Pakistan Journal of Ophthalmology

Serum MicroRNA-126-3p and Serum Vascular Endothelial Growth Factor for Vision Threatening Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients

Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To investigate the precise function of miRNA-126-3p in controlling the expression of the VEGF gene and the signalling cascade that it is linked to in patients with type 2 diabetes Mellitus (DM).

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Prof Ngoerah General Hospital as a tertiary hospital in Bali, Indonesia from January-April 2022

Methods: This study involved 35 vision-threatening diabetic retinopathy (VTDR) and 30 non-VTDR patients of type 2 DM. After diagnosis of DR by vitreoretinal specialist, blood samples were drawn. Real-time polymerase chain reaction assays were performed to examine miRNA-126-3p and ELISA to detect VEGF. Continuous data were analyzed using median (minimum-maximum range) and categorical data were analyzed using percentages. The statistical analysis was conducted using SPSS for Windows version 25.0.Thedifference and relationship between the proportions were tested by the Chi-square test and logistic regression test.

Results: In case group, there were 23 subjects (65.7%) with low serum miRNA-126-3p expression, while in the control group, there were 7 subjects (23.3%) with low serum miRNA-126-3p expression (OR=6.3; 95% CI 2.1-18.86). In the case group, 20 individuals (57.1%) had high serum VEGF levels of 71.6 ng/L, whereas in the control group, there were 6 individuals (20.0%) with high serum VEGF levels. There was a statistically significant difference between the two groups (OR=5.33; 95% CI 1.75-16.3).

Conclusion: The miRNA-126-3p expression and serum VEGF levels are the risk factors for VTDR development in patients with type 2 diabetes.

Comparison of Mean Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery Using Frown Vs Chevron Incision

Abdul Basit, Mir Zaman, Bakht Danyal Khan, Muhammad Abdullah, Saud Abdur Rehman — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To compare the mean surgically induced Astigmatism(SIA) in Manual Small Incision Cataract Surgery (MSICS) using frown (inverted U) versus inverted V (chevron) incision.

Study Design: Quasi experimental study.

Place and Duration of Study: Hayatabad Medical Complex from 27^th July 2018 to 27^th January 2019.

Methods: This study included 148 patients who were distributed into the Frown group (F) and Chevron group (C) by convenient sampling. Each group had 74 patients through block operative randomization. To eliminate bias, all the surgeries were performed by one surgeon having more than 5 years’ experience of MSICS. Pre-operative and Post operative keratometric readings were taken. SIA calculator was utilized, and data was analyzed through SPSS 26. Means and standard deviation for continuous variables like age and surgically induced astigmatism were calculated.

Results: In Group F, mean surgically induced astigmatism was 1.14±0.65D and in Group C it was 0.87±0.55D. The independent T test revealed that the mean SIA was significantly lower in the Chevron group compared to the Frown group.The post operative visual acuities showed that the proportion of patients with postoperative 6/6 vision in the Chevron group was more as compared to group F.

Conclusion: Chevron (inverted V) incision induces less postoperative mean surgically induced astigmatism than Frown (inverted U) incision in Manual Small Incision Cataract Surgery. These findings may have implications for cataract surgery techniques and may help in reducing postoperative astigmatism.

Nd: YAG laser of Weiss Ring for the Treatment of Symptomatic Vitreous Floaters in Patients with Posterior Vitreous Detachment

Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To assess the effect of Nd: YAG laser vitreolysis of the Weiss ring in the management of symptomatic vitreous floaters in patients with posterior vitreous detachment in the outpatient department of a tertiary care hospital.

Study Design: Quasi-experimental study.

Place and Duration of Study: This quasi-experimental trial was conducted in the out-patient department (OPD) of The Layton Rahmatullah Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital, Korangi, Karachi from February 2023 to July 2023.

Methods: In this study, 75 eyes of 75 patients were selected using non-probability purposive sampling technique. Dilated fundus examination was performed and The National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was used and compared pre and post Laser Floater Treatment (LFT).

Results: Out of 75 eyes, 65 patients were included in final analysis. Mean age was 54.63±4.1 years. Out of these, 69.2% were 48–56 years old and 56.9% were females. Mean number of shots were 160±15.53. Mean Pre-LFT, VFQ was 56±5.89 and post-LFT was 74±13.2. The mean difference pre versus post treatment was -18 units with p<0.001. Twenty patients complained of blurring of vision and one patient suffered mild retinal hemorrhage which resolved spontaneously, two patients were lost to follow up.

Conclusion: Nd: YAG laser vitreolysis of the Weiss ring can be a quick, and effective treatment option in patients suffering from symptoms of vitreous floaters after a posterior vitreous detachment. However, more trials with large number of patients and longer follow up durations are required for generalization of results.

Comparative Analysis of AI Chatbots ChatGPT, Gemini, and Copilot’s Answers to Common Cataract Questions

Busra Guner Sonmezoglu, Halil Ibrahim Sonmezoglu — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To compare the readability and quality of the answers given by artificial intelligence (AI) chatbots to the twenty-five most frequent searches about cataracts on Google.

Study Design: Cross sectional comparative study.

Place and Duration of study: Serdivan State Hospital's Ophthalmology Department from March 2024 to April 2024.

Methods: The word 'Cataract' was entered into Google Trends, and 25 trending searches made worldwide since 2004 were identified. These 25 trending searches were entered separately into AI programs. The answers were examined for quality using the Ensuring Quality Information for Patients (EQIP) test, while the readability was evaluated using the Flesch-Kincaid Reading Ease (FKRE) and Flesch-Kincaid Grade Level (FKGL).

Results: The keywords searched most frequently were ‘Cataract surgery,’‘Eye cataract and 'After Cataract’. The EQIP category of all three AI chatbots was found to be 'serious quality issues.' When EQIP scores were compared, ChatGPT had a lower median value than Gemini and Copilot (p:0.001, p:0.007, respectively), while there was no significant difference between Gemini and Copilot (p:0.098). When FKRE values were compared, ChatGPT had a lower median value than Gemini and Copilot (p:0.001, p:0.001, respectively), with no significant difference between Gemini and Copilot (p:0.557). When FKGL values were compared, ChatGPT had a higher median value than Gemini and Copilot (p:0.003, p:0.001, respectively), with no significant difference between Gemini and Copilot(p:0.245).

Conclusion: All three AI chatbots had an EQIP category of 'serious issues with quality .'The readability of all three was not at the recommended level.

Spectrum of Ocular Tuberculosis in Tertiary Care Hospitals of Khyber Pakhtunkhwa Peshawar

Hafsa Bibi, Fahad Zafar, Mustafa Iqbal , Shafiq Tanveer , Faizan Luqman — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To describe the spectrum of ocular tuberculosis (TB), highlight the difficulty in diagnosis and treatment of such cases encountered in a tertiary care hospital of Peshawar, Pakistan.

Study Design: Descriptive Case series.

Place and Duration of Study: Khyber teaching hospital MTI Peshawar from Jan 2021 till July 2022.

Methods: Eleven cases with Ocular tuberculosis are described. At presentation, complete history was taken and detailed examination was done including fundus examination and OCT macula. For diagnosis, a combination of Tuberculin skin test (TST) and Quantiferon-Gold was performed. On the basis of results of both tests Anti-TB treatment (ATT) was started and continued for an average of 9 months.

Results: This study highlights the diverse ocular manifestations of TB in patients, even without a known history of systemic disease. Among 11 patients, 3 presented with panuveitis, 6 with posterior uveitis, and 2 with serpiginous-like choroidopathy with uveitis. Notably, only 2 had a known history of systemic TB. The patients were treated primarily with Anti-Tuberculosis Therapy (ATT) along with steroids or other adjunct therapies. Most cases showed improved vision and stable disease post-treatment, with visual acuity ranging from 6/24 to 6/6. However, two patients were lost to follow-up, leaving their outcomes unknown.

Conclusion: In this case series, we explore different cases of Ocular Tuberculosis (OTB) seen at a busy hospital in Peshawar, Pakistan. There are variety of symptoms with which the patients present. The combined use of TST and Quantiferon-Gold proved an effective and affordable approach for diagnosis and timely initiation of ATT in ocular TB.

Association of Refractive Errors with Axial Length and Anterior Chamber Depth in Different Age Groups

Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To determine association of refractive errors with axial length and anterior chamber depth in different age groups.

Study Design: Cross-sectional study.

Place and Duration of Study: Ophthalmology Department of Dow University Hospital (Ojha campus),Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan from October 2020 to December 2020.

Methods: Eighty-three individuals of different age groups ranging from 11-80 years were included in the study.Ocular measurements including refractive error, axial length, and anterior chamber depth were determined in all participants. The association of refractive error with anterior chamber depth and axial length was tested by using two independent sample t test, Mann-Whitney U test and ANOVA.

Results: Among 83 individuals, males were 42.2% (n=35) and females were 57.8% (n=48). Most common type of refractive error was astigmatism which was found in 48.2% (n=40) participants. The overall average depth of anterior chamber (mm) and average axial length (mm) were 3.11±0.39 and 23.27±0.87 respectively. Mean differences in anterior chamber depth were statistically significant among different age groups . Statistically significant differences in mean axial length were found among different refractive errors .

Conclusion: These results show a significant relation of different refractive errors with axial length and anterior chamber depth and it can be helpfulin explaining the risk factors of different ocular diseases as well asit can also be helpful in clinical and diagnostic purposes in ophthalmology.

Computer Vision Syndrome and Ergonomic Practices among Students and Professionals

Bushra Kanwal, Iqra Khalil — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To investigate the frequency of Computer vision syndrome (CVS) and its association with ergonomic practices among students and professionals.

Study Design: Cross sectional observational study.

Place and Duration of Study: Online survey.

Methods: This study involved a pre-tested self-designed structured questionnaire distributed through Google Forms to gather responses from students and professionals regarding symptoms of CVS. The form was shared with approximately 2500 individuals, the response rate was 10.04%, resulting in 251 responses. After careful review, 237 responses were deemed suitable for inclusion in the study. The chi-square test was used and p-value less than 0.05 was considered statistically significant.

Results: The relationship between symptoms of CVS (headache, body fatigue or tiredness, burning sensation, blurred vision, and dry eyes) and various ergonomic practices (screen time, longest uninterrupted time, breaks during screen use, screen size, type of screen, font size, refresh rate, and screen resolution) was seen in 237 subjects. The study revealed increased frequency of CVS symptoms when using screens. There was a statistically significant effect of prolonged screen time (p<0.05), smaller screen sizes (p<0.05), lower refresh rates (p<0.05), small font size (p<0.05) and lower screen resolutions (p<0.05) on the severity of CVS symptoms.

Conclusion: These findings enhance our understanding of the complex relationship between ergonomics and visual discomfort, and they will guide future interventions aimed at improving visual comfort and ergonomics in screen-based environments.

Comparison of Peribulbar and Topical Anesthesia in Phacoemulsification Cataract Surgery in Terms of Pain

Fatima Ahmed, Abdul Hameed Siddiqui, Imran Ghayoor — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To compare effectiveness of Peribulbar and topical anesthesia in phacoemulsification in terms of severity of pain.

Study Design: Quasi experimental study.

Place and Duration of Study: This cross sectional study was conducted at Eye Department, Liaquat National Hospital, Karachi, from August 2017 to January 2020.

Methods: This study included 1154 patients of 40-75 years of age who underwent phacoemulsification. Complete ocular examination was performed. Patients were allocated into two groups by convenient sampling. Cataract surgery was performed under Peribulbar anesthesia in 577 patients and other 577 patients were operated using topical anesthesia. Pain was assessed by Visual Analogue Scale Score. Frequency and percentage and mean± standard deviation was computed for qualitative and quantitative variables respectively using SPSS version 21. Chi square test was used for stratification of gender, duration of symptom and age, p≤0.05 was considered significant.

Results: Average age of the patients was 57.43±6.70 years. There were 576(49.9%) males and 578(50.1%) females. There were 34 (5.9%) patients in Peribulbar group and 382 (66.2%) patients in topical group who had no pain (p=0.0005).Frequency of mild, moderate and sever pain was less in patients given topical anesthesia. The rate of pain was significantly higher in older and female patients with shorter duration of symptoms (p 0.0005).

Conclusion: Phacoemulsification can be accomplished efficiently and effectively using topical anesthesia. Compared to retro bulbar and Peribulbar anesthesia, it offers several advantages and a high degree of pain satisfaction for the patient.

Effectiveness of 0.05% Cyclosporine versus Standard Treatment of Vernal Kerato-Conjunctivitis (VKC) in Young Patients

Ramsha Jehangir, Humera Zafar Ali, Ayesha Parvez, Amna Farooq, Mushafia Hassan — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To compare the effectiveness of 0.05% cyclosporine eye drops versus standard treatment in patients of moderate to severe vernal kerato-conjunctivitis (VKC).

Study Design: Quasi experimental study.

Place and Duration of Study: Institute of Ophthalmology, Eye Unit-1, King Edward Medical University, Mayo Hospital, Lahore from June to December 2019.

Methods: This study includes 104 patients (age 5-16 years), with VKC. Patients were divided into two groups. Group A was given standard treatment for moderate to severe VKC, which included topical corticosteroids (FML 0.1% eye drops) QID, in addition to antihistamines and mast cell stabilizers (Olopat D 0.2% eye drops) QIDand group B was given 0.05% Cyclosporine A(CyS-A) eye drops QID.The frequency of mild, moderate, and severe disease was determined for each group. Data was analyzed and independent sample t-test was applied. P value of < 0.05 was taken as significant.

Results: There were 60 males and 44 female patients. The mean age in Group A was 9.34 ± 2.09 years and in group B was 9.36 ± 2.71 years. There was significant difference in mean clinical symptoms and sign score between group A and group B (p <0.001) at 3 months, suggesting that topical 0.05% cyclosporine is more effective as compared to standard therapy in moderate to severe VKC.

Conclusion: 0.05% cyclosporine eye drops are effective in treating moderate to severe VKC in terms of reduction of clinical manifestations of disease.

Change in Axial Length and Astigmatism after Scleral Buckling in Patients of Rhegmatogenous Retinal Detachment

Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To determine changes in axial length and corneal astigmatism caused by scleral buckling in patients of uncomplicated retinal detachment undergoing scleral buckling procedure.

Study Design: Quasi-experimental design.

Place and Duration of Study: Peshawar Medical College and Allied hospitals, Pakistan from December, 2020 to May, 2021.

Methods: This study included60 patients of uncomplicated rhegmatogenous retinal detachment, recruited through consecutive sampling technique and managed with primary scleral buckling. After a detailed history and complete examination including A-scan and Keratometric readings, patients underwent scleral buckling procedure. Changes in axial length and corneal curvatureswere measured at 6 months follow up. Quantitative analysis was done using paired T test.

Results: Mean age of the sample was 41.95±13.67 years. The sample consisted of 42 males and 18 females. Encircling Band was used in 46 patients, segmental circumferential tire was used in 58 patients in one or more quadrants depending on the extent of the retinal detachment. Two patients underwent additional surgeries. The pre-operative mean axial length (AL) was 23.44±1.51 mm and post-operative AL at 6 months was 24.25±1.61mm (p < 0.05). The pre-operative and post-operative astigmatism were 1.08±0.43 and 1.75 ± 0.33 diopter respectively (p < 0.05).

Conclusion: Scleral buckling led to a significant increase in axial length and astigmatism over a 6-month period. These changes suggest that scleral buckling can alter the optical properties of the eye, potentially affecting visual acuity and requiring careful consideration of these factors in post-operative management.

Distribution of Ocular Biometry and Intraocular Lens Power in Patients Undergoing Cataract Surgery in an Eye Camp in Northern Pakistan

Erum Shahid, Asad Raza Jafri, Uzma Fasih — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To report ocular biometric data of patients undergoing cataract surgery in an eye camp in a city of Northern area of Pakistan.

Design: Cross-sectional descriptive study.

Place and Duration of Study: A surgical eye camp was set up in the month of September 2022 for 6 days in a private hospital in Skardu.

Methods: A total of 119 patients were selected with a non-probability consecutive sampling technique. Ocular biometry of permanent local residents with significant cataractswas included. Incomplete biometry data and coexisting diseases like corneal opacity, pterygium, and severe dry eye causing errors in biometry were excluded. Keratometry was done with an automated refractor-keratometer. Axial length was calculated with an A-scan (ultrasound contact method) and intraocular lens (IOL) power was calculated.

Results: A total of 119 patients were selected for biometry among 3908 individuals visiting an eye camp. The mean axial length was 22.13 ± 1.25 SD mm. The mean keratometry readings (K1) was 43.28 ± 1.83 Diopter and (K2) 44.26 ± 1.67 D. The mean intraocular lens (IOL) power was 24.78 ± 3.43 D. The mean K readings were more in males as compared to females (p-value <0.005). There was no significant difference in axial length and IOL power among genders.

Conclusion: This study gives normative data on ocular biometric parameters of patients undergoing cataract surgery at high altitudes in Skardu, Pakistan. These biometric values can be used as reference values in the local population

Comparison of Retinal Thickness betweenDiabetic Patients without Diabetic Retinopathy and Non-Diabetic Controls Using SD-OCT

Muhammad Qasim, Anusha Lund, Sana Urooj, Asif Maqsood — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To determine retinal thickness in diabetic patients without diabetic retinopathy and non-diabetic controls using Spectral Domain Optical Coherence Tomography (SD-OCT).

Study Design: Cross-sectional observational study.

Place and Duration of Study: Diabetic Eye Clinic and General Eye OPD of Al-Ibrahim Eye Hospital, Karachi from July 2018 to August 2018.

Methods: Patients with type 2 diabetes and non-diabetic healthy control eyes of either genderand age between 20 and 60 years were recruited. Patients with any other systemic and ocular disease affecting retinal thickness were excluded. After initial examination and informed written consent, patients were referred to ocular investigation department for detailed retinal examination and SD-OCT for measuring central retinal thickness. Data were analyzed for continuous and categorical variable using SPSS.

Results: Average Central Retinal thickness was 297±21 and 315±13µmand Central Foveal Thickness was 246±16 and 249±19µmin diabetic and non-Diabetic patients respectively. Quadrant-wise evaluation revealed retinal thickness as follows; nasal 310 and 324µm), temporal (291and 304µm), superior (297and 316µm) and inferior (292and 314µm) in diabetics and non-diabetics respectively. Retinal thickness was greater at nasal and lesser at temporal regions.

Conclusion: Diabetic patients without DR had thinner central retinal thickness compared to non-diabetic controls, as measured by Spectral Domain Optical Coherence Tomography (SD-OCT). Specifically, the average central retinal thickness and central foveal thickness were slightly reduced in diabetic patients. Quadrant-wise analysis revealed that the retinal thickness was consistently greater in the nasal region and lesser in the temporal region in both diabetic and non-diabetic patients.

Review of Ocular and Non-Ocular causes of Headache in Adult and Pediatric Patients; A multicenter study

M Khizar Niazi, Hifza Masood, Faraz Sohaib, Asharib Arshad — Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To determine ocular and non-ocular causes of headache in adult and pediatric patients in three tertiary care hospital of Multan, Pakistan

Study Design: Cross-sectional study.

Place and Duration of Study: This multi-centre study was conducted in Combined Military Hospital, Multan, Pakistan and The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from February 2023 to September 2023.

Methods: The non-probability convenience sampling technique was used. The data collection and diagnosis were done by a consultant ophthalmologist. The statistical analysis of this study was conducted using SPSS version 23.

Results: The study comprised of a total of 600 patients. The mean age of the adult patients was 27.16±14.39 years ranging between 16to 80 years and the mean age of pediatric patients was 10.1±2.40 years. The patients were divided into four groups based on the etiology of headache that were ocular, non-ocular, combined ocular causes and ocular and non-ocular causes combined. The most common ocular cause was myopia in 43(14.3%) adults and 47 (15.8%) pediatric patients. However, the most common non-ocular cause was migraine in 72(24.0%) adult patients and frontal sinusitis in 43 (14.3%) pediatric patients.

Conclusion: Refractive errors were the most common ocular etiology of headache in ophthalmology patients predominately myopia in the adult and pediatric population. Migraine was the most common non-ocular etiology in adult population whereas frontal sinusitis was most common in the pediatric age group.

Managing Maggots in the Eye: A Case Series

Tue, 01 Oct 2024 00:00:00 +0000

Purpose: To describe the presentation and management of ocular maggots and to identify the factors contributing to their occurrence.

Study Design: Retrospective case series.

Place and Duration of Study: Department of Ophthalmology Mayo Hospital Lahore from 2015 to 2022.

Methods: The study involved retrospective chart analysis of patients who presented with Ophthalmomyasis and managed in the eye department. Data regarding age, gender, occupation, clinical findings, co-morbidities, associations and environmental factors were analyzed.Larvae were removed one by one under microscope. Follow up was done after 1 week, 1 month and 3 months. In patients with orbital myasis having distorted, large ulcerated wounds/socket, turpentine oil was used and larvae were removed mechanically under microscope.

Results: There were 15 fifteen patients included in the study. Underlying co-morbidities were present in 60% patients and the most common being basal cell carcinoma (46.6%). Seventy four percent patients had some systemic disease; Diabetes Mellitus, Hypertension, AIDS, Hepatitis C etc. One thirdpatients had external ophthalmo-myasis while two third had orbital myasis. Patients who did not complete follow-up were 33%. Use of suffocating agents like turpentine oil, periodic removal of larvae, topical and systemic antibiotics, topical lavage with copious irrigation with sterile fluids resulted in good outcome in all cases that completed the follow up.

Conclusion: The majority of patients came from rural communities and had underlying co-morbidities. Timely management resulted in good outcomes for all patients who completed the follow-up, highlighting the importance of comprehensive and sustained treatment protocols.

Starting a Glaucoma Fellowship in Pakistan: A Critical Step toward Enhancing Eye Care

Tayyaba Gul Malik, Rashid Zia — Tue, 01 Oct 2024 00:00:00 +0000

The prevalence of glaucoma in Pakistan, as in many developing countries, poses a significant challenge to the healthcare system. Globally, glaucoma is the second leading cause of blindness, affecting millions, often progressing

External Dacryocystorhinostomy Using Buccal Mucous Membrane Graft Following Resection of Lacrimal Sac: A Case Report

Yunia Irawati, Vega Casalita, Nadia Kartika Dewi — Tue, 01 Oct 2024 00:00:00 +0000

We report a case of a 10-year-old patient presented with recurring nasolacrimal duct obstruction post-lacrimal sac cyst extirpation in which CT scan revealed a solidlesion that was more depicted by contrast-enhancedimage. The initial surgery and flap creation had inadvertently led to a mucosal shortage, posing a challenge for the subsequent procedure, which aimed to create aDacryocystorhinostomy (DCR). In a challenging approach, a buccal mucous membrane graft was employed to address the lack of mucous membrane required for the DCR. Over the course of five years, there was no recurrence of the cyst, signifying the success of this innovative treatment method of using buccal mucous membrane graft for external DCR.

Ocular Manifestations in Paediatric Erythema Multiforme: A Case Report

Tue, 01 Oct 2024 00:00:00 +0000

Erythema multiforme (EM) is a type IV cytotoxic hypersensitivity reaction characterized by classic target lesions on the skin and mucosa, typically affecting the oral, genital, and rarely, ocular mucosa. We describe a 9-year-old girl with widespread rashes, blisters and target lesions on her trunkfor three days. She had eye redness, discomfort, a week-long fever, and a dry cough, without any medication. Ophthalmological examination revealed localized conjunctival injection in her right eye, with no visual impairment or corneal lesions. The diagnosis of EM major (EMM) was based on prior infection, characteristic skin lesions, and mucosal involvement, including ocular manifestation of conjunctival injection. Treatment requires addressing the underlying cause and ophthalmologic consultation for systemic or topical corticosteroids, antibiotics, lubricants, and antihistamines. This case highlights the diagnostic challenges of atypical EM presentations, emphasizing the need for comprehensive evaluation, early recognition, and interdisciplinary collaboration to prevent severe ocular complications and preserve vision.

Vision 2030: A Clearer Tomorrow – The Evolution of Cataract Surgery into Precision and Beyond

Ambreen Gull — Tue, 01 Oct 2024 00:00:00 +0000

By 2030, cataract surgery is poised for a transformative overhaul, driven by advances in technology and a shift towards patient-centric care. This editorial explores the anticipated developments in cataract surgery, highlighting the role of precision, efficiency, and sustainability. Key innovations include the integration of Artificial Intelligence (AI) and Femtosecond laser technology, setting the stage for a revolutionary patient experience.

The landscape of cataract surgery is set to change dramatically. Currently, cataract surgery is the most common ophthalmic procedure, with significant global and regional increases in the cataract surgical rate (CSR). Pakistan has almost doubled its CSR to 5307 in the last two decades.¹Over four million cataract surgeries are performed annually in the United States. This number is increasing by 3-4% each year and is projected to reach six million by 2030.²

Biometry, once a complex procedure, will be simplified through the use of swept-source OCT biometers equipped with the latest formulas. Modern IOL calculation formulae, like Barrett Universal II, Barrett True-K, Hill RBF, and Kane, are more precise than previous generations. The revolutionizing role of artificial intelligence (AI) and machine learning (ML) in optical biometry will ensure accurate measurements, further contributing to the overall success of the surgery.³

Cataract as the First Manifestation of Insulin Dependent Diabetes Mellitus

Aljawhara T. Aldamri, Mohammed Alshamrani, Saleh A. Al-Khaldi — Tue, 01 Oct 2024 00:00:00 +0000

An 8-year-old girl presented with blurry vision. Examination revealed impaired visual acuity (VA) in both eyes and significant lamellar and posterior subcapsular cataracts requiring surgery. Preoperative laboratory tests indicated elevated urine and blood glucose levels, leading to a diagnosis of insulin-dependent diabetes mellitus by a paediatric endocrinologist. She began insulin treatment and underwent lens aspiration with posterior chamber intraocular lens implantation. Postoperatively, her VA improved to 20/30 in the right eye and 20/60 in the left eye.

Retinopathy Due to Anemia

M Afzal Bodla, Maria Afzal Bodla, Nalain Syedah — Tue, 01 Oct 2024 00:00:00 +0000

Anemia-related retinopathy is a common condition, often asymptomatic and discovered incidentally during routine evaluations. A comprehensive, multidisciplinary approach is essential to ensure that even unusual presentations result in positive outcomes, preventing further morbidities and their long-term consequences. We present the case of a 22-year-old woman who reported a rapid decline in vision and sought care at Bodla Eye Care in Multan. She had only one functional eye (right), with the left eye affected by phthisis bulbi. Her best-corrected visual acuity in the right eye was limited to light perception.

Comparison between Epiretinal Membrane Component in Proliferative Vitreoretinopathy and Other Fibroproliferative Diseases: A Scoping Review

Amanda Natalie Wijaya, Raihanny Andrea Zahra, Anggun Rama Yudantha — Tue, 01 Oct 2024 00:00:00 +0000

The growth of proliferative vitreoretinopathy epiretinal membrane (PVR-ERM) is a major complication of rhegmatogenous retinal detachment (RRD). Despite surgery, adjunct treatment is necessary to control the aberrant wound healing response that occurs in PVR-ERM to prevent its recurrence. Existing studies on adjunct agents target pathways in the pathogenesis of PVR-ERM. We conducted a scoping review of composition of PVR-ERMs and other fibroproliferative ERMs. After literature search, 12 articles were included into the study. Outcome measured was gene expression, growth factors, extracellular matrix components, and enzymes.Among these studies, 9 compared PVR-ERM with PDR-ERM, 2 compared PVR-ERM with iERM, and 1 compared PVR-ERM with secondary ERM. Higher expression of certain genes or a higher concentration of particular factors can be observed throughout PVR, PDR, iERM, or secondary ERM.TGF-β, MALAT1 gene, and fibronectin are distinct factors that might play a bigger role on the pathogenesis of PVR compared to other fibroproliferative diseases.

Pink Eye Disease Surge in Pakistan: A Silent Epidemic of Adenoviral Conjunctivitis Demanding Urgent Action to Prevent Long-term Ocular Morbidities

Waseem Sajjad — Tue, 01 Oct 2024 00:00:00 +0000

Dear Editor! infectious disease has always been a challenge and burden on healthcare system of Pakistan. Beside other infectious diseasesin the recent years, there has been increase in cases of adenoviral conjunctivitis affecting almost all parts of the country from Karachi to Lahorereporting over 288000 cases in 2023 from January to September alone.^1,2No, doubt, Adenoviral Conjunctivitis has always been an important ocular infection around the globe causing a large part of over 65-90% of total vial conjunctivitis.³In Pakistan during 2024, this infection has quietly escalated into an epidemic, impacting nearly all major cities. Over 13,473 cases have been reported in various government hospitals within a span of thirty days (August-September 2024).²On Tuesday, September 4, a total of 907 cases were reported within just 24 hours, highlighting the widespread nature of the outbreak.⁴