Current Issues - Vol. 20, No. 2, April – June 2024

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Al-Shifa Journal of Ophthalmology

Editorial: Implementing Workplace-Based Assessments in Ophthalmology: CPSP’s Commendable Endeavor
Mahmood Ali

Effect of 0.1% Nepafenac Eye Drops on Macular Thickness After Uneventful Phacoemulsification Assessed by Optical Coherence Tomography
Anushka Shaukat, Muhammad Azam Khan, Ayisha Shakeel, Irfan Aslam Khattak, Maria Saleem, Huma Zainab

Objective: To compare mean macular thickness after uneventful phacoemulsification with 0.1% nepafenac eye drops using optical coherence tomography.
Methodology: A sample size of 170 patients was calculated using the WHO calculator. Patients were divided into two groups; Group A was given 0.1% nepafenac while Group B was given a placebo. Patients were selected through nonprobability consecutive sampling. Patients were followed after uneventful phacoemulsification. OCT scan of macula was performed preoperatively and on day 7 and day 30. Data was analyzed using SPSS version 24, T-test was applied and a P value <0.05 was considered significant.
Results: A total of 170 patients were included in the study with 85 patients in each group. There were 42(24.7%) males in group A and 49(28.8%) in group B and 43(25.3%) females in group A and 36(21.2%) in group B. The mean age of patients in group A was 51.3±6.2 years and 49.8±6.3 years in group B. There was no statistically significant difference in macular thickness of Group A and Group B (215.5±1.0 and 215.6±0.9, p=0.546 respectively) before phacoemulsification surgery. However macular thickness was significantly lower in the nepafenac group, 7 days (220.1±2.4 vs 228.8±4.4, p=0.000) and 30 days postoperatively (217.6±1.6 vs 231.7±6.3, p=0.000).
Conclusion: 0.1% Nepafenac is a well-tolerated drug with a significant decrease in macular thickness as compared to placebo following uneventful phacoemulsification. Post-operative use of topical NSAIDs leads to the prevention of cystoid macular edema following cataract surgery.

Primary Open-Angle Glaucoma and Serum Vitamin D Levels
Aqsa Malik, Masooma Talib, Saima Rasheed, Farah Naz Tahir, Yasir Iqbal Malik, Atteaya Zaman, Anoosh Qayyum, Tehmina Qamar

Objective: To compare the levels of vitamin D of patients having primary open-angle glaucoma with controls.
Methodology: This was an observational, cross-sectional study, carried out at the Department of Biochemistry & Department of Ophthalmology, Watim Medical College, Rawat, Rawalpindi. Medical records of 150 patients from the last 5 years were reviewed to categorize them into two groups, Group I diagnosed with POAG based on established criteria (specific optic nerve changes, open angle on gonioscopy and specific visual field defects) & Group II (Controls). Data collection from medical records included: age, gender & Serum vitamin D level in ng/ml. Data analysis was done using the Statistical Package for Social Sciences (SPSS)version 21. Descriptive statistics were used to review the demographic data (age & gender) and the vitamin D levels both for the POAG group and control. Independent t-test was used to compare serum vitamin D levels of the two groups while considering the p-value less than 0.05 as statistically significant.
Results: The mean vitamin D levels in Group I (POAG) was 39.75 ± 9.64 ng/ml vs vitamin D level in Group II (Controls) 38.22 ± 7.59 ng/ml with no statistically significant difference.
Conclusions: We found no role of serum vitamin D levels in primary open-angle glaucoma.

Etiology and Causative Bacteria of Microbial Keratitis in Mirpur Azad Kashmir
Muhammad Asif, Sara Najeeb, Nazish Babar, Muhammad Usman Sadiq, Muhammad Irfan Sadiq, Maliha Ansari

Objective:To determine the common etiology and causative bacteria in cases of microbial keratitis in Mirpur Azad Kashmir.
Methodology: This study is a retrospective analysis of the microbiological reports of all patients at Divisional Headquarters Mirpur Azad Kashmir who were diagnosed with bacterial keratitis between January 1, 2021, and December 31, 2022. The study included demographic information, past eye trauma history, ocular surface disease, usage of contact lenses and topical steroids, recent ocular surgeries, and diabetes mellitus.
Results: In a study involving 68 patients with eye infections, the average age was 39.93 years with a higher representation of males (47) than females (21). Most cases were due to trauma (62%), followed by ocular surface disease (19%), contact lens use (9%), topical steroid use (7%), and other causes like surgery or diabetes. Staphylococcus epidermidis was the most common causative bacteria (47%), followed by Streptococcus pneumonia (16%), Staphylococcus aureus (13%), Pseudomonas aeruginosa (10%), Staphylococcus hominis (9%), and Moraxella species (4%).
Conclusion: This study highlights the predominance of trauma as the leading cause of eye infections, with Staphylococcus epidermidis being the most common causative bacteria.

Effectiveness in Achieving Retrobulbar Infiltrative Anesthesia With and Without Prior Dermal Application of Lidocaine on Lids in Cataract Surgery Patients
Attiqa Riaz, Muhammad Ali, Afifa Ramzan, Saira Shahzadi, Muhammad Hannan Jamil, Memoona Arshad

Objective: To assess the effectiveness of infiltrative anesthesia with or without prior use of lidocaine gel at the site of needle-insertion in patients undergoing cataract surgery and its association with needle-insertion pain.
Methodology: An observational case-control study was conducted with a sample size of 214 cataract surgery patients, who were randomly and equally assigned to case and control groups. A self-designed questionnaire was used to collect information from the surgeon about effectiveness of anaesthesia and akinesia, and the patient was asked about pain during needleinsertion on a 1–10 pain scale. The surgeon performed all procedures with the same tools and techniques. The data was analysed using SPSS. Furthermore, qualitative data was analysed using Pearson’s chi-square association.
Results: This case-control study with equally distributed 214 participants, mean age 57.1 ± 9.34, shows significant differences in anaesthesia, akinesia, and pain levels between both groups. The case group showed better results: 78.5% had no movements during surgery while 62.2% had partial movement. In the control group (p = 0.000); 83.2% had complete anaesthesia in contrast; 64.5% had partial anaesthesia in the control group (p = 0.000); and 67.3% felt mild pain during needle insertion; on the other hand, 74.8% felt severe pain in the control group (p = 0.000).
Conclusion: The findings show that using dermal lidocaine gel before an ocular infiltrative block enhances level of anaesthesia and akinesia while decreasing needle-insertion pain. Resulting in more patient comfort and satisfaction during surgery.

Surgical Outcomes of Phacoemulsification at A Tertiary Care Eye Hospital
Rebecca Murtaza, Sabihuddin Ahmad, Sana Naveed, Inam Ul Haq

Objective: To evaluate the visual outcomes of phacoemulsification surgery at a tertiary care eye hospital.
Methodology: A retrospective clinical study was done in Al-Shifa Trust Eye Hospital Rawalpindi. A total of 3075 eyes were included that underwent phacoemulsification. Patients of >40 years with follow up visit were included. The best corrected visual acuity was noted before and after 06 weeks of phacoemulsification and categorized according to World Health Organization criteria (Good, Moderate and Poor). Data was analyzed by SPSS 22.0 version.
Results: Total 3075 eyes are included in the study, out of which males are 1816 (59.1%), and 1259 (40.9%) females, total right eyes were 1895 (61.6%) and left 1180 (38.4%). Only those patients are included who fulfilled the follow up criteria. The preoperative BCVA was poor in 1839 (59.8%), moderate in 801 (26%), and good in 435 (14.1%). The postoperative BCVA at 6 weeks was good in 2467 (80.2%), moderate in 449 (14.6%), and poor in 159 (5.2%).
Conclusion: The visual outcome of phacoemulsification by calculating vision post operatively is a good tool for maintaining high quality surgical performance. Proper follow up of patients can save patients from postoperative complications. An audit may benefit by refining surgical skills.