Past Issues - Vol. 17, No. 1, January – March 2021

Al-Shifa Journal of Ophthalmology

Editorial: Growing Menace of Diabetic Retinopathy in Pakistan
Ume Sughra

Knowledge And Attitude of Parents Towards Children Suffering from Strabismus Presenting in a Tertiary Care Eye Hospital at Rawalpindi
Naima Shakeel, Ayesha Babar Kawish, Momina Javed, Mussarat Ali, Fareeha Ayyub, Sadaf Qayyum

Background: Early diagnosis and treatment is very crucial for successful treatment, which is only possible if the parents notice their child’s strabismus early and take timely interventions
Objectives: The purpose of this study was to assess knowledge and attitude of parents toward children suffering from strabismus coming to Al-Shifa Eye Hospital, and to find out the association between parental knowledge and psychosocial aspects of strabismus.
Material and methods: A cross-sectional study was conducted from October 2019 to December 2019 at orthoptics department of Al-Shifa Trust Eye Hospital, Rawalpindi. The study population included all the parents of children with strabismus presenting in orthoptics department of Al-Shifa Trust Eye Hospital, Rawalpindi, fulfilling the inclusion criteria. Sample size calculated was 75 parents. Non-probability convenient sampling technique was used. Data was collected through interview-based questionnaire. Data analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Chi square test was used to find association between outcome variable and independent variable.
Results: The results showed that the association between education level of parents and their knowledge about strabismus is not statist1cally significant. Further the association between education level of parents and their attitude towards their child’s strabismus is not statistically significant however, there is significant association between knowledge and attitude. 72.1 % (N=31) of parents with good attitude had good knowledge.
Conclusion: The success of strabismus treatment primarily depends on the age of presentation when early diagnosis and treatment is possible. Lack of knowledge about strabismus delays the entire process of identification and treatment of strabismus.

Types of Refractive Errors and Visual Outcome with Spectacles and Telescopes among Albino Patients
Mutahir Shah, Saifullah, Maryam Firdous, Farah Amin, Sufian Ali Khan

Purpose: To determine types of refractive error and Visual Outcome with spectacles and telescopes in Albinism
Methodology: This was a Cross Sectional study conducted in Low Vision Department of Shifa Eye Foundation Hospital Haripur. Study duration was 6 months from March 2020 to September 2020. Sampling technique was non-probability convenience sampling. Refractive errors were evaluated subjectively and objectively. Best corrected visual acuity with spectacles and telescopes were assessed binocularly.
Results: A total of 37 patients with Albinism were examined and divided into two groups i.e., Ocular Albinism (OA) and Oculocutaneous Albinism (OCA). The frequency of OCA was 29 and that of OA was 07. OCA Astigmatism was the most common refractive error about 72.41%. Astigmatism was found with a mean value of 2.71D. Myopia had a mean value of -6.7D, while the degree of Hyperopia was found with a mean value of 7.20D. Main Refractive Errors found among OA was Myopia and Astigmatism with equal percentage of 42.85%, Hyperopia was 14.28%. Myopia was found with a mean value of - 9.66D. Astigmatism was found with a mean value of 3.5D and Hyperopia was 5.12D. In OCA the uncorrected Visual Acuity (VA) was found with a mean value of 0.99 Log MAR. In OA it was found with a mean value of 0.90 Log MAR. With Spectacle in OCA it was 0.82 Log MAR while with Galilean telescope the value was 0.54 Log MAR. With Keplerian telescope it was 0.25 Log MAR and in OA with Spectacles the mean value was 0.72 Log MAR.
Conclusion: Astigmatism was the most significant refractive error among Albino patients. VA had improved with spectacles and telescopes. Keplerian telescope improved vision more significantly compared with Spectacles and Galilean telescope.

Association of Consanguinity with Keratoconus Among Patients Presenting at A Tertiary Eye Care Hospital, Rawalpindi; Case Control Study
Shanza Khan, Ayesha Baber Kawish, Bilal Khalid, Nisma Sehar, Sadaf Qayyum, Fareeha Ayyub

Objective: The aim of this study was to find out an association between keratoconus with consanguinity of the parents of the patients and also find out the other risk factors associated with keratoconus.
Methodology: This case-control study was conducted over the duration of four months from October 2019 to January 2020 and it included patients who were diagnosed with keratoconus at the cornea department of Al-Shifa Trust Eye Hospital, Rawalpindi (ASTEH). The control group included age and sex matched individuals who were randomly selected from patients presenting in general OPD of ASTEH without keratoconus. Study subjects were asked to fill structured questionnaire that included demographic and geographic details, questions on ocular and general health and keratoconus profile history. Data was analyzed by using SPSS version 20.A Chi-square test was used to check the association of consanguinity with keratoconus.
Results: 115 cases and 230 controls were included in this study among them 52.2% were male in case groups and 48.6% were female in the control group. Majority of the respondents presented with positive ocular allergy in both cases 78.8% and controls 52.4%. There is significant association between the consanguinity and keratoconus with the p value of 0.00.
Conclusion: This study concluded that eye rubbing, ocular allergy, consanguinity and having family members with keratoconus emerged as significant risk factors for KC.

Assessment of Knowledge About Diabetic Retinopathy and Motivating Factors for Screening Among Diabetic Patients in Rawalpindi
Hira Ajmal, Hina Shareef, Sohail Ahmad, Mussarat Ali, Shahid Iqbal, Sadaf Qayyum

Background: Diabetic Retinopathy (DR) is the fifth leading cause of blindness in worldwide and fourth cause of blindness in Pakistan. This study assesses level of knowledge about DR among diabetic patient and the factors which motivate patient for DR screening.
Methodology: A cross-sectional study was conducted (including 370 diabetic patients) from October 2019 to December 2019 at three general hospitals of Rawalpindi. A structured questionnaire was used to collect the information from patients it consisted of three sections i.e., demographic profile of diabetic patient, knowledge about DR, the factors that motivates patient for DR screening. After collection of data, it was coded and entered into SPSS version 20. Then the data were analyzed using Chi-square test.
Results: About 45.7% had high knowledge about DR and 42.4% had high motivation level for DR screening. Socio-economic status like education level, family history of DM, and monthly income had influence on knowledge of DR and shows statistically significant effect on knowledge about DR (p-value < 0.001). Education level also shows statistically significant effect on the factors that motivate patients for DR screening (p- value<0.001).
Conclusion: The study showed lack of awareness of DR among diabetic patients in the study population. There is an urgent need for early DR screening and for refining knowledge and awareness of diabetes and DR in Rawalpindi, Pakistan.

Protecting Healthcare Workers from COVID-19 Hazards
Shehnilla Shujaat, Khalid Iqbal Talpur

Objective: To ensure, the quality and proper management of ophthalmic patients & protection of health care providers amidst hard time of COVID-19.
Study design: Study design is observational study.
Place and duration of study: The place of our study was Sindh Institute of Ophthalmology and Visual Sciences and duration of this study was nine months from 1st April 2020 to 31st December 2020. Methods: Ophthalmic patients and ophthalmologists were at higher risk of being infected by the novel corona virus because of close proximity during examination and procedures, so special strategies were adopted to protect them. Hospital as the hub of ophthalmic procedures was at the top target for this disease. The patients were ensured to be provided special care of hand wash / sanitizer & face mask for protection against covid-19. All the SOPs were strictly followed by health care providers, that included use of protective equipment like face masks, hand gloves, hand sanitizers. Also, special campaign was carried out, which educated people about complete awareness of symptoms pertaining to coronavirus. Elective procedures were deferred to prevent the spread of virus and emergency patients were attended on urgent basis.
Results: Gradual and timely change in strategies helped to ensure continued ophthalmic care in the challenging time of COVID-19 without interruption. Simultaneously the safety of health care providers was also being taken care of.
Conclusion: Precautionary steps to protect the health of ophthalmic practitioners may be considered during hard times and crisis like that of pandemic covid-19.

Unusual features of Orbital Xanthogranuloma: A Case series
Sunday Okonkwo, Fariha Taimur, Amna Manzoor, Maheen Akbar, Saadullah Ahmad, Tayyab Afghani

Purpose: To describe previously unreported features of patients with orbital xanthogranuloma.
Methods: This was a retrospective study of 5 patients with orbital xanthogranuloma treated and followed up within a twelve-year period from January 2007 to December 2018. Their clinical records were reviewed and analyzed.
Results: There were 2 cases each of juvenile xanthogranuloma and adult onset xanthogranuloma and one case of Erdheim – Chester disease of the orbit. Three patients were males and 2 were females. Three patients had unilateral disease while in two cases it was bilateral. The main presenting complaints were proptosis and loss of vision seen in 4 cases. CT scan demonstrated extraconally located fairly defined masses in all except for the case of Erdheim- Chester disease it was bilateral and intraconal. There was bony erosion involving frontal bone in the two patients with adult onset xanthogranuloma. All patients underwent orbitotomy with subtotal excision of yellowish masses from the orbits. They were all followed up for at least one year (range 1 to 12 years). One of the patients with juvenile orbital xanthogranuloma had bilateral recurrence of the lesion after 8 years. Histopathologic examination revealed foamy histiocytes as prominent feature in all cases and variable number of Touton multinucleated giant cells.
Conclusion: Orbital xanthogranuloma is a rare heterogeneous group of diseases with similar histopathologic profile. Diagnosis of the disease is made by considering both clinical and histopathological features. Bony destruction and presence of yellowish orbital masses in adult onset xanthogranuloma are being reported for the first time.