Current Issues
Current Issues - Vol. 21, No. 4, October - December 2025
Al-Shifa Journal of Ophthalmology
Editorial:
Light-Based Interventions in Myopia Control
Saif Ullah
Efficacy and Safety of Suprachoroidal Triamcinolone Acetonide in Refractory Diabetic Macular Edema in Khyber Teaching Hospital
Ansa Anam, Imran Ahmad
Objective: To evaluate the efficacy and safety of suprachoroidal triamcinolone (SCTA) in patients with refractory diabetic macular edema at Khyber Teaching Hospital, Peshawar.
Methods: This was a quasi-experimental study carried out in the department of ophthalmology at Khyber Teaching Hospital, Peshawar, from 20th March 2023 to 20th March 2024. Data was collected from 101 patients with refractory diabetic macular edema using non-probability consecutive sampling technique. Best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at baseline. The same clinical parameters were reassessed and analyzed at 1 week, 1 month and 3 months post SCTA injection. Data was analyzed through SPSS v 26.
Results: The mean age of the patients was 56.861 ± 6.59 years, and the mean duration of symptoms was 20.613 ± 5.41 months. Mean LogMAR BCVA showed statistically significant changes, being 0.792 ± 0.15 at baseline and 0.162 ± 0.07 after treatment (p < 0.001). CMT significantly decreased from 478.6 ± 43.3 μm to 312.5 ± 38.9 μm (p < 0.001). IOP did notsignificantly change (p = 0.09), and no patient experienced sustained IOP elevation. Efficacyand safety were observed in 84.2% and 87.1% of patients, respectively.
Conclusion: SCTA offer to be a highly effective and well-tolerated treatment option for patients with refractory diabetic macular edema, offering significant visual gain with a good safety profile.
Safety Profile of Bilateral Same Day Injections of Anti-Vascular Endothelial Growth Factor (Anti-VEGF)
Mehvash Hussain, Madiha Waseem, Tarique Saleem, Fizzah Farooq
Objective: To evaluate the safety profile of bilateral same-day intra-vitreal injections of antivascular endothelial growth factor and their possible complications.
Methods: A cross-sectional study was conducted in the Department of Ophthalmology, SMBB Trau-ma Center, Dow University of Health Sciences, Dr. Ruth K.M. Pfau Civil Hospital, Karachi. The study population comprised patients requiring bilateral intravitreal bevacizumab injections for the manage-ment of retinal vascular diseases. A non-probability consecutive sampling technique was used. Before enrollment, written informed consent was obtained. All collected data were entered into a structured database and subsequently analyzed using the Statistical Package for the Social Sciences (SPSS), version 26.
Results: We studied 103 patients who received simultaneous bilateral injections of anti-VEGF Intravitreal injections were indicated for a range of multiple pathologies. These in-cluded cystoid macular edema, proliferative diabetic retinopathy, vitreous hemorrhage, cho-roidal neovascularization , degenerative myopia, and central serous chorioretinopathy. Pa-tients were assessed on the first day, after a week and then after a month. No serious ocular or systemic complications were reported during this period. Few patients reported sub-conjunctival hemorrhage which spontaneously resolved within a week.
Conclusion: Bilateral same-day intra-vitreal injections using separate instruments for each eye appears to be safe, well tolerated and less time consuming. None of the patients in this study showed any serious complication necessitating the need to switch to alternate bilateral injections.
Comparison of Videokeratographic Changes Before and After Pterygium Surgery
Muhammad Jahanzaib, Samar Fatima, Fakhar Humayun, Junaid Afsar, Bushra Akbar, Muhammad Imran Sarwar
Objective: To compare the contrast sensitivity and videokeratographic changes of corneal surface topography before and after surgery in patients with pterygium.
Methods: This Quasi-experimental study was carried out at Department of Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from January to December 2024. A total of 130 patients with varying grades of pterygium were sampled using simple random sampling via lottery method. Values for best corrected visual acuity, astigmatism, corneal irregularity, refractive power and contrast sensitivity were assessed. Pterygium removal and conjunctival autograft were done. All values were re-assessed at 4 weeks after surgical removal and conjunctival autograft in all patients. Data were analyzed using SPSS version 26.
Conclusion: We concluded that pterygium surgery is associated with a statistically significant improvement in corneal topography including astigmatism, corneal irregularity, refractive power as well as improvement of corneal sensitivity. Download Issue
Safety Profile of Intravitreal Bevacizumab Injection: A Five Year Retrospective Analysis
Muhammad Kamran Khalid, Muhammad Asfandyar Akhtar, Laiba Gul
Objective: To evaluate the safety profile of office-based intravitreal Bevacizumab injection.
Methods: This was a retrospective observational study conducted at the private clinic of the author in Dera Ismail Khan, Pakistan from January 2017 to December 2021. The sampling method was non-probability consecutive sampling from the patients receiving intravitreal Bevacizumab (Avastin) injection for various retinal disorders. Each injection was treated as an independent event. Sample size was calculated using Raosoft online calculator keeping margin of error 2% and 95% confidence level. Data analysis was performed using SPSS-20 software.
Results: A total of 2377 patients receiving intravitreal Bevacizumab injection were included in the study. Of these, 1201 (50.53%) were female and 1174 (49.47%) were male. Two cases (0.084%; 95% CI: 0.010–0.302%) of post-injection endophthalmitis occurred. Minor complications included subconjunctival hemorrhage (n=7; 0.29%) and conjunctival hyperemia(n=9; 0.38%). No retinal detachments, lens trauma, or sustained intraocular pressure rises were observed.
Conclusion: Intravitreal Bevacizumab injection is a safe procedure when performed with strict aseptic technique.
Comparison of 0.1% Topical Tacrolimus with 0.05% Topical Cyclosporine in Treatment of Vernal Keratoconjunctivitis
Nauroz Fatima, Maeirah Shafique, Qaim Ali Khan, Naila Obaid, Tanzeel Fatima
Objective: To compare the effectiveness of 0.1% tacrolimus skin ointment with 0.05% cyclosporine eye drops in the initial management of moderate to severe vernal keratoconjunctivitis.
Methods: This quasi-experimental study was conducted at a tertiary care Hospital in Bannu, from Sep 22 to Apr 23. Total 46 patients (96 eyes) with moderate to severe VKC were enrolled. Consecutive sampling was done. All patients were off treatment before enrolment. Patients were divided into two groups. One group was given 0.1% tacrolimus dermatologic ointment and the other was given 0.05% cyclosporine eye drops. Subjective and objective signs were scored according to criteria and recorded pretreatment, at 2 weeks and 4 weeks with treatment. Data was analysed by using SPSS version 20.
Results: Mean age of the patients was 8.6 years ± 3.8 SD. Subjective and objective scores were analyzed by using paired sample T test and comparison between both medicines was done by applying independent sample T test. Both of the drugs showed statistically significant improvement at 2 and 4 weeks of treatment (p value< 0.001). Both of the drugs were found to be equally effective at 2 and 4 weeks (p value >0.05 %) except for photophobia and giant papillae which were improved better in cyclosporine group at 2 weeks. However, at 4 weeks there was no significant difference.
Conclusion: Both tacrolimus 0.1% ointment and 0.05% cyclosporine eye drops are equally effective in the treatment of VKC and can be used in the initial management of moderate to severe VKC.
Diagnostic Accuracy of B-Scan and Contrast-Enhanced High-Resolution Magnetic Resonance Imaging (MRI) for Detection of Retinoblastoma Taking Histopathology as Gold Standard
Abdul Shakoor, Sarah Nisar
Objectives: To determine the diagnostic accuracy of B-scan ultrasound and contrast-enhanced MRI (CEMRI) for detecting retinoblastoma, using histopathology as the gold standard.
Methods: This cross-sectional validation study was conducted at the Radiology Department of Bahawal Victoria Hospital (BVH), Bahawalpur, from June to December 2024. Children aged 6 months to 5 years with clinical suspicion of retinoblastoma were included. Exclusion criteria included prior diagnosis, treatment (chemotherapy or radiotherapy), or ocular trauma. All participants underwent B-scan ultrasound, CE-MRI, and surgical evaluation. Data was analyzed using SPSS v23.0. The values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
Results: We analyzed 64 patients who were suspected of having retinoblastoma. The mean age of patients was 2.6 ± 1.35 years. Overall diagnostic accuracy of B-scan was 62.50% and for CE MRI was 89.1%. B-scan ultrasound had sensitivity and specificity of 75% and 35% respectively. CE MRI was positive in 49 patients (76.6%) having sensitivity and specificity of 97.7% and 70% respectively.
Conclusion: B-scan is a cost-effective initial investigation with good sensitivity, and CE-MRI shows higher overall diagnostic performance.