Current Issues
Current Issues - Vol. 21, No. 3, July - September 2025
Al-Shifa Journal of Ophthalmology
Editorial:
Ethical Use of AI in Ophthalmic Research Writing
Mehmona Asgher
Frequency of Diabetes Mellitus in Cataract Patients Visiting Civil Hospital, Karachi
Fatima Usama, Abdul Rasheed Khokhar
Objective: To determine the prevalence of diabetes mellitus among cataract surgery patients. It aimed to explore the relationship between elevated blood sugar levels and cataract formation, assess the impact of diabetes on surgery outcomes, and recommend strategies for integrating diabetes management into ophthalmic care.
Methods: This cross-sectional study was conducted at a tertiary care hospital over period of six months, involving 163 participants aged 30 to 70 years, recruited through non-probability consecutive sampling. Patients with cataracts in one or both eyes were included, while those with secondary or congenital cataracts were excluded. Informed consent was obtained, assessments included visual acuity tests, slit lamp exams, and blood glucose measurements. Descriptive and inferential statistics were analyzed using SPSS version 22.
Results: Of the 163 patients, 54.6% were female and 45.4% male, with a mean age of 56.36 years. Bilateral cataracts were present in 65% of cases, with Nuclear Sclerosis being the most common (63.2%), followed by Posterior Subcapsular cataracts (18.4%). Blood sugar levels varied, and 14.1% had levels exceeding 200 mg/dL, indicating diabetes mellitus. While no significant correlation was found between demographics and high blood sugar, the study showed a significant link between diabetes and accelerated cataract formation.
Conclusion: The study suggests that diabetes mellitus accelerates cataract development, emphasizing the need to integrate diabetes management into ophthalmic care. Future research should focus on longitudinal studies and advanced tools like OCT for better early detection and management of diabetic eye complications.
Awareness of Contact Lens Related Ocular Complications among Opticians in Division Mirpur AJ&K
Muhammad Affan, Sana Ishaq Qureshi, Muhammad Irfan Sadiq, Marrium Qayyum, Muhammad Usman Sadiq
Objective:To assess the awareness of contact lens-related complications among opticians in Division Mirpur, Azad Jammu & Kashmir (AJ&K).
Methods: A cross-sectional study was conducted in optical shops across Division Mirpur from April to September 2023.The total number of recruited participants was 53; however, data from one participant was excluded due to incomplete responses, resulting in 52 analyzed datasets. Data was analyzed using SPSS version 10.
Results: All participants were male, with 23.0% aged 20–30 years, 42.3% aged 31–45 years, and 34.6% aged 46–60 years. Regarding professional qualifications, 13.5% held a contact lens dispensing diploma, 21.2% had completed a contact lens course, 7.7% had other qualifications, and 57.7% had no formal training. A total of 43 opticians provided contact lens fitting services, while 9 did not. Awareness of complications varied, with 46.2% recognizing dry eye, 25.0% bacterial keratitis, 17.3% corneal ulcers, 9.6% giant papillary conjunctivitis, and 5.8% corneal neovascularization, fungal, and Acanthamoeba keratitis.
Conclusion: Most opticians in Division Mirpur have inadequate awareness of contact lens-related complications. To promote safe contact lens use, all types of lenses should only be prescribed and fitted by an optometrist/ophthalmologist. Public health initiatives and training programs are essential to enhance opticians’ knowledge and reduce preventable eye complications.
Assessment of Macular Thickness in Myopic Eyes Using Spectral Domain Optical Coherence Tomography
Rida Azeem, Saliha Naz, Afshan Ali, Zeeshan Kamil, Amreen Wasif Hussain, Hamama Barry, Tooba Saman
Methods: The cross sectional study was carried out at LRBT Tertiary Hospital, Karachi. The study was conducted from July 2023 to June 2024. One hundred and seventy-seven patients with a mean age 28.62±12.30 years and axial length 26.46 ±1.92 mm were included. The inner macular thickness (para-fovea) and outer macular (peri-fovea) at four distinct locations i.e. the temporal, superior, nasal, and inferior quadrants, as well as the fovea itself were measured with the help of spectral optical coherence tomography. Axial length was measured with the help of A-scan. Data was analyzed using SPSS version 16.
Results: There is a negative weak correlation (r= -0.21) was reported between the axial length and inner macula (para fovea) at inferior quadrant thickness in total myopic patients (p<0.05). While positive moderate correlation (r=0.48) was found between axial length and foveal thickness in total myopic patients. Foveal thickness was significantly higher in high myopic group as compared to low myopic (p<0.05). Positive weak correlations were found between inner macular thickness (r=0.15) and axial length at inferior (P<0.05) and temporal quadrant (r=0.21) (p<0.05). While nasal (r=0.25) (P<0.05) and inferior quadrant of (r=0.19), at outer macula of low myopic subjects (p<0.05). In high myopic group, negative weak correlation (r= -0.29) was reported between inner thickness of macular and axial length at nasal quadrant (p<0.05).
Change in Central Macular Thickness After Uncomplicated Phacoemulsification Cataract Surgery
Hafsa Ahmed, Adnan Abdul Majeed, Saifulllah Tareen, Mahtab Mengal, Hafsa Bibi, Asma Imam
Objective: To determine the change in central macular thickness after uncomplicated phacoemulsification cataract surgery.
Methods: This cross-sectional study was conducted at the Helper&39#;s Eye hospital, Quetta from January 2022 to June 2022. A total of 126 patients aged between 40-70 years, having normal intraocular pressure and planned for phacoemulsification cataract surgery were included in this study. Central macular thickness was evaluated using optical coherence tomography 1 day before the operation and subsequently at weeks 1 and 4, post-operatively. The primary outcome of the study was the change in central macular thickness after uncomplicated phacoemulsification cataract surgery, while the secondary outcome was the frequency of patients with raised central macular thickness (an increase by 30% from the baseline), at week 4 following the phacoemulsification procedure.
Results: The mean age in this study was 56.16 ± 5.39 years. The female patients were 50.8% while male patients were 49.2% of total study population. There was a statistically significant increase in central macular thickness at week 4 after the procedure compared to the pre-operative levels (215.02±20.55 µm Vs 205.94±5.84 µm, p˂0.0001). The result of secondary outcomes showed that incidence of raised central macular thickness was observed in 10 (7.9%) of the patients. Stratification of results established an association between diabetes and incidence of raised central macular thickness (p=0.013).
Conclusion: Phacoemulsification cataract surgery significantly increases central macular thickness postoperatively. Diabetes is significantly associated with both the overall increase and the development of raised central macular thickness.
Comparison of the Efficacy of Starting Antibiotic Medications with Debridement of Ulcer Versus Antibiotics Alone in Cases of Bacterial Corneal Ulcer—A Randomized Control Trial
Muhammad Abdullah, Muhammad Shoaib Khan, Sidrah Latif, Hafiz Muhammad Waqas Zaman, Muhammad Ayub Khan, Muhammad Sharjeel
Objective: To compare the efficacy of antibiotic therapy combined with mechanical ulcer debridement versus antibiotic therapy alone in the treatment of bacterial corneal ulcers.
Methods: A randomized controlled trial was conducted at the Institute of Ophthalmology, Mayo Hospital, Lahore, over 12 months from January 2022 to &December 2022. Treatment-naïve patients (n=92) with culture-positive bacterial keratitis and ulcer sizes of 2–5 mm were randomized into two groups. Group A (n=46) underwent mechanical debridement followed by topical moxifloxacin 0.5%, while Group B (n=46) received topical moxifloxacin 0.5% alone. The primary outcome was the change in ulcer size (mm) measured on days 3, 7, 14, and 21. Treatment success was defined as a ≥25% reduction in ulcer size by day 21.
Results: The adjunctive debridement group (Group A) demonstrated a statistically significant improvement in healing outcomes. By the final assessment on day 21, the mean ulcer size in Group A was reduced to 1.08 ± 1.07 mm, which was nearly half that of Group B (2.05 ± 1.33 mm; p = 0.004). Treatment response was significantly better in Group A, with 91.3% of patients achieving treatment success compared to only 71.7% in the antibiotic-only group (p = 0.001).
Conclusion: Debridement with antibiotics expedites ulcer healing compared to antibiotics alone, reducing economic burden in resource-limited settings.
Prevalence of Ocular Manifestations in Thyroid Disorder Patients in A Tertiary Hospital of Karachi
Farnaz Siddiqui, Sadaf Zi, Zareen Kiran, Zile-Huma, Muhammad Nizamuddin, Saba Al Khairy
Objectives: To determine the frequency of various ocular manifestations in thyroid dysfunction and to assess their correlation with thyroid function test parameters.
Methods: A cross-sectional study was conducted at the National Institute of Diabetes & Endocrinology, Ear, Nose, Throat (ENT), and Eye outpatient department (OPD) between 2020 and 2023. All patients above 18 years of age diagnosed with thyroid dysfunction and referred to the Eye department from endocrine or ENT OPD were included in the study. An ophthalmologist did detailed clinical examination of the eyes as per the European Group on Graves&39#; Orbitopathy (EUGOGO) recommendations. Data analysis was done on SPSS version 23.
Results: A total of 441 thyroid patients were included in the study. The majority of them 378 (85.7%) were females aged between 20 to 40 years 266 (60.3%). Ocular manifestations were present in 252 (57.1%), where the most prevalent symptom was watering 154 (61.11%), followed by foreign body sensation 63 (25%). Prevalent lid signs were lid retraction and lid lag (97.06%). It was found that ocular manifestations were significantly correlated to the levels of STSH, FT3, and FT4 (P-value 0.018, <0.001, and 0.001, R-value -0.120 -0.317 and 0.054, respectively).
Conclusion: It is imperative that prospective clinical health professionals should be acquainted with all the information related to the clinical manifestations of thyroid eye disease for better management.
Association Between Choroidal Thickness and Glycaemic Control in Type 2 Diabetes Without Retinopathy
Aneeqa Naz, Intisar Ul Haq Rana, Asfandyar Asghar, Tehmina Nazir, Naila Obaid, Ayesha Majeed
Objectives: To evaluate choroidal thickness in patients with type 2 diabetes without retinopathy, comparing it to nondiabetic individuals and investigating the relationship between choroidal thickness and HbA1c levels.
Methods: A prospective, cross-sectional analytical study was conducted at the ophthalmology department of Fauji Foundation Hospital, Rawalpindi. The study included 110 diabetic patients without retinopathy and 55 age- and sex-matched nondiabetic controls. Choroidal thickness was measured at five locations (subfoveal, 1500 µm and 3000 µm nasal, and 1500 µm and 3000 µm temporal) using spectral domain-optical coherence tomography (SD-OCT). Sub-foveal choroidal thickness at 1500 μm nasal, 3000 μm nasal, followed by 1500 μm temporal, and 3000 μm temporal, followed by central macular thickness, was taken. Correlation analysis between HbA1c levels and choroidal thickness in diabetics was performed using SPSS version 24.
Results: Diabetic participants demonstrated significantly reduced choroidal thickness in subfoveal and nasal regions compared to nondiabetics (p < 0.01). No significant difference was found in temporal regions or central macular thickness. A strong negative correlation was observed between HbA1c levels and choroidal thickness (R = -0.783), whereas disease duration showed minimal association (R < 0.1).
Conclusion: The findings suggest that elevated HbA1c levels adversely impact choroidal thickness in diabetics, even in the absence of diabetic retinopathy. This highlights the potential role of choroidal alterations in the early stages of diabetic ocular changes. Further longitudinal studies are warranted to explore the prognostic significance of choroidal thickness in diabetic retinopathy progression.
Effects of Topical Dorzolamide on Serum Potassium Levels
Hussain Ahmad Khaqan, Atteq Ur Rehman, Hasnain Muhammad Baksh, Ahmad Fauzan, Eddaoui Hibat Allah, Aryj Dlensi, Ines Arfaoui, Boughanmi Heni, Muhammad Zafar Iqbal, Neeta Maheshwary, Athar Khan, Dilshad Hussain
Objective: To evaluate how serum potassium levels are affected by a 2% ocular solution of dorzolamide.
Methods: This study was conducted at the Department of Ophthalmology, Lahore General Hospital, Lahore. A total of 55 patients, with diagnosed cases of primary open-angle glaucoma were enrolled. All participants were prescribed dorzolamide 2% eye drops twice daily in both eyes. Serum potassium levels were recorded at baseline and then monitored monthly for four months. Data was analyzed by using SPSS version 22, and paired sample t-tests were applied to compare potassium levels at 2nd, 3rd and 4th month.
Results: Of the 55 patients, 28 (50.9%) were male and 27 (49.1%) were female, with a mean age of 49 years. The mean baseline serum potassium level was 3.94 ± 0.31 mEq/L. A significant reduction was observed in serum potassium levels from baseline to all follow-up visits, as assessed by paired sample t-test. At 1 month, the mean reduction was 0.21 mmol/L (p < 0.001), which increased to 0.46 mmol/L at 2 months (p < 0.001). By 3 months, the decline reached 1.03 mmol/L (p < 0.001), and at 4 months, the maximum reduction of 1.47 mmol/L was noted (p < 0.001).
Conclusion: Topical dorzolamide 2% is associated with a significant and progressive decline in serum potassium levels with continued use. Regular monitoring of electrolyte levels may be advisable in patients on long-term dorzolamide therapy to prevent potential complications of hypokalemia.
Analysis of Permanent Severe Impairment and Blindness in Visually Disabled Patients at a Public Teaching Hospital, Rawalpindi
Wajeeha Rasool, Kanwal Zareen Abbasi, Ambreen Gull, Muhammad Ali Khalid, Jawad Awan, Muhammad Rizwan Khan
Objective: To determine the prevalence and causes of permanent severe visual impairment and blindness in patients aiming for visual disability certification, visiting public teaching hospitals in Rawalpindi.
Methods: An observational cross-sectional study was carried out from April 2022 to April 2024, obtaining data of visually disabled people, selected via consecutive non-probability sampling. Demographic profile categories & causes of permanent severe visual impairment and blindness were noted. Data were analyzed & reported by descriptive statistics.
Results: Out of a total of 189 individuals, 67% were males & 32.8% females, 21.7% were less than 18 years of age. 79.6% of eyes had severe visual impairment, while 26.7% eyes were blind. Retinitis pigmentosa (33%), optic atrophy (13.4%), corneal opacity (12%), macular dystrophy (6.8%), and microphthalmia (6.6%) were the leading causes of permanent severe visual impairment & blindness.
Conclusion: A comprehensive, reliable yet small scale study showing younger age group & male predominance. The prevalence of retinitis pigmentosa is surprisingly high, while glaucoma & diabetic retinopathy contributed less than expected.
Association of HBA1C Value With The Severity of Diabetic Retinopathy in Type 2 Diabetic Patients
Arfa Shaikh, Zeeshan Kamil, Muhammad Tanweer Hassan Khan, Maham Sultan, Hamama Barry, Rida Azeem
Objective: To determine association between HbA₁c levels and severity of diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) of a tertiary care setting.
Methods: A cross-sectional study was commenced in type II diabetes patients of a tertiary eye hospital using non-probability sequential sampling technique. The degree of DR was assessed by thorough ocular examinations and classified as mild, moderate, severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). We assessed HbA₁c levels and examined the relationship between HbA₁c levels and DR severity using statistical package for social sciences (SPSS) version 19.
Results: A total 253 patients were involved in the study. Most of the subjects (61.3%) were men. Average age was 49.7 ± 7.3 years. According to DR classification, 35.6% had Mild NPDR, 56.9% had moderate NPDR, 5.5% had severe NPDR and 2% had PDR. Significant association was found between HbA₁c levels and DR severity ( p < 0.001).
Conclusion: Our study showed significant association between DR severity and higher HbA₁c levels. Early screening and timely management can minimize the threat of DR.