Current Issues - Vol. 20, No. 3, July – September 2024

Download Full Issue  

Al-Shifa Journal of Ophthalmology

Editorial: Ethical Consideration in Research and Practice
Mahmood Ali

Mean Errors From The Target Refraction at 1 Month After Phacoemulsification Surgery in High Myopes: A Comparison Of SRK/T, Haigis And Holladay 1
Shafaq Najmi, Badaruddin Athar Naeem, Tehmina Nazir, Fariha Taimur, Zawar Ali Rathore

Objective: To assess differences in mean numerical errors in high myopes from the predicted target refraction using SRK/T, Haigis, and Holladay 1 IOL formulas.
Methods: High myopes having ≤ - 6 D SER and/ or ≥ 26mm axial lengths undergoing uncomplicated phacoemulsification surgery for cataracts and completing 1-month follow-up were included. SRK/T was used for the implanted IOL and the target refraction was predicted using the 3 formulas mentioned above. At 1-month, spherical equivalent refraction was calculated and the difference from the predicted refraction was reported as a mean numerical error (MNE). The Kruskal-Wallis test was used to find differences between the data as it was not normally distributed. Mann-Whitney U test was used to find differences between genders and 2 age groups of 50-59 and 60-70 years.
Results: There were 57 females (45.6%) and 68 males (54.4%) included in the study with a mean age of 57.36 ± 6.17 years. There were no significant differences between the mean numeric error using the Kruskal-Wallis test, (p = 0.161). The Mann-Whitney U test did not find differences between the genders or the age groups using the 3 formulas.
Conclusion: Keeping in view, the limitations of the study, the 3 formulas in our sample performed similarly in high myopes for post-operative refractive outcomes. More studies with randomized designs and optical biometry are needed to elucidate differences in mean numeric error more accurately between the formulae.

Comparison of Anterior Lamellar Recession With and Without Blepharoplasty For Upper Eyelid Cicatricial Entropion
Asima Rafique, Muhammad Shaheer

Objective: To compare the success rate and cosmetic outcomes of anterior lamellar recession versus anterior lamellar recession plus blepharoplasty for treatment of cicatricial entropion of the upper eyelid.
Methods: This Quasi-Experimental study, after approval of the ethics committee of the institute, was carried out between 1st February 2022 to 30th June 2023 at the Institute of Ophthalmology, Mayo Hospital, Lahore. Eighteen patients presenting to the Institute of Ophthalmology and diagnosed with cicatricial entropion were selected for surgery. The subjects were divided into two groups 1 and 2. Group 1 patients underwent anterior lamellar recession alone while group 2 had anterior lamellar recession combined with blepharoplasty. Patients diagnosed with any coexisting senile entropion or ectropion were excluded from the study.
Results: Group 2, which underwent anterior lamellar recession with blepharoplasty, exhibited higher rates of complete success (77.8%) compared to Group 1 (44.4%), (p=0.43). Aesthetic outcomes favored Group 2, with 66.7% of patients in this group rated as having a good aesthetic outcome, compared to only 22.2% in Group 1. When evaluating post-operative success by grade, in Group 1, those with Grade 1 entropion exhibited a success rate of 60%, however, in Group 2, all Grade 1 cases achieved complete success.
Conclusions: There is no significant difference between anterior lamellar recession with blepharoplasty and without blepharoplasty for upper eyelid cicatricial entropion.

Obesity, Physical Inactivity, and Duration of Diabetes Mellitus as Risk Factors For Multiple Sessions of Retinal Photocoagulation
Muhammad Kamran Khalid, Muhammad Marwat, Muhammad Sharjeel, Muhammad Usman Awan, Uroosa Kanwal

Objective:Diabetic retinopathy (DR) is evolving as one of the leading causes of legal blindness worldwide. There is an immense need for the prevention of this potentially blinding disorder. Research has been going on to determine modifiable risk factors to decrease the progression of DR. More advanced cases of DR need pan-retinal photocoagulation (PRP) for the prevention of potentially blinding complications of DR. Our study aimed to evaluate obesity, physical inactivity, and duration of DM as risk factors for multiple PRP sessions and the severity of DR.
Methods: This was a cross-sectional comparative study conducted at the Department of Ophthalmology, Gomal Medical College, Dera Ismail Khan, Pakistan from January 2021 to June 2021. The sample consisted of consecutive patients of pan-retinal photocoagulation (PRP) laser procedures during this period at the Eye Unit, DHQ Teaching Hospital, Dera Ismail Khan, Pakistan.
Results: A total of 168 patients undergoing laser procedures were included in the study. Out of these 104 (61.9%) were male and 64 (38.1%) were female. Obesity and duration of DM >5 years were found to be statistically significant (p<0.05) risk factors for multiple PRP sessions and severity of DR, whereas physical inactivity was not a statistically significant risk factor for multiple PRP sessions.
Conclusion: Obesity and duration of DM >5 years are significant risk factors for multiple PRP sessions in our setup. Efforts should be made to control all modifiable risk factors for the prevention of the sight-threatening complications of DR.

Refractive Error Among Healthy Infants in Tertiary Eye Care Centre of Nepal
Dr Govind Gurung, Krishna Kant Gupta, Harikant Sah

Objective: To determine the prevalence of non-physiological Refractive error among all infants attending the hospital.
Methods: This Retrospective cross-sectional study was conducted among healthy infants attending the Department of Pediatric Ophthalmology in Kedia Eye Hospital, Birgunj, Nepal from January 2023 to June 2023. Informed consent from the infant’s parents was taken. Cycloplegic refraction was performed using retinoscopy to diagnose the refractive errors. Hyperopia of > + 4.00 D, Myopia of < -1.50 D, and Astigmatism of < -1.75 D were included in the study.
Results: A Total of 966 infants (0-12 months) were enrolled in the study. Number of male and female infants were 594 (61.5%) and 372 (38.5%) respectively (Table 1). The mean age was 6 months. The prevalence of Refractive error in infants was 21.5%. Astigmatism was found in 92 infants (9.5%), Myopia in 62 infants (6.4%), and Hyperopia in 52 infants ( 5.6%).
Conclusion: Refractive error is one of the major ocular morbidities affecting children. Detecting Refractive errors early in infancy is an advantage to the children's education, quality of life, and social development. Screening all the infants for Refractive errors along with other systemic illness can be recommended.

Comparison of Central Corneal Thickness Using Ultrasound and Optical Pachymetry
Nashmia Jalil Malik, Muhammad Azam Khan, Irfan Aslam Khattak, Ayisha Shakeel, Huma Zainab, Maria Saleem

Objective: To compare the mean difference in Central Corneal Thickness (CCT), between Standard Ultrasound Pachymetry and Optical Biometry scans, in healthy individuals.
Methods: This cross-sectional study was carried out from 01-02-2023 to 31-07-2023, using non-probability consecutive sampling, at the Department of Ophthalmology, PAF Hospital E-9 Islamabad. A sample size of 100 eyes was calculated, using the WHO calculator. First, the participant’s CCT was measured using an Optical biometry AL Scan. Then the same participant’s ultrasound pachymetry was performed and the results were compared.
Results: A total of 50 (100 eyes) participants were included in the study. With 33 (66%) male and 17 (34%) female participants. The mean age of the participants was 21.92±4.024 years, the mean Ultrasound CCT was 554.04±38.674 μm, and the mean Optical CCT was 539.45±35.666 μm. The mean difference in ultrasound and optical CCT was 15.09±10.309 μm. The paired samples t-test showed that the mean ultrasound CCT of 554.04±38.674 μm was greater than the mean optical CCT of 539.45±35.666 μm, and the difference was statistically significant (p < 0.05).
Conclusion: Even though the CCT measurements between ultrasound and optical pachymetry are comparable and repeatable, they cannot be used interchangeably in follow up visits in clinics. The study also proved a linear correlation between the two modalities, in which if one reading increases, the other increases as well, and vice versa. The CCT measurements by optical pachymeter were lower than by USP (Ultrasound Pachymeter).

Ocular Features of A Rare Case of Noonan Syndrome in A Pakistani Population
Murtaza Sameen Junejo

A heterogenous congenital disorder characterized as Noonan syndrome (NS), presents with typical features like a triangular face, short stature, and cardiac defects. It typically presents as an autosomal dominant trait. Noonan syndrome is one of the RASopathies due to the involvement of the RAS-MAP-Kinase pathway. Diagnosis is based on clinical features that include, typical facial features (triangular face, hypertelorism, ptosis), skeletal abnormalities(scoliosis), short stature, mild developmental delay, presence of cardiac defects, lymphatic dysplasia, and a family history of NS. Here we report a case of 12 years old boy with bilateral upper eyelid ptosis. On detailed examination, it turned out to be Noonan Syndrome.