Past Issues - Vol. 17, No. 4, October – December 2021

Al-Shifa Journal of Ophthalmology

Editorial: Myopia Epidemic in Covid Pandemic
Tayyab Afghani

Mode, Type and Pattern of Ocular Trauma in Patients Presenting to Ophthalmology Department Benazir Bhutto Hospital, Rawalpindi
Kanwal Zareen Abbasi, Wajeeha Rasool, Mustafa Abdul Hameed Ismail, Maria Zubair, Kashif Ahmad Bhatti, Seher Umar

Purpose: To assess the mode, type and pattern of ocular trauma.
Method: An observational prospective cohort study of 201 eyes of 201 injured patients managed at the Department of Ophthalmology, Benazir Bhutto Hospital, Rawalpindi. For the purpose of assessing mode and pattern of trauma, an Ophthalmologist examined each patient and appropriate investigations were carried out. Patients were analysed for age, sex, mode of injury, type of injury, part of the eye injured, IOP and the presence of intra-ocular foreign body. Results: Road traffic accidents were the commonest mode of trauma found in 74(36.8%) of 201 patients while second most common being domestic accidents constituting 26.9%. According to type of injury, patients with blunt ocular trauma were 117(58.2%), with penetrating trauma were 83 (41.3%) and chemical injuries in only one patient (0.5%). As far as pattern of ocular trauma is concerned, sub-conjunctival haemorrhage was commonest of all, lid lacerations being 2nd most common and corneal tears3rd most common. Ocular trauma peaked in 3rd decade of life.
Conclusion: Study results seem to provide important data to enable concerned government organisations to make safety strategies and provide better health education in terms of domestic activities, traditional work, sports, and leisure environments for the prevention of serious eye injuries.

Evaluating The Pharmacological Effectiveness and Local Side Effects of Topical Cyclosporine A 0.05% in Ocular Dryness Resistant to Lubricating Drops
Adnan Ahmad, Mubashir Rehman, Hamid Rehman

Objective: To assess the therapeutic response and safety of topical cyclosporine A (Cs-A) 0.05% in ocular dryness resistant to topical lubricants.
Material and Methods: An interventional case series study was performed on the participants recruited from Eye OPD of Qazi Hussain Medical Complex, Nowshera from Sept. till Nov. 2019. All the patients were suffering from ocular dryness, resistant to standard therapy with topical lubricants. Topical cyclosporine A 0.05% was used twice daily. The participants were assessed at baseline, 4th week, 12th week and at 26th week. During these follow ups participants were examined for any changes from baseline with regard to Schirmer test, rose Bengal and fluorescein staining of ocular surface, tear film break up time (TBUT), ocular surface disease index (OSDI) and visual acuity.
Results: Mean age was 57.1 ± 11.8 (35.0 -80.0) years. A total of 30 (90%) of the patients were female and 6 (10%) were male. Mean Schirmer’s test value was 4.0 ± 0.8 (0.5-10.0) mm at baseline and raised to 9.0 ± 3.8 (2.6-18.8) mm post therapy at 26th week (p =0.001). At the first visit, mean tear break-up time was 4.4 ± 1.8 (2-9) seconds. It increased to 11.8 ± 4.8 (4-22) seconds at the end of 26th week (p =0.001). Mean clinical score at baseline was 2.0 ± 1.0 (1.0-3.0) and this dropped down to 1.0 ± 0.8 (0-3) post therapy (p=0.001), similarly mean OSDI score was 31.2 ± 10.5 (10-52) before the treatment and 21.3 ± 11.0 (5-45) post therapy (p =0.001). Visual acuity also improved significantly after 26th week of therapy (p=0.01). No side effects were reported with topical therapy other than transient ocular burning and itching that resolved after a week of its initiation.
Conclusion: Topical cyclosporine A 0.05% is found to be therapeutically effective yet without having any local or systemic toxicity in management of dry eye disease refractory/resistant to conventional treatment.

Visual Outcome after Manual Small Incision Cataract Surgery (MSICS) With Intravitreal Triamcinolone Acetonide in Complicated Cataracts
Hamid ur Rehman, Sana Ullah Jan, Nazli Gul, Waliullah Jan

Objective: To determine visual outcomes after manual small incision cataract surgery in eyes with complicated cataract with Intravitreal Triamcinolone Acetonide (IVTA).
Design: Descriptive, cross-sectional study, interventional case series
Place and duration: This study was carried out at Eye department Hayatabad medical complex Peshawar for duration of 6 months.
Material and Methods: A total of 196 patients were included. Patients with complicated cataract, base line visual acuity of at least positive projection to light in all quadrants (PL+ve), and male and female of any age were included. Eyes of patients with retinal detachment, intraocular inflammation, corneal opacity and dislocated or subluxated lens were excluded.
Results: In this study most of the patients (37%) were in age range 20 - 30 years followed by 32% patients were in age range of 31- 40 years. Mean age was 29 with SD ± 1.26. Sixty two percent were male patients, whereas female patients were 38%. Improvement in the visual acuity was noted in 40% of patients, while the rest 60% had stable visual acuity.
Conclusion: Our study concludes that, intravitreal triamcinolone acetonide improves visual outcome after manual small incision cataract surgery in complicated cataract.

Frequency of Hyperopia in Children Between 5 to 15 Years of Age
Muhammad Usman Arshad, Aunaza Maqbool, Rabia Sharif Bhatti, Sohail Zia, Masud Ul Hassan, Zameer Iqbal Awan

Objective: To determine the frequency of hyperopia in children between 5 and 15 years of age.
Setting and Duration of Study: Al-Shifa Trust Eye Hospital Rawalpindi between March 2015 to September 2015 for a duration of 6 months
Methodology: This Cross-sectional study included 150 children between the ages of 5-15 years. All children with eye disorders like corneal opacity, retinoblastoma, cataracts, amblyopia, chronic metabolic disorders, and hemoglobinopathies were excluded from the study. The participants were assessed for visual acuity was checked through a LogMAR visual acuity assessment chart for each eye. Those who found to have decreased visual acuity their pin-hole visual acuity was determined and then they got thorough examination by slit lamp biomicroscopy and fundoscopy to rule out causes of decreased vision other than refractive errors. Magnitude of hyperopia was measured using cycloplegic refraction on an auto refractometer followed by retinoscopy and then subjective trials. Data obtained for both the normal and refractive error children in a specific Performa.
Results: A mean (SD) age of 8.57 (2.52) years with 106 (70.76%) children between 5-10 years and 44 (29.33%) were between 11-15 years of age. Males were predominant in our study with 90/150 (60%) male patients and 60 (40%) female population. The frequency of hyperopia I our study was 93 (62%). Out of 60 female patients, 35 (58.33%) had hyperopia whereas, out of the 90 male patients, 58 (64.4%) patients had hyperopia.
Conclusion: We reported that hyperopia is a very frequent refractive disorder found in children. Male are more frequently diagnosed with the disorder between the age of 5-10 years. Further large-scale cohorts should be conducted to determine the correlating factors that increase the risk of hyperopia and prognosis.

Prevalence of myopia in Urban and Rural School going Pediatric Population in Four Districts of Azad Jammu and Kashmir
Saba Haider Tarar, Waseem Ahmed Khan, Shazia Siddiq, Muhammad Irfan Sadiq, Syeda Marrium Batool, Zain Qayyum

Objective: To assess the Prevalence of myopia in Urban and Rural School going Pediatric Population in District Mirpur, Bhimber, Kotli and Pallandri, AJK.
Study Design: Cross-sectional Descriptive Study.
Place and Duration of Study: Study was conducted on school going pediatric Population in District Mirpur, Bhimber, Kotli and Pallandri, AJK from 1st March ,2016 to 30th June,2021
Materials and Methods: After taking permission from hospital ethics committee, a community-based study was carried out in both private as well as public sector schools of 04 districts including Mirpur, Bhimber, Kotli and Pallandri, AJK after informed consent. After taking consent, data was collected through a self-designed proforma from schools. A team of teachers from each school was trained by conducting workshops to detect visual deficits. The initial screening was carried out at the community level and then the affected children were referred for further examination to Divisional Headquarters Teaching Hospital Mirpur, AJK, Pakistan. Data was analyzed by using SPSS 20.
Results: 155,776 children were screened from the schools from 04 districts including both public as well as private schools. 6043 (03.87%) children were found to have refractive error. Among these, 3259 (53.93%) children were myopic. The affected children in Urban Areas were 2070 (63.52Prevalence of myopia was less1419 (43.54%) in Males and higher 1840(56.46%) in Females.
Conclusion: School screening programs at the community level can play a significant role in improvement of eye health care. This will also help in treatment of preventable blindness among school going Pediatric population of Pakistan.

Effect of Ametropic Spectacles Correction on Contrast Sensitivity
Rafia Batool, Sadaf Qayyum, Qurat- ul- Ain, Shahid Iqbal, Sohail Ahmad

Background: The disruption of normal visual experience may lead to the development of refractive error. Contrast sensitivity is a vital visual function for accurate vision in normal and dim light. Early detection of decrease in contrast sensitivity and taking measures at early stage help the patient to perform their daily activities easily even if they have 6/6 visual acuity.

Objectives: To find out the effect of ametropic spectacle correction on contrast sensitivity.

Methodology: A descriptive cross-sectional study was carried out Al-Shifa Eye Trust Hospital Rawalpindi within the duration of six months. Total of 90 ametropic patients, including 56 (62.2%) females and 34 (37.8%) males were included in the study after qualifying on the basis of inclusion and exclusion criterion. The refractive errors were categorized in to mild (+_0.25 D to +_2.00D), moderate (+_2.25D to +_4.00D) and severe (>+_4.00D) degrees and the contrast sensitivity was measured for each group. Descriptive and inferential statistics was used to analyze the result. A self-structured Performa was used and analyzed using SPSS version 26.

Results: The results showed that there was no significant (p=0.145) decrease of contrast sensitivity in myopic spectacle correction 27 (30.0%), while in Hypermetropic spectacle correction 33 (36.7 %) had considerable decrease in contrast sensitivity which was significant (p = 0.018 While in astigmatic spectacle correction 30 (33.3%) had more significant decrease in contrast sensitivity than the non-astigmatic ones (p=0.017).

Conclusion: Contrast sensitivity is very important to measure and should be taken in to consideration while doing subjective correction for the correction of refractive errors. Despite the fact that the measure of visual acuity gives essential clinical data, the ability to quantify contrast sensitivity in a clinical setup has much significance in all ages.