Current Issues - Vol. 20, No. 4, October – December 2024

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Al-Shifa Journal of Ophthalmology

Editorial: Teleophthalmology and use of Artificial Intelligence in Ophthalmic Care
Ume Sughra

Images of Defaced Ocular Anatomy and Malignant Blood Disorders: An Evaluation of Inter-Relationship
Muhammad Yousuf Khoso, Raja Faisal Zulfiqar, Sadia Sundus, Raheela Adil, Sayed Liaquat Ali, Tazeen Kohari

Objective: To document spectrum of fundoscopic ocular findings and their association with malignant blood disorders in order to develop better diagnosis and treatment guidelines.
Methods: From March 2022 to February 2023, this study was conducted by joint effort of ophthalmology and hematology departments of Sheikh Zayed Hospital and RYK Hospital & Medical College. Participants with leukemia, lymphoma and multiple myeloma were included in study. Detailed eye examination and extensive hematological assessments were performed for every participant.
Results: The retrospective observational study included 90 cases of malignant blood disorders. In 86.66% cases, ophthalmic pathologies of sub-conjunctival hemorrhage, intra-retinal hemorrhage, cotton wool spots and retinal detachment were observed. Most dominant malignant blood disorder was acute lymphocytic leukemia having 35.55% cases, acute and chronic myeloid leukemia both had equal number of cases, 20.00% each. Anterior segment was involved in 12.22% of cases. Posterior segment was involved in 74.44% of the cases. Multivariable logistic regression analysis to assess the association between hematologic parameters and presence of ophthalmic findings revealed that total white cell count (TWCC) (p = 0.031) and total thrombocyte count (TTC) (p = 0.046) had statistically significant correlation with ocular pathologies.
Conclusion: The results suggest that retina is often directly or indirectly affected by malignant blood disorders, most common pathology being intra-retinal hemorrhage. In light of present study, it's evident to conduct an eye examination as a compulsory part of initial diagnosis for malignant hematologic conditions and to continue these checks regularly to identify any ophthalmic pathologies.

Analysis Of Corneal Endothelial Cells Post Pars Plana Vitrectomy And Silicon Oil Tamponade Treatment for Rhegmatogenous Retinal Detachment
Muhammad Hannan Jamil, Bilal Ashraf, Asmatullah Khan, Aneeb Ashraf, Nida Amin, Taha Sahar, Ferheen Shahbaz

Objective: To examine the effects of pars plana vitrectomy (PPV) with silicone oil tamponade on corneal endothelial cell density in patients with rhegmatogenous retinal detachment (RRD).
Methods: The study was conducted at Ali Fatima Hospital in Lahore, Pakistan, 120 individuals with RRD diagnoses between the ages of 30 and 70 participated in a quasi-experimental design. Consecutive non-probability sampling was used. Pre- and post-PPV corneal endothelial cell density was assessed.
Results: There were notable differences in the quantity of corneal endothelial cells among the groups. Before surgery, no discernible changes were discovered. However, following surgery, there were significant differences in mean change between genders (p = 0.001) and age groups (p < 0.0001). The mean change between phakic and pseudophakic eyes varied significantly after surgery (p < 0.0001). The mean count was significantly different before and after surgery (-49.85 cells/mm2, p = 0.005).
Conclusions: This implies that PPV combined with silicone oil tamponade has a significant positive effect on the density of corneal endothelial cells. PPV combined with silicone oil tamponade has a good impact on RRD patients' corneal endothelial cell density. The mean change after surgery varied by gender and age, highlighting the significance of individualized treatment plans.

Association Between Dry Eye And Stress In Undergraduate Medical Students In Mirpur, Azad Jammu and Kashmir
Umair Tariq Mirza, Kanwal Ijaz, Filza Haqiq, Muhammad Luqman Ali Bahoo, Kashif Iqbal, Muhammad Umer Khan

Objective:To determine the correlation between psychological stress and dry eyes, and to assess gender distribution for the latter in undergraduate medical students.
Methods: This cross-sectional study was done at Mohi-ud-Din Islamic Medical College Mirpur, Azad Jammu and Kashmir, from June to September 2021. A final sample of 157 students were recruited. Dry eye symptoms were assessed using a 12-item questionnaire, the Ocular surface disease index (OSDI, Total Score 0 – 100), and Psychological Stress was measured using Perceived Stress Scale 4 (PSS-4) questionnaires (Total score 0-15). For the Ocular surface disease index, 0 -12 was taken as normal, 13 -22 as mild, 23 – 32 as moderate, and 33 – 100 as severe disease.
Results: Out of 157 students, 82(52.2%) were Male, and 75 (47.8%) were females with a Median age of 22 (21-27) years. 97 (61.8%) had dry eyes. Median OSDI score was 15.45(0-73) and Median PSS-4 score was 8(0-15). Subjects with DED (DED group) showed significantly higher OSDI& PSS scores compared to those without DED (non-DED group) (p<0.001, P=0.003 respectively). A strong correlation was found between the severity of dry eye disease & PSS-4 score in the study population rs = 1 (p=0.001).
Conclusion: DED is prevalent among medical students, and it has different symptoms. Males predominated over females in the DED group. Factors involved in the correlation between dry eye disease and psychological stress among medical students should be evaluated to minimize the burden of the disease.

Prevalence and Types of Retinal Vein Occlusion in Patients Undergoing Green Laser Photocoagulation InDera Ismail Khan Division, Pakistan
Muhammad Kamran Khalid, Muhammad Shoaib Khan, Muhammad Sharjeel, Muhammad Abdullah, Muhammad Sohail Arshad

Objective: To determine the prevalence and type of retinal vein occlusion in patients undergoing green laser photocoagulation.
Methods: A descriptive cross-sectional study was performed at the eye unit of DHQ Teaching Hospital Dera Ismail Khan from January 2017 to December 2022. All patients of retinal vein occlusion (RVO) treated with green laser photocoagulation were included in the study. The sample was analyzed using frequencies and percentages in SPSS version 22.
Results: Out of 2058 patients having green laser, 86 (4.18%) had retinal vein occlusion, while 1972 (95.82%) had other retinal diseases. Out of 86 patients of RVO, 47 (54.65%) were female while 39 (45.35%) were male. A total of 20 (23.26%) were below 40 years and 66 (76.74%) were over 40 years. A total of 56(65.125%) were from urban areas and 30(34.88%) from rural areas. Out of 86 patients with retinal vein occlusion, 70 (3.40%) had branch retinal vein occlusion (BRVO) and 16 (0.78%) had central retinal vein occlusion (CRVO).
Conclusion: Retinal vein occlusion is more prevalent among females, particularly in older patients living in urban areas. These patients typically present with sudden, painless loss of vision. Additionally, branch retinal vein occlusion is significantly more common than central retinal vein occlusion.

Prevalence of High Myopia in Young Adult Patients Presenting to a Tertiary Eye Hospital in Rawalpindi, Pakistan
Waleed Ahmad, Saud ul Hassan Memon, Mehwish Ameer, Yasir Ahmad

Objective: To determine how common high myopia is among the younger patients seen at a tertiary eye facility.
Methods: A descriptive Cross-Sectional study, carried out at the Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, from 1st June 2022 till 1st August 2022. Seventy participants aged 18 to 30 years old, were tested for refraction using nonprobability consecutive sampling and both automated and manual methods, if needed. Refractive error values reported in this study are based on Spherical Equivalent Refraction (SER), calculated using the formula: SER = Sphere ± ½ Cylinder. This method was applied to ensure standardized measurement of refractive errors across all participants. Data were analyzed using SPSS Version 22.0.
Results: The study found that 42.9% of participants had a refractive error between -7.0 to -7.9 D, 40.0% had -6.0 to -6.9 D, and 17.1% had -8.0 D or higher. Females exhibited a slightly higher prevalence of severe myopia than males.
Conclusion: This study assessed the severity of high myopia among young adults attending a tertiary eye hospital in Rawalpindi. The findings revealed a significant portion of participants with severe refractive errors, particularly among females. These results highlight the need for early detection and tailored interventions to manage the high degree of myopia effectively, aiming to reduce the risk of complications and improve vision-related quality of life.

Ethics in Clinical Trials (Letter to Editor)
Muhammad Rafay Imran