Current Issues - Vol. 20, No. 1, January – March 2024

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Al-Shifa Journal of Ophthalmology

Editorial: An Elite Surgeon - Dethroning the Master Surgeon
Rashid Zia

Bacterial Flora of Conjunctiva in Medical Students of Mohtarma Benazir Bhutto Shaheed Medical College Mirpur Azad Kashmir
Muhammad Usman Sadiq, Sara Najeeb, Umair Tariq Mirza, Fatima Akbar Shah, Muhammad Irfan Sadiq, Nazish Babar

Objective: To determine the bacterial conjunctival flora present among medical students of Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad Kashmir.
Methodology: A microbiological analysis on 196 conjunctival swabs from 196 students with healthy eyes was carried out in this prospective, cross-sectional study conducted at the Divisional Headquarters Hospital, Mirpur, Azad Kashmir. These swabs were used to inoculate blood agar and chocolate agar plates for culture.
Results: The study included a total of 196 students. The mean age was 21.26±1.555 years. Of the 196 participants, 131 (66.8%) were males and 65 (33.2%) were females. The number of right and left eyes were 100 and 96, respectively. Only 86 (43.88%) specimens showed growth while the remaining 110 (56.12%) showed no growth. 76 (88%) of the 86 positive isolates were Gram Positive Bacteria. The most common bacteria were Staphylococcus epidermidis (67%), followed by Staphylococcus aureus (6%). There were only 10 (12%) gram-negative bacteria found in the positive isolates. With 1% of the total, the three most often isolated species were Citrobacter freundii, Burkholderia cepacia, and Pseudomonas aeruginosa.
Conclusion: The most common isolated bacteria from the conjunctiva were game positive bacteria, with Staphylococcus epidermidis being the most common.

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Beyond the Colors: Exploring the Association between Eye Color and Hair Color for Forensic Identification
Zulfiqar Ali Buzdar

Objective: This study aimed to investigate the association between eye color and hair color within the local population of Pakistan for forensic identification purposes.
Methodology: Data on eye color and hair color were collected from 293 MBBS students at Sahara Medical College Narowal over three academic years (2021-2023). Data were collected using a questionnaire, with data on specific colors of hair and eyes, and analyzed. Statistical tests including the chi-square test, were conducted to assess the association between eye color and hair color.
Results: The findings revealed a statistically significant relationship between eye color and hair color (p value <0.01). Brown and black hair colors were predominant among the study population, while brown and black eyes were the most common eye colors. The association between these phenotypic traits has practical implications for forensic identification, highlighting their importance as distinctive markers of individual identity.
Conclusions: The association between eye color and hair color underscores their potential utility for forensic identification purposes. Integrating information on these phenotypic traits into forensic investigations can enhance the accuracy and reliability of identification techniques, contributing to the administration of justice.

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Analysis Of Senile Cataract Induced Anatomical/Histo-Pathological And Biochemical Changes In Human Crystaline Lens
Raja Faisal Zulfiqar, Raheela Adil, Syed Liaquat Ali, Adeel Zafar, Yousuf Khoso, Zen ul Abideen

Objective:To evaluate histopathological & physiological alterations in lenses affected by senile cataracts for a better understanding of the disease.
Methodology: After approval from the relevant ethical committee, analysis of 20 lenses removed surgically for Implant of a synthetic lens in patients aged 55 to 70 years was performed by histopathologic techniques using hematoxylin & eosin-stained slides and anatomical micrometric measurements. The duration of the study was approximately six (6) months. Random probability sampling was used.
Results: 55% of the crystalline lenses were found to have pathologic calcification, 45% of them showed enlarged or bladder cells, 40% presented with nuclear fibrosis, 20% had ectopic shifting of surface lining epithelial cells underneath the posterior capsule, and finger-like microstructures were seen projecting in the posterior wall of the capsule of the lenses in 15% of lenses.
Conclusion: Most of the lenses attributed more than one histopathological finding. A marked decrease in the size of epithelial cells was observed, whereas alterations in the thickness of the lenses were insignificant with a p-value of >0.05.

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Prevalence of Trachoma in Gilgit, Pakistan: A Cross-Sectional Study at Tertiary Care Center (2018-2023)
Qaim Ali Khan, Muhammad Tahir, Yasir Iqbal, Nauroz Fatima, Qurat ul Ain Ghazanfar, Benish Ali

Objective: To assess the prevalence of trachoma among patients attending a tertiary care hospital in Gilgit, Pakistan.
Methodology: Data for this descriptive cross-sectional study was collected by consecutive sampling from analyzing the medical records of all the patients presenting to the Gilgit Eye Care Centre during the spanning from January 2018 to January 2023 (a 5-year period) ensuring that diagnosis of trachoma was based upon the WHO criteria (FISTO). The data was analyzed according to gender and age on SPSS and results were compiled.
Results: A total of 24,589 patients were examined during the study period consisting of 61.8% females and 38.2% males. The estimated prevalence of trachoma was 0.22% (95% confidence interval: 0.14% - 0.30%). Among them, 54 were diagnosed with active trachoma, with mean age 23.30, SD 14.32 years with a female to male ratio of approximately 4.26:1 (81% females, 19% males).
Conclusion: This pilot study identified prevalence of trachoma in a hospital setting, highlighting the need for population-based studies to assess the true disease burden in Gilgit.

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A Novel Approach – Extra-capsular Cataract Extraction under Topical Anesthesia
Muhammad Sharjeel, Hafiza Sadia Imtiaz, Muhammad Awais Ashraf, Muhammad Rizwan Khan, Irfan Ullah

Objective: To determine the efficacy of topical anesthesia for performing extra-capsular cataract extraction in patients with mature, hypermature and brunescent cataract.
Methods: Patients of either gender, between 40-80 years of age, with mature, hypermature and brunescent cataracts, having uneventful ECCE were included in this study at eye department of Gomal Medical College, from Jan 2022 to Dec 2022. Topical anesthesia was acquired by proparacaine hydrochloride 0.5% eye drops. Pain score from patient and satisfaction score from surgeon were assessed during each surgery and recorded on proforma. Data was analyzed using SPSS v 25.
Results: Out of 52 patients, 46.1% were male and 53.8% were female with mean age of 60.7 ± 6.5 years. Mean pain score experienced by patients during surgery was 2.86±1.32 with the range of 1 to 7. Maximum patients (30.7%) experienced a score of 03 and none of the patients reported pain score above 07. Maximum pain was experienced at the time of suturing by majority of patients (53.84%). Surgeon’s satisfaction score was also assessed and Mean satisfaction score found was 8.24±2.39 with the range of 03-10. Maximum score for surgeon’s satisfaction was 10 in 3 cases (5.76%) and score of 8 was found in majority of patients (32.69%).
Conclusion: Thus, ECCE can be safely performed under topical anesthesia that helps in achieving tremendous patient’s as well as surgeon’s comfort during surgery.

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Persistent High Intraocular Pressure (IOP) After Phaco Vitrectomy In A Case Of Trauma
Xianxin Gao, Rong Zhao, Guohua Wang, Xiaonian Liu

This report delineates a case of persistent intraocular pressure (IOP) after trauma, phaco vitrectomy, necessitating repeated surgical interventions for effective management. A 51-year-old male presented with a history of right eye basketball injury, reporting a month-long experience of a dark shadow in his vision. Initial assessment revealed visual acuity (VA) of 50/100 in the right eye and 80/100 in the left eye, accompanied by elevated IOP (25 mmHg) and several ocular anomalies, including lens opacity and vitreous hemorrhage. Surgical procedures, including phacoemulsification, intraocular lens (IOL) implantation, vitrectomy, gas-liquid exchange, and retinal laser photocoagulation, were performed on the right eye. Despite these interventions, persistent high IOP necessitated further management, including anterior chamber punctures followed by tube implant.

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