Centre for Sight

To investigate the safety and efficacy of combining minimally invasive glaucoma surgery (MIGS) endocyclophotocoagulation (ECP) in advanced primary glaucomas and compare them with those of the current gold standard of phaco-trabeculectomy (PT). This is a retrospective study of subjects with advanced primary glaucomas (primary open angle glaucoma and primary angle closure glaucoma), more than 30 years, and who underwent ECP or trabeculectomy with Mitomycin C along with phaco-surgery. The primary outcome measure was IOP. The secondary outcomes were the number of anti-glaucoma medications (AGMs), best corrected visual acuity (BCVA), total success (defined as complete and qualified), complications, and interventions for these. Twenty-eight eyes with phaco-ECP and a mean follow-up of 18 months were compared to 24 eyes that underwent PT (mean follow-up of 16 months). IOP reduced from 24.9 ± 12.9 to 14.0 ± 2.3 mmHg in the former group, and from 26.7 ± 8.7 to 13.7 ± 3.0 mmHg in the latter (p=.667); AGM was reduced from 3.6 ± 1.0 to 0.9 ± 1.0 and 3.5 ± 1.1 to 1.4 ± 1.5 in each group, respectively (p=.624). No sight-threatening complications occurred in either group; however, BCVA improved significantly in the phaco-ECP group (p=.04). Though complications were more in the PT group, and so were the interventions (excluding suturelysis) they were marginally short of reaching significance (p=.05). No loss of vision occurred in either group. There were two failures in the PT group. Combining ECP with phaco has the potential to be as effective as the current gold standard in advanced primary glaucomas. It is safer with significantly improved BCVA and a much-reduced need for any interventions. Larger studies and longer follow-ups are recommended.

Comparative evaluation of the corneal biomechanical parameters by the dynamic corneal response imaging with CORVIS-ST ST in normal and post-keratoplasty eyes. Cross-sectional observational study of CORVIS-ST imaging of 150 normal corneas and 150 post-keratoplasty corneas was done to evaluate corneal biomechanics of normal Asian-Indian corneas and post-keratoplasty corneas. Data on demographic details, postoperative period, visual acuity (UCVA, BCVA) (logmar units), refraction, axial length (D), corneal topography Scheimpflug's imaging with Pentacam [Anterior-K1(AK1), Anterior-K2 (AK2), Posterior-K1(PK1), PosteriorK2(PK2), Mean keratometry (Kmean), Keratometry maximum (Kmax), Q-value, D-value, Thinnest pachymetry (TP), Corneal elevation [anterior (CE ant) and posterior (CE post)], CORVIS-ST imaging (bIOP, 1st and 2nd Appl time HCT, 1st Appl length, DA, TBI, CBI, HC rad, Vel in and out, DA ratio, IR, Inv CR, SSI, SPA1, ARTh) were recorded. Comparative evaluation of CORVIS-ST in 150 normal corneas [mean age 32.54 ± 10 (9-68) years] and 150 post-keratoplasty corneas [mean age 35.14 ± 16.96 (8-72) years; PK (58), DSAEK (29), DALK (58), HALK (8), and SALK (3)] noted 18 parameters (bIOP, 1st and 2nd Appl time HCT, 1st Appl length, DA, TBI, CBI, HC rad, Vel in and out, DA ratio, IR, Inv CR, SSI, SPA1, ARTh) and showed that 12 of these were statistically different in post-keratoplasty corneas. Parameters of DA, TBI, CBI, IR, and Inv CR were higher, whereas HC rad, SSI, SPA1, and ARTh showed significantly lesser values in post-keratoplasty corneas as compared to normal corneas. Subgroup analysis (PK, DSAEK, DALK, HALK) showed eyes that underwent DSAEK had biomechanical values closest to that of normal corneas. Post-DALK in comparison to post-PK corneas showed significantly higher values in CBI and IR, and lower values in HC rad, SSI, and ARTh (0.87 ± 0.17, 9.9 ± 3.5, 0.85 ± 0.25, 190.92 ± 119.06 and 0.71 ± 0.25, 8.19 ± 1.92, 1.02 ± 0.38, and 340.90 ± 178.37, respectively). Correlational analysis showed significant mild positive correlation of CBI with corneal curvature in normal and post-PK corneas (P = 0.004 and 0.040, respectively). Post-keratoplasty corneas were seen to have lesser biomechanical strength as compared to normal corneas. Post-DSAEK corneas had a better biomechanical strength than other groups and closest biomechanics to normal corneas. Post-DALK in comparison to post-PK corneas showed a lower biomechanical strength in our study.

Familial hypercholesterolemia is a monogenic Mendelian disorder characterized by elevated LDL cholesterol and premature atherosclerotic cardiovascular disease. It is caused by pathogenic variants in LDLR, APOB, and PCSK9, with rarer involvement of LDLRAP1 and APOE. Despite advances in molecular diagnostics, no causative variant is identified in approximately 25-75% of clinically diagnosed cases. Familial hypercholesterolemia is currently defined as an autosomal semi-dominant disorder with a gene-dosage effect, whereby biallelic pathogenic variants result in markedly more severe phenotypes than heterozygous variants. Terminology for homozygous familial hypercholesterolemia has been refined. Former terms such as 'true homozygote', 'compound heterozygote', and 'double heterozygotes' have been replaced by monogenic biallelic forms, with identical or different variants, and digenic biallelic forms involving two familial hypercholesterolemia-associated genes. Polygenic risk score (PRS) and lipoprotein(a) measurement help explain familial hypercholesterolemia-like phenotypes in patients without a monogenic cause and enable determination of polygenic severe hypercholesterolemia and/or hyperlipoproteinemia(a). Although advances in molecular genetics have improved variant detection, interpretation remains challenging. Integration of case-level data and functional studies, including high-throughput LDLR assays and APOB structural analyses, has enhanced variant pathogenicity classification. Combining monogenic variant detection, PRS determination and lipoprotein(a) assessment enables comprehensive diagnosis, tailored risk stratification, and personalized familial hypercholesterolemia management.

Analysis of 1175 Korean adults in the 2019 KNHANES study found that sensitization to house dust mites and birch pollen significantly increased glaucoma risk, while oak pollen sensitization showed a protective effect. The relationship between allergen sensitization and glaucoma remains poorly understood. This study investigated the association between specific allergen sensitization patterns and glaucoma risk using data from the 2019 Korea National Health and Nutrition Examination Survey. In this population-based cross-sectional study, we analyzed 1175 adult participants (≥19y) who completed ophthalmologic examinations and allergen sensitization assessments. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Specific IgE antibodies against 7 common allergens were measured using ImmunoCAP assays, with significant sensitization defined as IgE ≥3.5kU/L. We employed the Synthetic Minority Over-sampling Technique to address class imbalance. Multiple logistic regression models were employed to evaluate associations between allergen sensitization and glaucoma, adjusting for demographic and clinical factors. Among the participants, 50 (4.3%) were diagnosed with glaucoma. Analysis of allergen sensitization patterns revealed house dust mites as the most prevalent allergen (11.7% overall), with comparable rates between the glaucoma (12.0%) and non-glaucoma groups (11.7%). Birch pollen sensitization followed at 4.1% and 4.0% in the glaucoma and non-glaucoma groups, respectively. Multivariate logistic regression analysis, after adjusting for confounders, identified house dust mite sensitization as having the strongest positive association with glaucoma (OR: 3.08, 95% CI: 1.40-6.77, P =0.005), followed by birch pollen (OR: 2.69, 95% CI: 1.02-7.12, P =0.046). Interestingly, oak pollen sensitization demonstrated a protective effect (OR: 0.24, 95% CI: 0.07-0.81, P =0.022). Our findings suggest a complex relationship between allergen sensitization and glaucoma, with different allergens showing varying associations with disease risk.

The research analyzes the drug trafficking control strategies deployed by the United Nations Office on Drugs and Crime throughout Pakistan. Pakistan faces critical threats to national security combined with public health and economic issues stemming from its position in the worldwide drug trafficking hubs. Pakistani authorities together with the UNODC and international organizations work to combat this issue by launching multiple programs. This research analyzes drug trafficking strategies by investigating their operational practices and both the encountered difficulties and achieved results. This research utilizes quantitative investigation approaches to evaluate UNODC’s anti-drug trafficking efforts in Pakistan by interviewing stakeholders and examining UNODC reports with statistical drug seizure and arrest data to conduct a thorough assessment. The research identifies both potential strengths and vulnerabilities which exist in modern interventions and proposes methods to boost future intervention performance. The progress made requires more strategic collaborative work because the region needs better methods to fight its complex drug trafficking challenge. The paper examines drug trafficking in Pakistan while discussing UNODC activities together with anti-drug strategies, the narcotics trade, international cooperation, security challenges, public health aspects, drug control policies, regional security and law enforcement approaches.

Purpose The primary aim of this study is to ascertain whether early postnatal weight gain serves as an independent predictor for the severity of retinopathy of prematurity (ROP) in preterm infants. Method In this prospective observational study, 50 preterm infants (<34 weeks GA at birth or <2000 gm BW) in the Neonatal Care Unit were screened for ROP from June 2021 to June 2022. All infants were assessed weekly for postnatal weight gain during the first six weeks of life and the results were correlated with the severity of ROP. Result Out of 50 preterm infants, 25 (50%) developed ROP, and 25 (50%) had no ROP. Type 1 ROP was identified in two (8%) preterm infants. The mean gestational age and birth weight for the ROP group were 29.98 ± 1.80 weeks (SEM 95% CI) and 1161.32 ± 340.55 gm (SEM 95% CI), which were lower than those of the No ROP group, which had 31.94 ± 1.71 weeks (SEM 95% CI) and 1359.80 ± 313.52 gm (SEM 95% CI), respectively. The change in weight (grams) between the ROP and No ROP groups was statistically significant each week, except for the first week. However, for the first six weeks, no statistical correlation was found between Type 1 ROP and Type 2 ROP regarding weight change. Conclusion This study posits that postnatal weight gain, particularly evident in the fourth week, may be a pivotal factor in predicting the onset and severity of ROP in preterm infants. Further research and analysis are required to validate these findings and enhance our understanding of the relationship between postnatal growth patterns and ROP development.

Cognitive impairment in multiple domains was observed in primary open angle glaucoma patients as compared with age and gender-matched healthy controls. Evaluation of cognitive impairment in individuals with primary open angle glaucoma (POAG). In this case-control study, individuals with POAG (cases, n=70) were compared with age-matched and sex-matched healthy individuals (controls, n=70) using detailed ophthalmological evaluation, cognitive assessment, and serum cortisol level. A multitude of tests were employed to comprehensively assess various domains of cognitive function: Addenbrooke Cognitive Examination (ACE-III; attention/orientation, memory, language, verbal fluency, and visuospatial skills), Postgraduate Institute Memory Scale (PGIMS; verbal and nonverbal memory), Wisconsin Card Sorting Test (WCST; nonverbal executive functions), Go No-Go task (GNG; inhibitory control), and Trail Making Test (TMT; attention and working memory). Intraocular pressure and cup disc ratio were significantly higher ( P <0.001), while retinal nerve fiber layer (RNFL) thickness and mean deviation were significantly lower in cases as compared with controls. Cases had significantly lower scores on ACE-III and PGIMS ( P <0.001) and longer test completion time in TMT-A ( P =0.001). The performance of cases was also significantly worse on most parameters of the WCST and GNG tasks. Serum cortisol level was significantly higher in cases (11.75±7.41mcg/dL) compared with controls (7.93±2.39mcg/dL; P =0.02). A significant correlation was observed between serum cortisol level and WCST correct response ( P =0.04), WCST error response ( P =0.002), and total time taken in TMT-A ( P =0.03). Visual field mean deviation also exhibited a significant correlation with serum cortisol level ( P <0.001) and total time taken on WCST ( P =0.03) and TMT-A ( P =0.03). Individuals with POAG exhibited higher cognitive impairment and raised serum cortisol levels than age-matched healthy controls. Early recognition and management of cognitive impairment are pivotal for enhancing the quality of life and implementing comprehensive glaucoma care.