Past Issues - Vol. 18, No. 2, April – June 2022

Al-Shifa Journal of Ophthalmology

Editorial: Minimally Invasive Glaucoma Surgery (MIGS)- Choices and Challenges
Mahmood Ali

Topography Patterns In Keratoconus Observed at Al-Shifa Trust Eye Hospital Rawalpindi
Warda Ali, Rabia Sharif, Faheem Ullah Khan, Shama Khan

Purpose: To determine the frequency of the patterns of topography in keratoconus in Pakistani population
Methods:: A retrospective observational study carried out in Al-Shifa Trust Eye Hospital Rawalpindi included 452 eyes of 226 patients with diagnosed bilateral keratoconus without any treatment, from January 2018 to December 2021. There were 114 (25.2%) female and 112 (24.8%) males with mean age 12.6 ± 8.3 years. For all eyes, topographic patterns of the axial power maps, anterior and posterior elevation maps and pachymetry maps were obtained using Galilei G4.
Results: Out of 452 eyes there were 40.3% with symmetric patterns and 59.6% with asymmetric patterns. Oval pattern cone was commonly observed pattern (28.8%) and irregular was the least observed 2.2%. SRAX was observed in 5.7 % of eyes.
Conclusion:The distribution of topographical patterns in keratoconus are almost like Iranian population. Patterns with SRAX were 5.7% which showed that keratoconus prevalence may be high in our population.

Oculosystemic Associations and Surgical Complications of Congenital Cataracts: A Four-Year Review
Aamna Jabran, Zeeshan Hameed, Usama Iqbal, Muhammad Rizwan Khan, Fuad Ahmad Khan Niazi, Muhammad Sharjeel

Purpose: To study the ocular and systemic associations as well as complications related to congenital cataracts presenting in a tertiary care setup of Punjab.
Study Design: Cross-sectional study
Place and Duration: Department of Ophthalmology, Holy Family Hospital, Rawalpindi from 1st January 2011 to 31st December 2014.
Material and Methods: A retrospective review, of all the patients who were operated for congenital cataracts, was performed. A total of 167 patients with all types of congenital cataracts were included in this study with particular emphasis on oculosystemic associations and complications of cataracts. All patients were subjected to meticulous history taking, ocular and systemic examination, investigations and pediatrician consults. Data readings were analyzed using SPSS v. 25.0.

Results: Out of 167 patients 92 (55.08%) were males and 75 (44.92%) were females. Most common age of presentation was between 6 to 10 years. Most cataracts were bilateral in 135 (80.83%) patients. Nystagmus was noted in 10 (5.98%), strabismus in 6 (3.58%), microphthalmia in 4 (2.39%) and raised IOP in 2 (1.19%) each. Most commonly noted complication of congenital cataract surgery was posterior capsular opacification (PCO) in 30 (17.96%) cases followed by posterior synechiae formation in 8 (4.79%).
Conclusion: Nystagmus and strabismus are most common ocular while mental retardation is most likely systemic association of congenital cataract and posterior capsular opacification is the most common complication of congenital cataract surgery.

Comparison of High Versus Low Energy Used In Neodymium-Yttrium Aluminum Garnet Laser Capsulotomy
Muhammad Azam Khan, Sehrish Sohail Shuja, Irfan Aslam Khattak, Zaheeruddin Babar, Muhammad Tariq Khan, Asif Mehmood

Objective: To compare the frequency of intraocular pressure spike in high versus low energy used in Nd-YAG Laser Posterior Capsulotomy in pseudophakic patients.
Study Design: Randomized controlled trial.
Study Duration: 6 months (20-03-2021 to 20-09-2021).
Study Settings: Department of Ophthalmology, PAF hospital E-9 Islamabad
Material and Methods: A sample size of 160 patients was calculated using WHO calculator. Patients were recruited through non probability consecutive sampling. Nd YAG capsulotomy was performed on patients randomly divided into two group using lottery method; Group A underwent high laser energy >100mj while group B underwent low energy laser 21-100 mj. Tonometry was performed after 4 hours of procedure. Data was analyzed using SPSS version 20. Post stratification chi square test was applied. P value ≤ 0.05 was considered significant.
Results: Total 160 (80 in each group) patients were included in study. There were 98(61.3%) male and 62(38.3%) female. Mean age of patients was 51.9±9.0SD years. Among all the patients in low energy group 11.9% showed IOP spike while 38.1% did not show IOP spike. Among all the patients in high energy group, 28.1% showed IOP spike while 21.9% did not show IOP spike (p=0.000).
Conclusion: Nd YAG Capsulotomy had significant association with intraocular pressure spike. Patients treated with high energy are more prone to have elevated intraocular pressure as compared to patients treated with low energy Nd YAG.

Awareness of Diabetic Retinopathy in Diabetic Patients at a Private Vision Care Centre in Islamabad
Muhammad Zubair Nazar, Afresh Maqbool, Muhammad Basit

Ojective: To determine the awareness of Diabetic Retinopathy in Diabetic Patients.
Materials and Methods: After taking consent and recording demographic details, an interviewer-based questionnaire was used to assess patients’ awareness about ocular complications of diabetes on a 10 points questionnaire before their fundus examination using Ophthalmoscope and slit lamp microscope with +90 Diopter lens in the eye OPD.
Results: Among the enrolled 300 patients, 146 (48.7%) were male and 154 (51.3%) patients were female. As far as the age of the patients was concerned, 5% were from less than 20 years, 29% from 21-40 years, 43% from 41-60 years and 22.3% were more than 60 years. The mean age of the participants was 49 + SD 10.01 years. Maximum number was seen in 41-60 years age group i-e 131 patients. There were 44(14.7%) patients with newly diagnosed Diabetes. 124(41.3%) patients with less than 5 years diabetes durations and 132(44.00%) patients had diabetes for more than 5 years. 118(64.49%) were responded that diabetic retinopathy is corrected with glasses. 162(88.52%) were responded only good control of diabetes is sufficient for control of blindness with diabetic retinopathy.
Conclusion: The knowledge about diabetic retinopathy and its treatment was inadequate along with poor compliance with annual fundus examination. This is directly related to the educational level of the patient and the duration of diabetes.

Prevalence of Myopia and its Associated Risk Factors Amongst Fifth Year Medical Students of Islamabad and Rawalpindi
Fizza Najeeb, Tatheer Zahra, Rameen Iftikhar, Fatima-tu-Zahra, Maira Syed, Maryam Atif Chohan, Nihal Fatima, Nimrah Iqbal

Objective: To determine and compare the prevalence of pre-admission and post-admission myopia along with their associated risk factors in final year students enrolled in MBBS in Shifa College of Medicine, Rawalpindi Medical College, Federal Medical and Dental College, Fazaia Medical College, Foundation University Medical College, Islamabad Medical and Dental College, Hazrat Bari Imam Sarkar Medical College.
Methodology: A cross-sectional study was conducted amongst the final year students admitted in the medical universities mentioned above. The data was collected by hard copies of questionnaire for students of Shifa College of Medicine. For the students of remaining medical universities, the same questionnaire was provided online on google forms.
Results: Out of a total of 394 participants, 230 (58.4%) individuals reported myopia while the remaining 164 (41.6%) people had no myopia. Of the 230 people that had myopia, 183 (79.6%) participants reported myopia before admission into medical college while the remaining 47(20.4%) students had acquired myopia after admission into medical college. Of 183 pre-admission myopes, 82% had family history of myopia, 38.8% had low vitamin D levels, 44.8% were non-compliant with glasses, 50.3% neglected healthy diet, 42.6% neglected sleep, 74.8% had excessive screen time, 64.5% had depression. Of 47 post-admission myopes, 70.2% had family history of myopia, 85.1% were non-compliant with glasses, 40.4% had low vitamin A levels, 53.2% neglected healthy diet, 38.3% neglected sleep, 44.7% studied in dim light, 72.3% had excessive screen time.
Conclusion: A large proportion of the target sample suffered from myopia of which most acquired it before admission into medical universities.