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.

Purpose:  To compare the control of intra ocular pressure (IOP) after trabeculectomy with adjunctive use of Mitomycin–C (MMC) versus Bevacizumab. Study Design:  Quasi experimental study. Place and Duration of Study:  Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi, from August 2017 to August 2019. Methods:  One hundred and six patients of either gender, fulfilling the inclusion criteria were planned for trabeculectomy with adjunctive use of Mitomycin-C (MMC) or Bevacizumab. Each group consisted of 53 patients (53 Eyes). The patients diagnosed with Primary Open Angle Glaucoma (POAG) with IOP ? 21 mm Hg and not controlled with topical anti-glaucoma medication were selected. Data were analyzed by using SPSS Version 22.0. Independent sample t test was used to check significance between two drugs. Paired sample t test was used to check significance of pre and post-operative IOP. Results:  Mean age of patients was 56.67±7.34 years. Mean preoperative IOP was 31.51 ± 9.66 mm Hg in MMC group and 29.21 ± 7.69 mm Hg in Bevacizumab group. At first postoperative day, mean IOP after use of MMC was 14.75 ± 9.46 mm Hg and for Bevacizumab was 15.07 ± 6.47 mm Hg (p-value 0.001). Similarly, at one year follow-up, mean IOP for MMC group was 11.26 ± 2.31 mm Hg and for Bevacizumab was 11.73 ± 2.12 mm Hg(p-value 0.001). Conclusion:  There was significant reduction in IOP in both MMC and Bevacizumab groups. However, the difference between the two groups was not statistically significant at mean follow-up of one year. Key Words:  Primary Open Angle Glaucoma, Mitomycin–C, Intraocular Pressure, Bevacizumab, Trabeculectomy.

Purpose:  To find out visual outcome of cataract surgery at secondary eye care hospital in Karachi, Pakistan. Study Design:  Surgical audit. Place and Duration of study:  Al-Baseer Eye Hospital, Karachi from January 2019 to January 2021. Methods:  A total of 1540 cataract surgeries were performed. Patients referred from distant eye camps (outside of city limits) were not included. Data collection was done using hospital medical records on patient’s age, sex, pre-operative best-corrected visual acuity (BCVA), surgical complications, visual acuity(VA) at 1st post-operative day, 1, 3 and 4 – 16 post-operative weeks, BCVA at 4 – 16 post-operative weeks and causes of poor visual outcome (BCVA worse than 6/60) at 4 – 16 post–operative weeks. For data analysis, IBM SPSS Statistics 23 was used. Results:  Out of 1540 cataract surgeries, 81% (1248) cases underwent phacoemulsification with intraocular lens implantation. Mean age at the time of surgery was 56.24 ± 11.45 years. Males were 54.9% (845) while 45.1% (695) were females. Rate of intraoperative complications was 0.9% (14 cases). Posterior capsule rupture occurred in 0.8% (13 cases), and zonular disinsertion in 0.1% (1 case). At 4 – 16 weeks post-operatively, follow–up rate was 53.8% (828 patients); and the percentages of patients with good, borderline and poor BCVA were 94.7% (784 cases), 2.3% (19 cases), and 3.0% (25 cases) respectively. Conclusion:  Good visual outcome can be obtained after cataract surgery at a secondary eye hospital, provided the surgeons and operating room team are trained, well equipped and follow aseptic measures. Key Words:  Phacoemulsification, Cataract, Posterior capsule, Blindness.

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.