Purpose: This study evaluated the effect of preoperative brimonidine tartrate 0.2% on intraocular pressure (IOP) during robotic-assisted laparoscopic radical prostatectomy in steep Trendelenburg position (sTBURG). Materials and Methods: In this prospective randomized controlled masked interventional trial, eligible patients scheduled for robotic-assisted laparoscopic radical prostatectomy in sTBURG at the Toronto General Hospital had one eye randomized to placebo (artificial tears) or drug (brimonidine tartrate 0.2%) preoperatively. Visual acuity (VA), tonometry, disc photography, visual field (VF), and retinal nerve fiber layer (RNFL) assessments were performed preoperatively and postoperatively. A standardized anesthetic protocol was followed intraoperatively. IOP was measured using Tono-Pen AVIA (Reichert Inc., New York, NY) as follows: preanesthesia supine, anesthetized supine, hourly in sTBURG and awake supine. The primary outcome was IOP in sTBURG in the drug group compared with the placebo group. Secondary outcomes were changes in VA, VF, RNFL thickness, mean arterial pressure, and ocular perfusion pressure. This study was approved by University Health Network Research Ethics Board. Results: In total, 26 eligible patients, mean age 61.9±5.1 years, were randomized to brimonidine (11 patients) and placebo (15 patients). Baseline IOP was not significantly different between the drug and placebo groups (P=0.42). Significant and sustained IOP elevation of >1.5X baseline in the sTBURG was noted in both groups. The mean IOP 1 hour after sTBURG was 29.4±6.9 and 27.2±3.4 mm Hg in the drug and placebo groups, respectively (P=0.35). No significant changes were noted in VA, VF, or RNFL. Conclusions: Significant and sustained IOP increases occur during sTBURG. Preoperative brimonidine does not prevent IOP spikes in sTBURG.

This study aimed to compare medical students' satisfaction with their choice of the medical field in their fifth year to their first year of MBBS and to compare speciality choices and career plans between public and private medical students. It was an online survey conducted from December 2020 to April 2021. Two consecutive classes of final-year medical students from five medical schools (2 public and 3 private) were included. They were asked about their satisfaction with the medical profession, intentions to practice abroad, intended speciality, and career plans in the final year and the first year of medical school via a 24-item semi-structured pre-piloted ques-tionnaire. Of 468 responses (34.41% response rate), 331 (70.7%) were females. There was a significant change (p = 0.002) in the inten-tion of students to practice abroad, however, no significant change (p=0.11) in their satisfaction with the medical profession was observed.

Purpose: To determine the outcomes of trabeculectomy in patients with open angle glaucoma at a newly established glaucoma clinic in a tertiary care hospital of Khyber Pakhtunkhwa. Study Design: Retrospective chart review. Place and Duration of Study: Glaucoma Clinic, Hayatabad Medical Complex, Peshawar from May 2018 to December 2019. Methods: A retrospective chart review of patients of 18 years age or above and who underwent trabeculectomy for open angle glaucoma, with at least one follow-up visit were included. Data was collected for age, gender, type of glaucoma, preoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of pre-operative/post-operative topical anti-glaucoma medications, indication for trabeculectomy, preoperative comorbidities and postoperative complications. Data were analyzed using SPSS version 23. The student’s paired t-test was used for comparative analysis of the same group. A p-value of < 0.05 was considered significant. Results: A total of 20 eyes of 20 patients were included in this study, 13 (65%) patients were males, and the mean age was 54.60 ± 18.22 years. There was a statistically significant change in mean IOP postoperatively (35.60 ± 13.28 versus 11.2 ± 6.1, P < 0.001) and number of antiglaucoma medication (2.95 ± 1.19 versus 0.4 ± 0.99, P < 0.001). While there was no significant change in best-corrected visual acuity (1.35 ± 0.88 versus 1.06 ± 0.72, p = 0.36). Conclusion: Trabeculectomy performed at the newly established glaucoma clinic showed a significant reduction in Intraocular pressure without compromising the visual acuity of the study participants. Key Words: Trabeculectomy; Open Angle Glaucoma; Intraocular pressure.

Purpose: To determine the early and late complications of Ahmed Glaucoma Valve (AGV) implant surgery. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology department of MTI-Hayatabad Medical Complex Peshawar, from May 2018 to February 2023. Methods: All the patients between May 2018 and February 2023 who underwent AGV implant were included in the study. Data included patient's age, gender, indications for surgery, type of AGV implant used, length of follow-up period, intraocular pressure (IOP), number of topical glaucoma medications used, early and late complications, and the final outcome. Continuous variables (duration of follow-up, best corrected visual acuity, IOP, and number of topical anti-glaucoma medications) were represented in means and standard deviations. Paired t-test was applied for comparison of means between baseline and last follow-up data. A p-value of < 0.05 was considered statistically significant. Results: A total of 28 eyes were included. Mean age of the patients were 28.75 ± 20.5 years. Duration of follow-up was 213.96 ± 169.33 days. There were 53.85% females. Commonest indication was congenital glaucoma 7 (25%). Majority, (n = 18, 64.3%) of the eyes had previous cataract surgeries followed by glaucoma, 13 (46.4%). The commonest early post-operative complication was hyphema (25%) and commonest late complication was hypertensive episode 32.1%. Majority of the eyes 23 (82.1%) did not require any further intervention for these complications. Conclusion: Majority of AGV complications are self-limiting, necessitating just conservative therapy. However, serious complications might happen that could lead to blindness, therefore the surgeons should have strategies for treating or preventing them.

OBJECTIVES: To compare the effect of intravitreal-bevacizumab (IVB) and intravitreal-triamcinolone (IVT) with IVB alone on visual acuity (VA) and central foveal thickness (CFT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). METHODS: This quasi-experimental study was conducted from June 2018 to December 2018 on patients with ME secondary to CRVO, admitted at Hayatabad Medical Complex, Peshawar, Pakistan. Out of thirty patients included in this study, fifteen were included in Group-A (received combination therapy IVT and IVB) and 15 in Group-B (received IVB alone). The subjects were followed up at 3^rd and 6^th month post-treatment and changes in VA (logMAR) and CFT were recorded at each visit. The comparative analyses of variables were carried out with-in the groups and between the groups. RESULTS: Mean age of patients was 60.93±4.38 years (group-A) and 60.73±3.67 years (group-B). Mean VA at baseline & 6^th month was 0.87±0.09 & 0.32±0.06 in group-A as compared to 0.88±0.10 to 0.44±0.06 LogMAR units in group-B respectively (p<0.001). Mean CFT at baseline & 6th month was 673.67±38.33 & 264.4±16.73 in group-A as compared to 674.07±36.32 & 271.01±20.14 μm in group-B respectively (p<0.001). There was no significant difference in CFT between the two groups at 3^rd month (p=0.84) and 6^th month (p<0.33) post-treatment, although it was statistically significant when compared within the groups. CONCLUSION: Combined treatment is more effective than IVB alone in improving VA in CRVO related ME. However, the effect of combined treatment on CVT is not superior to IVB alone.

Objective: To compare the safety and efficacy of ultra-widefield fluorescein angiography-based targeted retinal photocoagulation with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy. Methodology: This randomized controlled trial was conducted from September 1, 2022, to February 28, 2024. Patients with proliferative diabetic retinopathy were randomly allocated to targeted retinal photocoagulation (TRP) and panretinal photocoagulation (PRP). In TRP group, the laser was applied only to the ischemic area demarcated by ultra-widefield fluorescein angiography, whereas in PRP group, the conventional PRP laser photocoagulation protocol was followed. Data was gathered for the treatment effects on best corrected visual acuity (BCVA), central macular thickness (CMT), mean deviation (MD) and visual field index (VFI). Results: A total of 120 participants were recruited during the study period, with 60 in each group. The mean age was 65.66 ± 9.33 years with 64 (53.3%) males. There was no statistically significant difference between the two groups at baseline and after the treatment for BCVA, CMT, MD and VFI. When compared within the groups, CMT improved from baseline which was statistically significant (p=0.002) in TRP group. The PRP group also showed significant improvement in CMT from baseline (p=0.01), but MD and VFI worsened significantly from the baseline (p<0.001). Conclusions: Targeted retinal and panretinal photocoagulation are equally effective in reversing proliferative diabetic retinopathy, but panretinal photocoagulation negatively affects mean deviation and visual field index.