Current Issues - Vol. 19, No. 3, July – September 2023

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Al-Shifa Journal of Ophthalmology

Editorial: Navigating Hope and Reality: Challenges in Communicating Glaucoma Diagnosis and Prognosis
Mahmood Ali

Exploring Diagnostic Precision: A Comparative Analysis between Aqueous and Vitreous Taps for the Diagnosis of Bacterial Endophthalmitis
Sara Najeeb, Muhammad Irfan Sadiq, Fatima Akbar Shah, Umair Tariq Mirza, Muhammad Usman Sadiq, Muhammad Shuaib

Objective: The primary objective of this research was to investigate and compare the diagnostic precision of aqueous and vitreous taps in detecting bacterial endophthalmitis.
Methodology: A retrospective analysis was conducted, involving a cohort of patients with clinically suspected bacterial endophthalmitis who underwent either aqueous or vitreous taps as part of their diagnostic evaluation at Divisional Headquarters Teaching Hospital, Mirpur Azad Kashmir between January 1, 2020, and December 31, 2022. Total sample size was 86 (43 in each group). Relevant clinical and laboratory data were meticulously collected and analyzed. Statistical methods were employed to compare the diagnostic accuracy, sensitivity, and specificity of the two sampling techniques.
Results: Mean age in aqueous tap group was 59.2 ± 8.7 years and in vitreous tap was 60.5 ± 9.2 years. Out of 86 patients, 48 were males and 38 were females. The sensitivity (93.2%) and specificity (95.1%) of vitreous taps were higher than sensitivity (88.5%) and specificity (92.7%) of aqueous taps.
Conclusion: This study suggested that vitreous taps are more effective in correctly identifying true positive cases of bacterial endophthalmitis. The higher sensitivity & specificity of vitreous taps can be attributed to the direct sampling of the vitreous humor, which is in closer proximity to the site of infection.

Retinal Nerve Fibre Layer Thickness Among Children with Refractive Errors Using Spectralis Optical Coherence Tomography
Alizay Gohar Afzal, Aunaza Maqbool, Usman Arshad, Sehrish Khan, Rabia Sharif Bhatti, Sohail Zia

Objective: To determine mean RNFL thickness among the pediatric population with refractive errors using Spectralis optical coherence tomography.
Methodology: The study was conducted in a tertiary eye care hospital located in Rawalpindi, Pakistan between March 14, 2018, and September 14, 2018. The research included children aged 4-12 years who had refractive errors and received a complete basic ophthalmologic examination, including VA, cycloplegic refraction, slit lamp examination of anterior and posterior segment examination after pupillary dilatation, and intraocular pressure measurement. The spherical equivalent was determined in diopters and taken as a quantitative measure. Axial length was calculated by non-contact optical biometry and recorded in millimeters.
Results: A total of 165 individuals were recruited with a mean age (years) in the study of 9.07+2.43 years. There were 114 (69.1%) male and 51 (30.9%) female patients who were included in the study. Mean spherical equivalent was 1.25+4.21 whereas mean RNFL thickness was 102.99+5.86 among children with refractive errors using Spectralis optical coherence tomography among the participants.
Conclusions: The study has found that there is a notable connection between the average thickness of the retinal nerve fiber layer (RNFL) in children with refractive errors using Spectralis optical coherence tomography in the Pakistani community. Further studies are needed in various settings to investigate the factors that affect RNFL reserve in childhood. This information would be beneficial in diagnosing and keeping an eye on optic nerve diseases.

Comparison between Efficacy of Sulfur hexafluoride (SF6) Gas Tamponade and Air Tamponade after Pars Plana Vitrectomy in Fresh Rhegmatogenous Retinal Detachment
Muhammad Muneeb, Kanwal Zareen Abbasi, Muhammad Rizwan Khan, Bilal Humayun Mirza

Objective:To compare the efficacy of gas (SF6) tamponade vs. filtered air tamponade after PPV “pars plana vitrectomy” in cases of fresh RRD “Rhegmatogenous Retinal detachment”, in terms of anatomical attachment of retina and Best Corrected Visual Acuity assessment.
Methodology: A Randomized controlled trial was conducted in Ophthalmology Department Unit-I, Lahore General Hospital, Lahore, from January 2020 to January 2022. Patients of fresh rhegmatogenous retinal detachment fulfilling inclusion criteria were admitted from Eye OPD. Patients were divided into two groups. All the patients were evaluated for anatomical success by dilated fundus examination. SPSS v25.0 was used to analyze the data.
Results: In group A (SF6 gas), the mean value of BCVA post-operative (1 month) was 0.19±0.40 and in group B (filtered air) was 0.22±0.42. In group A (SF6 gas) 24 (88.9%) patients had attached retina after one month of surgery and similarly in group B (filtered air) 24 (88.9%) patients had attached retina after one month of surgery. The results showed that there was no significant difference in both groups. Both the treatment procedures had same efficacy.
Conclusion: Efficacy of gas (SF6) vs. filtered air after PPV “pars plana vitrectomy” in cases of fresh RRD “Rhegmatogenous Retinal detachment” in terms of anatomical attachment of retina and best corrected visual acuity assessment, was same.

Efficacy of 0.03% Tacrolimus in Refractory Vernal Keratoconjunctivitis
Afia Matloob Rana, Sidra Jabeen, Sidra Fatima

Objective: To determine the frequency of patients with different stages of diabetic retinopathy presenting to a tertiary care eye hospital in Rawalpindi.
Methodology: In this quasi-experimental study, the data of 152 patients who presented with “refractory vernal keratoconjunctivitis (VKC)” was collected through “non-probability consecutive sampling” technique. Baseline characteristics including age, gender, duration of disease and baseline OSS score were documented. Patients were treated with 0.03% tacrolimus and post-therapy OSS scores were assessed at week 4 and week 12. To determine the efficacy of 0.03% tacrolimus, the frequency of “treatment success” was measured. Data was analyzed using SPSS version 22.
Results: Mean age of the study participants was 13.48 ± 5.22 years. 98 (64.47%) of the patients were males and remaining 54 (35.53%) patients were female. Mean baseline OSS score was 20.93 ± 2.34. Mean OSS score after 4 weeks of therapy was 14.87 ± 2.32 and after 12 weeks of therapy was 7.59 ± 3.49. Frequency of “treatment success” was 124 (81.58%). Conclusion: 0.03% tacrolimus is an efficacious therapeutic option to treat patients with “refractory vernal keratoconjunctivitis (VKC)”.
Conclusion: In conclusion, 0.03% topical tacrolimus provides successful treatment of refractory “vernal keratoconjunctivitis (VKC)” in 81.58% which shows that it is a highly useful and efficacious mode of intervention to manage this vision threatening ocular condition.

Awareness, Perception and Preferred Modality of Refractive Error Correction Methods
Nalain Syedah, Muhammad Afzal Bodla, Maryam Syedah

Objective: To determine the level of awareness and perception towards refractive error correction methods and to analyze the preferred corrective modality i.e. among spectacles, contact lenses and refractive surgery.
Methodology: This was a cross-sectional study conducted at a Tertiary Eye Care Hospital of district Rawalpindi. Age ranging from 18-35 years. Focusing on the objective of the study data was collected with the help of self-administered questionnaire after taking verbal informed consent Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20.
Results: The study included 95 participants; all were spectacle wearers in age group (18-35) out of which 45 respondents were females and 50 were males. The respondents those were in age range between 18-23 (60.9%) had a good level of awareness while participants of age range 31-35(19.0%) had a poor level of awareness towards correction method. Their choice was according to their needs. On investigating preference of individuals regarding vision correction tools, spectacles (62.1%) were found to be the more preferred choice as compared to contact lens (10.5%) and refractive surgery (27.4%).
Conclusion: People with higher education and in age group 18-23 are more aware than those with basic education. Myths about correction methods were also found to be one of the hurdles towards treatment. Knowledge about refractive errors and benefits of using other correction modalities, their advantages and disadvantages should be addressed in the daily health talks to all patients and attendants visiting to eye care professionals.

Impact of Gadgets on Amblyopic Therapy and Risk of Astigmatism Development: A Prospective Case Report of a 5 years old
Mutahir Shah, Saif Ullah

This prospective case report was carried out to investigate the effect of electronic gadget use during amblyopic therapy in a 5-year-old child with monocular hyperopia of +6DS. The child received glasses and underwent patching therapy for the amblyopic left eye while using electronic devices. The therapy successfully improved visual acuity over two years, an unexpected development of with-the-rule astigmatism in the left eye raised concerns about the role of gadget use in astigmatism development. This prospective case report highlights the efficacy of patching therapy combined with gadget, but suggests the need for further investigation of the potential risks of developing astigmatism.