Current Issues
Current Issues - Vol. 21, No. 2, April – June 2025
Al-Shifa Journal of Ophthalmology
Editorial:
Gene Therapy in Ophthalmology: The Future of Inherited Retinal Diseases
Mehmona Asgher
Comparative Efficacy Of Intravitreal versus Posterior Sub-Tenon Triamcinolone Acetonide Injections For Diabetic Macular Edema
Mahwish Shahid, Anum Nadir, Fauzia Naureen, Uzma Rehman, Alizay Gohar, Summaya Anjum
Objective: To evaluate and compare the efficacy and safety of intravitreal versus posterior sub-tenon injections of triamcinolone acetonide in treating diabetic macular edema among patients with diabetic retinopathy (DR).
Methods: A total of 66 participants were enrolled in this randomized controlled trial conducted at Al Shifa Trust Eye Hospital in Rawalpindi. The participants were randomly allocated into two equal groups of 33 each.. The IVTA group received a 4 mg intravitreal injection of triamcinolone acetonide, while the STTA group received a 40 mg posterior sub-tenon injection. Follow-up was conducted one- and three-months post-injection.
Results: Pre-injection central macular thickness (CMT) was similar between groups (IVTA: 375.9 μm ± 103 μm vs. STTA: 380.3μm ± 101 μm, p = 0.921). Post-injection, CMT significantly improved in both groups, with a more prominent effect in the IVTA group (223 μm ± 59 vs. 299 μm ± 79, p = 0.01). Pre-injection best-corrected visual acuity (BCVA) was comparable (IVTA: 0.83 ± 0.1 vs. STTA: 0.80 ± 0.17 LogMAR, p = 0.334), but the IVTA group showed significantly better BCVA post-injection (0.38 ± 0.08 vs. 0.67 ± 0.08 LogMAR, p <0.001). While pre-injection intraocular pressure (IOP) was similar (p = 0.753), post-injection IOP was lower in the STTA group (15.8 ± 0.59 mmHg) compared to the IVTA group (18.3 ± 1.7 mmHg, p <0.001).
Conclusion: Both injection methods effectively treated diabetic macular edema, with the posterior sub-tenon approach showing a lower risk of raised IOP.
Effective Way Of Local Anesthesia For External Dacryocystorhinostomy (Ex-Dcr); A Three Point Infiltrative Local Anesthesia
Piya Muhammad Musammat Rafi, Muhammad Rizwan Khan, Shehzad Manzoor, Muhammad Jahan Zaib Khan, Sarfraz Ahmad Mukhtar, Asif Manzoor
Objective: To document and illustrate the pain-free method for external dacryocystorhinostomy (Ex-DCR) under 3-point infiltrative local anesthesia.
Methods: A total of 30 patients were operated on by the new local anesthesia technique after approval from the institutional Review Board of the Bahawalpur Victoria Hospital, Bahawalpur. Patients between 20 and 70 years of age and of any sex were included in the study. SPSS was used for analyses. A Verbal Rating Scale (VRS) was used in our study for pain scoring as described by the patient.
Results: Among the patients, 12(40%) were males and 18(60%) were females with a mean age of 53.73 ±13.128 years. During the skin incision, 25(83.3%) patients described no pain, while 5(16.7%) had only discomfort. While elevating the periosteum, only 10(33.3%) patients felt discomfort. During Ostium Creation, 15 (50%) patients felt discomfort, and 2 (6.7%) felt distressed. 8(26.7%) participants felt discomfort at Flap Creation and Wound Closure, and it was pain-free for 25(83.3%). Only 8(26.7%) felt discomfort 2 hours post-operatively. A weak correlation was observed when using Pearson’s Correlation.
Conclusions: Our three-point local anesthesia technique is highly effective for External Dacryocystorhinostomy. It eliminates the need for general anesthesia in carefully selected patients. Even without intravenous sedation, the procedure was completed successfully with high patient comfort and acceptability. The technique is easy and can be employed when local anesthesia is selected for patients undergoing External Dacryocystorhinostomy.
Correlation of vitamin D levels with Myopia in Children: A Cross-Sectional Survey at a Tertiary Care Hospital in Rawalpindi.
Saba Afzal Shaikh, Nazia Mushtaq, Nyla Gill, Khadija Mohammad, Ayyaz Hussain Awan, Ayesha Tariq
Objective:To find out the effect of duration of type II diabetes mellitus on intraocular pressure and central corneal thickness.
Methods: From August 2023 to January 2024, a cross-sectional survey was conducted at Farooq Hospital in Rawalpindi. The trial included 100 children with vitamin D levels <10 ng/mL, ages 3–12, after obtaining parental consent. Children with a history of refractive problems, ocular illnesses, or systemic ailments were excluded from the study. Serum vitamin D levels were measured, and cycloplegic and noncycloplegic refractions were performed. SPSS version 23 was used to do the statistical analysis, and the student’s t-test was used, and significance was indicated by p<0.05.
Results: Of the 100 children,38 (38%) had myopia. mean age was 7.04 ± 2.38 years. The sample consisted of 54 females (54%), and 46 boys (46%). Myopia and vitamin D deficiency had no significant association (p=0.115). However, myopia was linked to older age (p=0.005). It was more common in females than males (55.3%).
Conclusion: This study raises the possibility that a vitamin D deficit may not substantially raise the prevalence of childhood myopia. Further research must look at various genetic and environmental factors that affect the development of myopia.
Intracameral Lidocaine: A Safe and Effective Anesthetic Option for Manual Sutureless Cataract Surgery
Qaim Ali Khan, Muhammad Usman Arshad Qureshi, Rabia Sharif Bhatti, Aunaza Maqbool, Yasir Iqbal Malik
Objective: To assess the effectiveness of intracameral lidocaine in manual sutureless cataract surgery (MSCS), focusing on intraoperative pain control, surgical duration, postoperative recovery and complication rates.
Methods: A prospective observational study was conducted over 12 months at Al Mustafa Trust Medical Center on patients undergoing MSCS. Each patient received 0.1 mL of 1% intracameral lidocaine injected into the anterior chamber at the start of surgery as the primary anesthetic. Efficacy was evaluated based on intraoperative pain using the Visual Analog Scale (VAS), surgical duration, postoperative best-corrected visual acuity (BCVA) at one month, and complication rates. Data were analyzed using descriptive statistics, Student’s t-test, and chi-square tests, with statistical significance set at p < 0.05.
Results: The mean intraoperative pain score on the VAS was 2.1 ± 0.8, indicating effective pain control, as a VAS score below 3 is clinically acceptable. The mean surgical duration was 14.2 ± 1.6 minutes. Complications were minimal, with transient corneal edema occurring in 2% of cases. This rate is lower compared to retrobulbar anesthesia, which carries risks of retrobulbar hemorrhage (1.7%) and optic nerve injury (0.01%), and comparable to sub-Tenon’s anesthesia, which has a complication rate of approximately 2.5%.
Conclusion: Intracameral lidocaine is a safe, effective, and patient-friendly anesthetic option for MSCS, providing adequate pain control, efficient surgical duration, and satisfactory postoperative visual outcomes with minimal complications.
Aqueous Misdirection Syndrome in Post-trabeculectomy Patients
Rima Khan, Yousaf Jamal Mahsood
Objective: To determine the frequency of aqueous misdirection syndrome and its association with gender and age in post-trabeculectomy patients.
Methods: An observational study was conducted at the Department of Ophthalmology of Hayatabad Medical Complex, Peshawar, from November 2021 to May 2022. The patients who underwent uncomplicated trabeculectomy in the last two months at our department were included in this study. The data were collected for age, gender, best corrected visual acuity, time since surgery, intraocular pressures and presence or absence of aqueous misdirection syndrome. Aqueous misdirection syndrome was diagnosed if there was a shallow anterior chamber with high intraocular pressure in the presence of a patent iridectomy. Association of this complication with age and gender was also determined.
Results: A total 179 participants were recruited with a mean age of 44.30± 15.71 years and 103 (57.54%) male participants during the study period. The frequency of aqueous misdirection syndrome was found to be 5 (2.8%) in this study. No statistically significant association was found between development of the complication and age (p=0.36) and gender (p=0.30) of participants.
Conclusion: Aqueous misdirection syndrome is a rare complication in uncomplicated trabeculectomy surgery. Age and gender have no effect on the occurrence of aqueous misdirection in these patients.
Histological/pathological Evaluation of Post Photo-Refractive-Keratectomy(PRK) Induced Changes in Corneal Epithelial Thickness and its Impact on Physiological Eye Functions
Raja Faisal Zulfiqar, Muhammad Yousuf Khoso, Tayyaba Kazmi, Sadia Sundus, Irfan Ul Akbar, Raheela Adil
Objective: To evaluate histological changes and epithelial thickness (ET) post-photo refractive keratectomy (PRK) at two regions: apex of cornea (ETapex) and middle of cornea (ETmiddle). To evaluate changes of Lower Order Aberrations (LOAs), Higher Order Aberrations (HOAs), Contrast Sensitivity (CS) and Corrected Distance Visual Acuity (CDVA), and the relationship of these parameters with change of ET(apex and middle) after PRK.
Methods: Thirty-five patients, aged between 24 and 40, who had PRK were selected. Patient received eye examination, including cycloplegic refraction, non-contact intraocular pressure monitoring, slit-lamp biomicroscopy, corrected distance visual acuity (CDVA), and uncorrected visual acuity measurement. Using epithelial map of optical coherence tomography, changes in Epithelia thickness (ET) apex and ET middle were measured. Statistical Package for Social Sciences SPSS version 24 was used for data analysis.
Results: Following PRK, there was statistically significant difference in ET apex and ET middle measurements before and after surgery. ET (apex) increased after PRK, this appeared to be related to increased LOAs and increased HOAs, it was also associated with increase inCS and CDVAD (Shapiro Wilks test) with a P value of 0.006 and 0.001 respectively).
Conclusion: our study concludes that following PRK, there is a correlation between ET (apex &middle) changes and variations in CDVA, LOAs and HOAs, and SC.Post-PRK care should be tailored based involve follow-up appointments, medication, activity restrictions, sunprotection, and careful monitoring of vision and healing to ensure optimal recovery and prevent complications.
Association of Age Groups, Gender, Smoking, and Hypertension with Pan-Retinal Photocoagulation Sessions in Diabetic Retinopathy Patients in the Population of D.I. Khan
Muhammad Shoaib Khan, Muhammad Kamran Khalid, Muhammad Sharjeel, Muhammad Abdullah, Hidayatullah Mahsud
Objective: To evaluates age groups, gender, smoking, and hypertension as risk factors for requiring more than one session of pan-retinal photocoagulation (PRP) and the severity of DR in the population of D.I. Khan.
Methods: This cross-sectional study was conducted at the Eye Unit of Gomal Medical College, Dera Ismail Khan, from January to December 2023. Patients undergoing single or multiple PRP sessions during this period were included. Consecutive, non-probability sampling was used, and data were analyzed using SPSS version 23.
Results: Of the 84 patients included, 52 (61.90%) were male, and 32 (38.10%) were female. Age above 50 and hypertension were significant risk factors for requiring more than one PRP session (p = 0.006 and p = 0.031, respectively). Gender and smoking were not statistically significant risk factors.
Conclusion: Hypertension and older age are significant risk factors for multiple PRP sessions and the severity of DR in the population of D.I. Khan. Managing these modifiable risk factors may reduce the need for repeated treatments.
Disorganization of Retinal Inner Layers in Diabetic Patients
Nimra Akram, Mazhar Ul Hassan
Objective: To investigate the prevalence of Disorganization of Retinal Inner Layers (DRIL) in patients with diabetes and its relationship with Diabetic Macular Edema (DME) and initial visual acuity.
Methods: This cross-sectional study involved 96 patients aged between 30-70 years with diabetes who underwent spectral-domain optical coherence tomography (SD-OCT) scans to evaluate Disorganization of Retinal Inner Layers (DRIL) and Diabetic Macular Edema (DME). Data were entered and analyzed using SPSS version 23.
Results: Out of 96 patients, 46 (47.9%) were males and 50 (52.1%) were females. Diabetic Macular Edema (DME) was found in 60 (62.5%) patients. There was a significant association between the existence of diabetic macular edema and DRIL. The findings revealed that DRIL was present in 44.8% of patients and was significantly linked to central foveal thickness and visual acuity.
Conclusion: The study suggests that DRIL is a valuable indicator for predicting visual outcomes in patients with DME. The presence and extent of DRIL may also have prognostic implications, helping clinicians to identify patients who are at higher risk of vision loss.
Effect of Peroperative Use of Heparinised Irrigating Solution on Postoperative Inflammation in Phacoemulsification
Erum Nasir, Intisar Ul Haq Rana, Sana Nadeem, Asfandyar Asghar, Naila Obaid, Tehmina Nazi
Objective: To evaluate the effect of Heparin Sodium on postoperative inflammation following cataract surgery in adults.
Methods: A Quasi experimental study was conducted at Fauji Foundation Hospital, Rawalpindi during May to October 2023 which include one twenty (120) cases diagnosed with uncomplicated cataracts booked for phacoemulsification were randomized to Group 1 (heparinized solution) and Group 2 (Standard irrigating solution) using lottery method. Surgery was performed by single surgeon as per standard protocols. Patients were assessed preoperative and post-operative on day 1, day 7 and day 28 for visual acuity, intraocular pressure and detailed slit lamp examination to measure the AC cellular activity and AC flare in for all cases. SPSS-26 was used. Mean and standard deviations were computed for quantitative data, whereas, frequency and percentages were computed for qualitative data. The independent t-test was used to compare quantitative variables, while the chi-square/fisher exact test was used to evaluate qualitative variables. A P-value < 0.05 was deemed as significant.
Results: The mean age of patients in the group 1 and group 2 were of 64.71+9.69 years and 68.45+9.69 years respectively. In both groups, most of the patients were female. However, no significant difference found in both groups in terms of baseline data. Significant difference in IOP, AC-cells and AC-flare was observed on day-1, day-7 and day-28 between both groups, as p-value was < 0.05.
Conclusion: The study concluded that using heparin sodium as an anti-inflammatory drug could be effective in lowering post-operative inflammatory reaction.