Current Issues - Vol. 19, No. 4, October - December 2023

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Al-Shifa Journal of Ophthalmology

Editorial: Shedding Light on the Ethical Dilemma: The Avastin Injection Crisis in Punjab
Mahmood Ali

Clearing the Path to Healthy Vision: Navigating Common Pediatric Ophthalmological Disorders
Sidrah Riaz, Muhammad Tariq Khan, Samina Bilal, Hussain Ahmad Khaqan, Muhammad Saghir

Objective: To study the frequency of common pediatric ophthalmological disorders among patients presenting in an outpatient department of a Trust Hospital in Lahore, Pakistan.
Methods: A retrospective descriptive cross-sectional study was carried out at the outpatient department of Akhtar Saeed Trust Hospital, Lahore, from 15th March 2023 to 15th November 2023. Non-probability conventional sampling technique was used. The data were analyzed using SPSS-25 and presented in the form of pie charts, bar graphs, and tables. A total of 1119 patients were included, aged between 0-14 years. A provisional diagnosis was made after a detailed history and ocular examination and were prescribed treatment in the form of topical, oral, or systemic drugs. Refractive errors were corrected if applicable, and surgical treatment was discussed with parents if required. The exclusion criteria were patient’s age above 14 years of age.
Results: There were 577 (51.56%) females and 542 (48.44%) males. The most common diagnosis was a refractive error, seen in 321 (28.68%) patients followed by conjunctivitis, including bacterial 285 (25.47%), allergic 95 (8.49%), and viral conjunctivitis 49 (4.38%). This was followed by routine emmetropes with complaints of headaches. Nasolacrimal duct blockage was present in 67 (5.98%), and strabismus in 41 (3.66%) individuals. Furthermore, some benign disorders were also seen.
Conclusion: Pediatric ophthalmological disorders require our attention, and efforts should be made to ensure their early detection and appropriate intervention, especially considering that relatively common disorders represent the larger proportion of diseases in our sample.

Attitudes and Knowledge of Corneal Donation among Medical Students of Poonch Medical College, Rawalakot
Muqeet Ahmed Zaheer, Hira Naveed, Ali Amjad, Safa Tariq, Muhammad Muneebullah Siddiqui, Azhar Iqbal

Objective: The objective of this study was to determine the awareness and perspectives of medical students regarding corneal donations. This research strives to elevate students awareness, consequently fostering an increase in corneal donations.
Methods: Cross-sectional investigation on the premises of Poonch Medical College, Rawalakot was conducted in duration of 3 months. An English-language self-administered questionnaire was used to assess different aspects of the participants awareness and perspectives on corneal donation. Data were analyzed using SPSS software. Tests were applied and a p-value of < 0.05 was taken to be significant.
Results: total of 292 students participated in this study. A mean score of 3.22 ± 1.78 was achieved by the participants on the knowledge test. The most common reason for corneal donation was empathy for a blind person (62.3%), while a lack of information concerning corneal donation (61%) was seen to be the greatest barrier. There was no significant correlation between the knowledge and attitude of participants regarding corneal donations.
Conclusions: This study highlights a concerning lack of awareness about corneal donations among the participants. To boost donation rates, it's crucial to raise awareness among medical students. Bridging this knowledge gap necessitates organizing awareness-raising activities and motivating students for voluntary participation, ensuring they gain a fundamental understanding of corneal donation.

To Compare the mean Difference in Central Macular Thickness and Best Corrected Visual Acuity in Patients of Diabetic Macular Edema Receiving Intravitreal Ranibizumab versus Bevacizumab
Rehan Saleem , Afia Matloob rana, Waseem Akhter , Salman Tariq Toosy, Fuad Khan Niazi, Irum Yousafzai

Objective:To compare the efficacy of two anti VEGF ranibizumab and bevacizumab in diabetic macular edema.
Methods: It was a randomized control trial conducted at Eye department of Holy Family Hospital Rawalpindi 23rd April 2021 to 23rd April 2022. A total 60 patients (30 in each group) with diabetic macular edema of age range from 15-65 years. In Group A 30 patients received three consecutive monthly intravitreal injection of ranibizumab 0.03mg/0.05ml. In Group B 30 patients received three consecutive monthly intravitreal injection of bevacizumab 1.25mg/0.05ml. After 3 months best corrected visual acuity and central macular thickness was recorded. Data was entered and analyzed by using SPSS VERSION 22.
Results: Total 60 patients were included in the study, 30 in each group. The mean age of patients in group A was 38.67 ± 7.88 years and in group B was 39.43 ± 8.02 years. Out of 60 patients, 45 (75.0%) were female and 15 (25.0%) were male. The reduction in central macular thickness (CMT) after three months with intravitreal bevacizumab and ranibizumab was 342.23 ± 6.41 and 320.10 ± 9.79 respectively (p-value = 0.0001). The improvement in best corrected visual acuity with intravitreal bevacizumab and ranibizumab after three month was 0.45 ± 0.02 and 0.48 ± 0.03 (p-value = 0.0001).
Conclusion: This study concluded that ranibizumab is better as compared to bevacizumab in terms of mean central macular thickness and best corrected visual acuity in patients of diabetic macular edema.

Knowledge and Practice trends of Optometrists and Refractionists at LRBT Regarding Myopia
Muhammad Nadeem, Adnan Afsar

Objective: To assess the Knowledge and Practice trends of optometrists and refractionists working at various eye care facilities of Layton Rahmatullah Benevolent Trust (LRBT) on myopia management and control.
Methods: A questionnaire-based online survey was conducted, which took 6 weeks to conclude. The participants’ responses comprised their current trends towards the management of childhood myopia, knowledge & awareness level concerning modern concepts of myopia control strategies, and the extent of applicability of control measures in their practices.
Results: 105 professionals including 57 optometrists and 48 refractionists participated in the survey. Almost 50% of the participants were unaware of the current myopia control strategies. 75% of participants didn’t attend any course or CME (Continuing Medical Education) session about current myopia management and control. The majority of participants (65%) considered myopia > 1D annual progression alarming for initiation of myopia control measures. Moreover, 67% were unaware of the significance of outdoor activity for myopic children. About 85% of participants were under-correcting myopic children to slow down myopia progression. Most respondents (69%) were not measuring the Axial Length of myopic children in their practice. More than 50% were neither testing binocular vision nor assessing accommodation lag. Furthermore, around 55% were not performing baseline fundus examination, whereas 64% considered pathological myopia > 6D as the standard criteria for peripheral fundus examination.
Conclusion: The responses of participants to survey questions reveal inadequacy in knowledge and practice concerning current myopia management and control strategies.

Comparison Of Causative Bacteria In Acute And Chronic Dacryocystitis
Sara Najeeb, Muhammad Usman Sadiq, Umair Tariq Mirza, Fatima Akbar Shah, Muhammad Irfan Sadiq, Muhammad Shuaib

Objective: This study aimed to compare the causative bacteria in acute and chronic dacryocystitis, to identify specific bacterial strains associated with each form of the condition.
Methods: A retrospective comparative analysis was conducted in the Ophthalmology Department, Divisional Headquarters Teaching Hospital, Mirpur AJK in which data of 54 patients was collected. Clinical data and microbiological findings from patients diagnosed with either acute or chronic dacryocystitis were collected from 1st January 2019 to 31st December 2022. The study encompassed a comprehensive review of patient records, including demographic information, clinical presentations, and laboratory results. Microbiological cultures of lacrimal sac secretions were performed to isolate and identify the bacteria associated with each type of dacryocystitis.
Results: The study included 54 patients, with 26 diagnosed with acute dacryocystitis and 28 with chronic dacryocystitis. The mean age was 49.98±3.912 years. Out of 54 patients, 21 were males and 33 were females. Microbiological analysis revealed distinct microbial profiles in each group. In cases of acute dacryocystitis, Staphylococcus aureus emerged as the predominant pathogen, accounting for 35% of cases compared to Chronic Dacryocystitis, in which, Propionibacterium acnes emerged as the most prevalent pathogen, contributing to 32% of cases.
Conclusion: The findings of this study underscore the importance of microbial analysis in distinguishing between acute and chronic dacryocystitis. Identifying specific bacterial strains associated with each form enhances diagnostic precision and informs targeted therapeutic strategies.