Past Issues - Vol. 17, No. 3, July – September 2021

Al-Shifa Journal of Ophthalmology

Editorial: Role of Pachymetry in Glaucoma Management
Mahmood Ali

Role of Ultrasonography in Detecting the Posterior Segment Pathologies in Pre-operative Cataract Patients
Samina Karim, Hamid ur Rehman, Adnan Ahmad

Objectives: To study the role of B scan in detecting the posterior segment pathology in pre-operative cataract patients
Study design: A cross sectional descriptive study
Place and Duration of Study: The study was carried out at Department of Clinical Ophthalmology, Khyber girl’s medical college, Hayatabad Medical Complex (HMC), Peshawar from 15th August 2019 to 15th February 2020.
Materials and Methods: This was a cross-sectional descriptive study. There were 317 eyes of 260 patients and both male and female were included in the study. First the visual acuity and detail slit lamp examination of all the patients was carried out in the OPD. Then ultra-sonography was performed in all the patients with dense cataract to evaluate the posterior segment pathology and the findings was documented in proforma.
Results: In this study, we evaluated 317 eyes of 260 patients who present with dense cataract to the OPD of eye department. Among 260 patients, 58 (22.3%) patients develop cataract after a history of trauma while 202 (77.7%) have no history of trauma. On ultrasound examination 215 (67.8%) patients have no posterior segment pathology but in 102 (32.2%) patients a significant posterior segment pathology was detected. Posterior vitreous detachment (PVD) and vitreous opacities was the most common pathology among the dense cataract eyes which was 7.6% and 5.7% respectively. Which was followed by retinal detachment (4.7%) and vitreous hemorrhage in 4.7% eyes of dense cataract. Conclusions: It was concluded that in the preoperative dense cataract patients, the two-dimensional ultrasonography was the most effective tool in detecting the posterior segment pathology. It will also affect the strategy of the surgical procedure, outcome of the surgery and postoperative visual prognosis.

Association Between Central Corneal Thickness and Intra Ocular Pressure in Management Of Primary Open Angle Glaucoma
Saman Ali, M Ali Haider, Nida Usman, Hafiza Ummara Rasheed

Purpose: To assess the differences between intraocular pressure measured by Goldman Applanation Tonometer and adjusted value of intraocular pressure (IOP) based on central corneal thickness (CCT) and emphasize the significance of use of this adjusted value IOP based on central corneal thickness for management of Glaucoma.
Methodology: Patients of primary open angle glaucoma meeting the criterion coming to glaucoma clinic Mayo Hospital Lahore were included in the study. After taking informed consent patients were examined on slit lamp, IOP by GAT was taken with & without CCT(done by pachymeter). Probe of pachymeter after sterilization touched the center of the cornea and average of five connective readings in micrometer with standard deviation of three were taken. The adjusted IOP and target IOP was calculated. Visual field (VF) and Optical Coherence Tomography (OCT) were performed and previous treatment noted and change in treatment made according to adjusted IOP. Comparison was seen between the both treatment strategies that is treatment on bases of IOP without CCT and with CCT.
Results: Out of 105 patients, 40.9% males and 59% females were included in this study. The male corneas were found to be thinner in the range 445-617 micrometer with the mean 523 micrometers than females in the range of 475-650 micrometers with the mean of 552 micrometers. In our study it was found that there is a positive relationship between adjusted IOP based on CCT and treatment according to it where r = 0.723 and p = 0.000, which is less than p = 0.05 and shows significant results. Pearson correlation results shows positive direct relationship by adjusting IOP based on CCT and treatment affect according to adjusted IOP.
Conclusion: Exact/adjusted IOP help in accurate assessment and management of glaucoma and imparts less financial burden on the society.

Association between Manifest Horizontal Ocular Deviation and Color vision deficiency: A Cross-Sectional Study
Bushra Sajid, Wajid Ali Khan, Nisma Sehar, Khizar Nabeel, Nusrat Sharif, Fareeha Ayyub

Objectives: The main objective of the study was to determine the effect of manifest horizontal ocular deviation on color vision.
Materials and Methods: A cross-sectional study was carried out in the Orthoptics department of Al-Shifa Trust Eye Hospital from November, 2018 to March, 2019. A total of 100 patients who were diagnosed with manifest horizontal ocular deviation were included in this study. Horizontal deviation was categorized into esotropia, exotropia, alternate esotropia and alternate exotropia. To achieve the objective of the study data was collected from patients through a structured Performa after taking informed consent.
Results: A total of 100 patients participated in this study. Almost half 50% (n=50) of the patients were female with the age ranging from 5 to 30 years. Color vision deficiency was found to be present in only 4% of the patients with manifest horizontal ocular deviation. Out of the total patients, 2% were found to have protanopia while 2% had deuteranopia. Chi-square test of independence was used to find the association between color vision deficiency and manifest ocular deviation.
Conclusion: The results of the present study showed that there is no significant association between manifest horizontal ocular deviation and color vision.

Assessment of Tear Film Stability in Patients with Pterygium
Ayesha Kiran, Shakeela Abbas, Nimra Gul, Maryam Jabbar, Sadaf Qayyum

Objectives: To assess tear film instability in pterygium patients and to compare tear film stability in different grades of pterygium.
Methodology: Descriptive cross-sectional study was carried out from October 2017 to May 2018 at Madina Teaching Hospital, Faisalabad Ophthalmology Department. Pterygium patients of all grading with age ranging from 30 to 60 years were included. Total population of 30 subjects of both genders was included. Slit lamp examination was performed to assess ocular surface pathologies and tear breakup time test was measured with fluorescein strips. Data analyzation was done, using SPSS 20 software. To compare tear film stability in different grades of pterygium, the association was determined using chi-square test.
Results: Total 30 subjects; there were 20 (66%) males and 10 (33%) females. Tear film instability was noted in majority of pterygium patients with TBUT < 10 seconds. The results were significant with level of significance 0.001. The mean of TBUT test value was 5.567± 2.956 seconds. In total 20 right eye cases, 7(35%) had Grade-I pterygium, 3 (15%) had Grade-II pterygium and 10(50%) patients had Grade III pterygium. In total 10 left eye cases, 2(20%) cases had Grade I pterygium, 7(70%) cases had Grade II and 1(10%) case had present Grade III.
Conclusion: The result showed that there was significantly tear film instability present in pterygium patients and mostly patient reported in grade 3 showed that as disease worsens TBUT also decreases.

Assessing The Therapeutic Response of Topical Azithromycin 1% In Addition to Oral Form for The Treatment of Meibomian Gland Dysfunction
Adnan Ahmad, Mubbashir Rehman, Mohammad Farhan, Hamid Rehman, Javed Rasul, Jawad Humayun

Purpose: The efficacy of topical azithromycin supplementation to systemic form has not been studied. This study evaluates the efficacy of topical azithromycin supplementation to systemic azithromycin with hot compresses, artificial tears, and lid scrubs for the treatment of meibomian gland dysfunction (MGD).
Methods: 70 patients with stage 4 meibomian gland dysfunction were enrolled in the study. The patients enrolled into the study were divided into 2 groups. Group A comprised 35 patients who received preservative free topical 1% azithromycin administered as once daily and group B comprised 35 patients who did not receive topical azithromycin. Both groups were prescribed artificial tear eye drops and systemic azithromycin along with lid hygiene measures. Fluorescein break-up time evaluation of tears (T-BUT), staining of cornea, Ocular Surface Disease Index (OSDI) symptom score, and meibum quality were assessed prior to therapy and after 04 and 12 weeks.
Results: The average age of participants in group A was 51.3 ± 14.2 yrs. (15 male and 20 female) and in group B was 52.7 ± 11.3 years (14 male and 21 female). At 4- and 12-weeks post-treatment, group A achieved a level of statistical significance in all given parameters for assessment as compare to baseline (p < 0.05). While group B achieved statistically significant improvement only in OSDI score and meibum quality post therapy as compare to baseline (p < 0.05).
Conclusions: There was clinical and symptomatic improvement observed in meibomian gland dysfunction with the addition of topical azithromycin to the systemic treatment.

Knowledge and Practices Regarding Self-medication of Ophthalmic Products in Rawalpindi
Aiman Fayyaz, Khizar Nabeel, Sana Azam, Fareeha Ambreen, Maryam Firdous

Purpose: The main aim of this study was to assess the knowledge and practices regarding self-medication of ophthalmic products and to determine the factors leading to self-medication in local setting Rawalpindi, Pakistan.
Materials and Methodology: A cross-sectional study was carried out at Outdoor Patient Department (OPD) of tertiary care hospital from November 2019 to December 2019. A total of 300 individuals, who first time visited tertiary care eye hospital, were interviewed using a structured questionnaire.
Results: Out of 300, 65.67% individuals had good knowledge regarding ophthalmic products while only 26.67% had good practices. Chi square test of independence was used to find association between independent variables (age, gender, education, marital status and residence) and dependent variables (knowledge and practices). Statistically significant association was found among knowledge, practices and sociodemographic factors (p < 0.05).
Conclusions: Individuals despite having good knowledge were poorly practicing self-medication with ophthalmic products. Knowledge about ophthalmic drugs was significantly associated with sociodemographic factors such as gender, education and residence. Young people had more good practices. Poor knowledge about side effect of drugs can have serious consequence on visual outcome.