Past Issues - Vol. 18, No. 3, July – September 2022

Al-Shifa Journal of Ophthalmology

Editorial: Addressing the Gap in Emergency Ophthalmology Services: A Critical Need for Pakistan
Muhammad Ahmed Abdullah, Ahmad Hasan Khan Alizai

Comparative Study of Stop and Chop Versus Phaco Chop Nucleotomy Technique in Phacoemulsification
Waleed Ahmad, Tahira Afzal

Objective: To carry out comparison between Phaco-chop Nucleotomy and stop-and-chop technique for phacoemulsification, in terms of operative time, phaco time, visual acuity, fluid volume, post-operative best corrected visual acuity, pachymetry, endothelial cell count and ultrasound power.
Methodology: A prospective comparative study was carried out on 50 patients (25 patients in each group) at the Department of Ophthalmology, Al Shifa Trust Eye, Hospital Jhelum Road, Rawalpindi Pakistan from 1st Nov 2021 to 31st January 2021. Patients in Group A were assigned to Phaco-chop Nucleotomy technique whereas patients in Group B were assigned to stop and chop technique through blocked randomization and non-probability consecutive sampling technique.
Results: Statistically significant improvement was observed in terms of post-operative best corrected visual acuity, phaco time, ultrasound power usage and operative time following Phaco-chop nucleotomy technique with p value < 0.01 was between both the groups for each variable using independent samples t test, Shapiro Wilk Test and On Way ANOVA Test.
Conclusion: Phaco-chop nucleotomy technique proved significantly superior to stop and chop technique specially in terms of post-operative best corrected visual acuity, phaco time, ultrasound power usage and operative time.

Diagnostic Accuracy of Spectral Domain Optical Coherence Tomography in the Diagnosis of Cystoid Macular Edema among Diabetes Mellitus Patients Using Fundus Fluorescein Angiography as Gold Standard
Raheela Naz, Hussain Ahmad Khaqan, Hasnain Muhammad Buksh, Muhammad Ali Haider, Ateeq Ur Rehman

Objective: To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) to detect diabetic macular edema (DME) in diabetic patients using fundus fluorescein angiography (FFA) as gold standard.
Methodology: A cross sectional study was conducted in the Outpatient Department of Ophthalmology, Lahore General Hospital, Lahore from October 1, 2019 to April 1, 2020. A total of 161 patients who fulfilled the inclusion criteria were selected randomly from outpatient department. Informed consent was taken from all patients for taking retinal images and examination. All participants were examined by indirect bio microscopy. Fundus fluorescein angiography and optical coherence tomography were done for the cystoid macular edema. A proforma was designed to collect data. All the collected data was analyzed by SPSS version 25v.
Results: The mean age of patients was 47.47±10.32 year. In our study 133(89.9%) patients were positive in cystoid macular edema in OCT findings while 148(91.9%) patients were detected positive by FFA. Cystoid macular edema was not detected by OCT in 15(10.1%)
patients. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of presence of cystoid macular edema detected on OCT vs FFA was 89.86%, 38.46%, 94.33%, 25.00% and 85.71% respectively. Conclusion: The present study showed exhibited the diagnostic potential and efficacy of OCT compared to FFA as is reliable and safe for the detection of diabetic macular edema in diabetic mellitus patients.

Results of Double Corneal Forceps Technique for Pterygium Excision at a Tertiary Care Hospital
Muhammad Sharjeel, Muhammad Sohail Arshad, Rafih Razzaq Wattoo, Muhammad Ayub Khan, Muhammad Shoaib Khan, Asif Mehmood Orakzai

Objectives: To study the efficacy and safety of a new technique for pterygium head excision using double corneal forceps.
Methodology: This descriptive longitudinal case series was conducted at Department of Ophthalmology, Mufti Mahmood Teaching Hospital, Dera Ismail Khan from 1st January to 30th June 2022 (6 months). After Informed consent and IRB approval, 25 patients with primary nasal pterygia were included. All patients underwent double corneal forceps removal of pterygium head irrespective of what procedure was followed to cover bare sclera. Ease of pterygium head removal, surgical time and complications were noted and were analyzed later.
Results: Out of 25, 18 (72%) were male and 7 (28%) were female with mean age of 45.5 ± 9.5 years. The mean size of the pterygia was 3.1 ± 0.8 mm. All patients underwent double corneal forceps technique of pterygium head removal quite easily. The mean duration of surgery was 25.6 ± 8.5 minutes. 17 (72%) had no need for corneal scrapping with No. 15 blade. The mean follow-up period was 2.7 ± 1.6 months. No patient had recurrence of pterygium.
Conclusion: Double corneal forceps technique is a novel, easy and very effective method for pterygium head removal. It reduces mean surgical time and overall need for corneal surface scrapping after head removal.

Incidence of Adnexal Tumors in a Tertiary Care Hospital: A Study of 118 Asian Pakistani Patients
Murtaza Sameen, Muhammad Shahid, Muhammad Adnan, Rebecca, Muhammad Awais, Sakeenah Hussain Naqvi

Objective: To evaluate the frequencies of various ocular malignancies in a tertiary care hospital.
Methodology: This multi-centered retrospective study was conducted at Armed Forces Institute of Ophthalmology (AFIO) and Armed Forces Institute of Pathology (AFIP) over a period of 3 months. A total of n=118 subjects with ocular malignancies were included in this study. The data was collected and analyzed with the help of Armed Forces Institute of Pathology. Subjects who presented to AFIO from 2018 – 2022 were included. The record was collected from record room of AFIO and AFIP and was analyzed. Initially incisional biopsy was performed to confirm the diagnosis followed by excisional biopsy with frozen section. Reconstruction was done on same day after histopathological proven biopsy results.
Results: A total of n=118 subjects with eyelid lesions were included. 88 (74.5%) were males, while 30 (25.4%) were females. 66% were benign in origin while 34% were malignant. Out of 34% of malignant tumors, Basal Cell Carcinoma were 67%, Squamous Cell Carcinoma were 23% and Squamous Gland Carcinoma were 9% while 1% were miscellaneous (i.e. hemangiopericytoma).
Conclusion: In Pakistani Asians, BCC was almost 3 times more common than SCC and SGC. This incidence can further be reduced by adapting preventive measures like avoiding sunlight exposure and adapting good life style.

The Frequency of Tear Film Abnormalities Among Medical Students of 4th Year MBBS Class
Sidrah Riaz, Umair Tariq Mirza, Muhammad Tariq Khan

Objectives: Dry eye is a common ocular condition with potential implications for the academic performance and overall well-being of medical students. Understanding the prevalence and associated factors of tear film abnormalities among this specific group is crucial. This study aimed to investigate the frequency of tear film abnormalities among fourth-year MBBS students in a private medical college in Lahore and explore potential correlations with screen time.
Methodology: A cross-sectional survey was conducted, involving fourth-year medical students. A questionnaire was administered, informed consent was obtained, and students were trained on Schirmer tests and tear film breakup time (TFBUT) assessment. Ophthalmologists conducted the evaluations. Data were analyzed using SPSS-25, and the prevalence of dry eye was determined based on diagnostic criteria.
Results: Among 163 fourth-year medical students (91 females, 72 males), dry eye symptoms were prevalent, with burning sensation and heaviness being the most common (89%). Screen time of more than 6 hours per day was identified as a significant risk factor for dry eye (p < 0.004). The prevalence of dry eye among the study population was 9.36%.
Conclusion: This study underscores the importance of recognizing and addressing tear film abnormalities among medical students, particularly those with prolonged screen time. Dry eye, with its physical and mental impact, remains underdiagnosed and calls for awareness campaigns and further investigations into its relationship with excessive screen time.