were female and 16 were male (80%). Mean baseline score for clinical symptoms was 6.65±1.81 that reduced to 1.65±0.81 after 12 weeks treatment course of tacrolimus with a significant p-value of 0.006 (p<0.05). Mean baseline score for clinical signs was 5.9±1.59 that improved to 1.80±0.83 after 12 weeks treatment course with a statistically significant p-value of 0.003 (p<0.05). Conclusions: In conclusion, topical tacrolimus dermatological ointment 0.03% is highly effective in refractory VKC and can be safely used as an alternative in VKC patients who are steroid-responders.

Purpose:  To determine the relationship between HbA1c and severity of retinopathy in diabetic patients. Study Design:  Cross sectional study. Place and Duration of Study:  Eye department of DHQ-UTH Gujranwala, from July 2020 to Dec 2020. Methods:  An observational cross-sectional study including 100 patients was conducted at eye department of DHQ-UTH Gujranwala from January 2018 to December 2018. After approval from institutional review board, written informed consent with demographic variables was collected from every patient. Patients of either gender between 40-80 years of age with both types I and type II diabetes were included in this study. Complete ophthalmic examination including Best Corrected Visual Acuity, slit lamp biomicroscopy, Goldmann Applanation tonometry and fundus examination carried out. Diabetic retinopathy was classified from grade 0 to grade 5. Results:  Out of 100 patients, 46 (46%) were males and 54 (54%) were females. Mean age was 60 ± 2.4 years with a range of 40 – 80 years among males and 40 – 70 years among females. Forty patients presented with grade 1 diabetic retinopathy and 4% presented with grade 5. Thirty two patients had good glycemic control while 20% had glycemic control of grade III. Patients with grade 4 diabetic retinopathy had the worst glycemic control of HbA1c level of 11.5. Conclusion:  This study concluded that patients with poor glycemic control had severe diabetic retinopathy as compared to the patients with good diabetic control. There is a direct relation between HbA1c level and severity of diabetic retinopathy. Key Words:  HbA1C, Diabetic retinopathy, Non proliferative diabetic retinopathy, Proliferative diabetic retinopathy, Vitreous hemorrhage.

Objective: To determine the frequency and various associations of Marcus Gunn Phenomenon in patients of congenital ptosis. Study Design: Cross-sectional observational study. Place and Duration of Study: Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, from Jun to Sep 2020. Methodology: A total of 100 patients with congenital ptosis were included. Patients with any cause of secondary or acquired ptosis were excluded. Congenital ptosis was classified as simple and complex. Assessment for ptosis severity, presence of jaw winking ptosis, jaw winking severity, refractive error, amblyopia, strabismus, systemic association and family history for congenital ptosis was performed. Results: Simple congenital ptosis was the most common type overall (84%). A total of 60% patients were males and 40% were females. More than 90% of the patients had severe ptosis. Ninety eight percent cases had onset since birth. No patient had systemic association or positive family history. Nine percent frequency of Marcus Gunn Phenomenon was noted with congenital ptosis. All the patients with Marcus Gunn Phenomenon had unilateral presentation. Left eye was affected predominantly (88.89%). A total of 22.22% of the patients with Marcus Gunn Phenomenon had anisometropic amblyopia. No other ocular or systemic association of Marcus Gunn Phenomenon was observed. Conclusion: Simple congenital ptosis is the most common type of congenital ptosis. The authors report 9% frequency of Marcus Gunn Phenomenon with congenital ptosis and left side effected predominantly. Anisometropic amblyopia was the major ocular association of Marcus Gunn Phenomenon observed.

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,