Purpose:  To compare the post-operative appearance of external Dacryocystorhinostomy scar resulting from W and C shaped incisions. Study Design:  Interventional case series. Place and Duration of Study:  Khalid eye clinic, Karachi, from July 2018 to June 2019. Methods:  We recruited ninety-six patients of nasolacrimal duct obstruction by convenience sampling technique. Age ranged from 20 to 50 years and both genders were included. Two groups were made. Group A comprised of patients who underwent external Dacryocystorhinostomy (Ex-DCR) surgery through W shaped incision and group B patients underwent Ex-DCR with curvilinear C shaped incision. Main outcome measure was to observe minimal to no visible scarring at wound site after six months of follow up. All patients were explained about the difference in incision technique and consent was obtained from each patient. Results:  Mean age was 34.3 ± 6.897 years. There were thirty-six (37.5%) males and sixty (62.5%) females. Right side was affected in forty-six (47.9%) cases whereas left side was involved in fifty (52.1%) cases. In Group A, 20 (41.6%) out of 48 patients, whereas in Group B, 38 (79.2%) out of 48 patients had no visible scar at all and it was statistically significant with a p-value of < 0.05. Suture abscess developed in four (8.3%) patients in group A, no other serious complications were observed in either group. Conclusion:  Curvilinear C shaped incision in Ex-DCR has better cosmetic outcome. Key Words:  External dacryocystorhinostomy, C shaped incision, W shaped incision.

Purpose:  To study the effect of Triamcinolone Acetonide injection into the ostium through the external wound after one week of external Dacryocystorhinostomy. Study Design:  Quasi experimental study. Place and Duration of Study:  Khalid Eye Clinic, Karachi, from July 2018 to June 2019. Methods:  This study included forty patients with age ranging between 18 to 36 years. All patients had obstruction of the nasolacrimal duct. Patients were categorized into two groups. Both groups underwent external dacryocystorhinostomy with silicone intubation, with the difference being that patients in group A were injected with 20 units of Triamcinolone acetonide 40 mg/ml into the ostium through wound using 27 gauge needle, one week after the surgery. Group B did not receive any injection. Both groups were followed for a period of four months, at which time the silicone tube was removed and patency of lacrimal system was ascertained via syringing with balanced salt solution through the lacrimal puncta. Main outcome measure was the success rate of procedure. Results:  The mean age of the patients was 27.1 ± 5.48 years. Success rate was 100% among the patients of group A and 85% in the patients of group B at the end of the four months followup period. However, the results were statistically insignificant (p = 0.115). Conclusion:  Although statistically insignificant but clinically Triamcinolone Acetonide proved helpful in reducing fibrosis and ostium granuloma formation in patients with Ex-DCR. Thus preventing failure of external Dacryocystorhinostomy. Key Words:  Triamcinolone acetonide, external dacryocystorhinostomy, DCR.

Purpose: To study the results of a modified technique of Entropion correction at a Tertiary care hospital.Study Design: Quasi experimental study.Place and Duration of Study: Layton Rahmatullah Benevolent Trust (LRBT), a tertiary care teaching Eyehospital, Korangi, Karachi, for a duration of six months, from January 2018 to June 2018.Material and Methods: Patients with senile entropion were included in the study. Patients with recurrententropion, cicatricial entropion, chronic/acute ocular and adnexal infection were excluded. Three equally spaceddouble-armed 6–0 vicryl horizontal mattress sutures were used to close the skin and orbicularis muscle of thewound with a bite of the retractors in the center and a 5 mm silicone tube bolster place in the superior loop. Postoperativetreatment of antibiotics, anti-inflammatory drugs and topical lubricant eye gel were given. Patients wereexamined on 11stpost operative day and then weekly interval for up to one month and thereafter every month forup to six months.Results: There were 40 eyes of 30 patients with ages ranging from 50 to 65 years. Twenty (66%) patients hadunilateral repair and 10 (33%) had bilateral repair done. No recurrence was seen in 39 (97.5%) eyes at the endsix months after surgery. Out of the 40 patients, only 2 (5%) patients complained of heaviness which went awayeventually with the disintegration of the external tamponade.Conclusion: This modified technique of entropion repair using skin excision with retractor plication in the woundhas a favorable outcome with minimum recurrences and complications.

Background: A gold standard surgical technique, trabeculectomy is used in the management of glaucoma which is not controlled medically to lower the intraocular pressure (IOP) by creating a conduit via the sclera via which aqueous humor passes into the subconjunctival space through the anterior chamber. Objective: This study assesses the reduction in intraocular pressure (IOP) with two suturing techniques during trabeculectomy with a triangular shaped scleral flap. Method: This study was carried out from January 2019 to June 2019 at BHY Hospital, Karachi and engaged patients belonging to either gender between 40 to 60 years of age. Patients included had primary open angle glaucoma with IOP > 24 mmHg despite full medical treatment. Patients having other types of glaucoma or previous history of undergoing trabeculectomy were excluded from the study. Trabeculectomy with triangular shaped scleral flap was performed on patients of both the groups with the difference being the number of sutures placed and their site. In group A, flap was approximated using a single suture, applied at the apex of the triangular tip, whereas two sutures were passed in group B on each side of the triangle close to the flap apex. Results: The study comprised a total of twenty-four patients divided in two equal groups. Mean age was 49.3±3.61 years. Mean pre-operative IOP in all the patients was 26.9±1.48 mmHg whereas post-operative mean IOP at the end of follow up was 14.0±2.08mmHg in group A and 15.1±1.67mmHg in group B patients (p = 0.181). Two patients of group A reported hypotony in the immediate postoperative period which was managed conservatively where as one patient from group A and one patient from group B required revision surgery owing to episcleral fibrosis. Conclusion: Both techniques were found to be equally effective for lowering the IOP with similar minimal risk profile.

Purpose:  To share the results of Levator resection with additional blepharoplasty in patients with ptosis. Study Design:  Interventional case series. Place and duration of study: This study was carried out at Khalid eye clinic, Karachi, from January 2019 to June 2019. Methods: We recruited twelve patients belonging to either gender with ages ranging from 18 to 35 years. Patients with moderate to severe ptosis with fair to good Levator function were included in the study. Whereas, patients with previous history of eyelid procedure or any bleeding diathesis were excluded. All patients were briefed about the study dynamics and complete ocular examination along with ptosis evaluation were performed. Levator resection was done with additional blepharoplasty. The amount of skin removal was solely dependent upon the surgeon’s clinical judgment. Main outcome measure was cosmetic appearance by assessing the vertical fissure height as compared to the contra lateral eye, and the amount of overhanging skin at the lid crease as judged by the patients and the oculoplastic surgeon. Result:  This study included thirteen eyes of both genders with a mean age of 23.7±4.19 years. Twelve out of thirteen eyes had a satisfactory final cosmetic appearance, and were also graded as excellent by another oculoplastic surgeon. One patient required revision of surgery for the overhanging skin at the lid crease. Conclusion:  Additional blepharoplasty with Levator resection can be a good option for ptosis correction and it provides a good aesthetic appearance. Key Words:  Ptosis, Levator resection, Blepharoplasty.