Ophthalmology Pakistan

Changes in Central Macular Thickness After Pan-Retinal Photocoagulation (PRP) in Proliferative Diabetic Retinopathy.

2025-04-20T16:47:48+00:00

Objective: This study evaluates the impact of pan-retinal photocoagulation (PRP) on central macular thickness (CMT) and visual acuity in patients with proliferative diabetic retinopathy (PDR).

Methods: This clinical case series followed 35 subjects with PDR who underwent PRP. Ethical approval was obtained from the research committee of Pak International Medical College and Hospital, Peshawar. Subjects underwent a baseline assessment, including visual acuity, refraction, slit-lamp microscopy, fundoscopy, and intraocular pressure measurement. Optical coherence tomography (OCT) was performed pre- and post-PRP to measure central macular thickness (CMT). A total of 1500–2000 mild to moderate burns were applied. Data analysis was conducted using SPSS Version 27, and paired T-tests was used to assess differences in pre- and post-treatment CMT values.

Results: The study participants' ages ranged from 32 to 65 years, with a mean age of 48.68. The pre-treatment CMT ranged from 231.51 to 244.49 µm (mean: 238.00 µm), while post-treatment CMT ranged from 239.42 to 245.85 µm (mean: 239.42 µm). The mean change in CMT was 1.42 µm. Significant increases in CMT were observed in both age groups (≤50 years, p=0.001; ≥50 years, p=0.002) and gender (males, p=0.002; females, p=0.001) after one month. The mean number of laser burns applied was 2013.

Conclusion: After one month, PRP significantly increased macular thickness in patients with PDR. The findings suggest that PRP is effective in managing proliferative diabetic retinopathy by altering retinal thickness, potentially impacting visual acuity outcomes.

Ocular Injuries and The Associated Clinical Patterns

2025-07-26T11:36:03+00:00

Objectives: To determine the frequency of ocular injuries and associated clinical patterns and to determine the association between gender and causative agent.

Methods: It was a descriptive cross-sectional study conducted at the Department of Ophthalmology, MTI-Hayatabad Medical complex in Peshawar from 16^th December 2022 to 16^th June 2023. We collected data from patients that presented with a history of trauma to the eye. Data collected included age, gender, laterality, occupation, agent of injury, place of injury, time since injury, and visual acuity. In those with open globe injuries data regarding zone of injury and ocular trauma score (OTS) was also collected. We also determined the frequency of open globe injuries among trauma patients presenting to our department.

Results: A total of 121 patients were recruited during the study period with their mean age as 28.85±13.28 years. The frequency of open globe injury was found to be four (3.3%). In patients with open globe injuries, the majority (50%) sustained Zone I injuries, while Zone II and Zone III injuries each accounted for 25% of cases. Although males constituted the majority of cases 75 (62%), no statistically significant association was found between gender and the type of causative agent (p = 0.96).

Conclusion: This study has identified the population at risk and provided an overview of the causes and clinical features found in cases of ocular trauma. Armed with this knowledge, targeted interventions can be implemented, including awareness campaigns, advocacy for workplace eye protection, and legislative reforms to enhance traffic safety and mitigate RTA-related ocular trauma. The insights gained from this study can guide both clinical practice and public health policies, ultimately reducing the incidence and improving outcomes for affected individuals

Comparison of Conjunctival Transposition Flap Versus Conjunctival Autograft in Pterygium Recurrence

2025-07-19T05:32:03+00:00

Purpose: To compare outcomes of conjunctival transposition flap versus conjunctival autograft techniques in terms of recurrence following primary pterygium excision.

Methodology: This randomized controlled trial was conducted at the Department of Ophthalmology, Bakhtawar Amin Medical and Dental College, Multan from June 2023 to June 2024. A total of 144 patients with primary pterygium were enrolled and randomly assigned to undergo either conjunctival transposition flap (Group A) or conjunctival autograft (Group B). Surgeries were performed by a single experienced ophthalmologist. Patients were followed postoperatively at one, three, and six months to assess recurrence and complications.

Results: The mean age was 50.9 ± 10.5 years; 52.8% were male. The recurrence rate was 8.3% overall, with Group A showing 11.1% and Group B 5.6% (p = 0.367). A significantly lower mean operative time was observed in Group A (17.2 ± 1.0 minutes) compared to Group B (25.4 ± 1.0 minutes) (p < 0.001). Graft edema and dellen formation were slightly more frequent in Group B but did not reach statistical significance.

Conclusion: Both techniques had comparable recurrence and complication rates. However, the transposition flap technique offered the advantage of significantly reduced surgical time, making it a viable alternative in routine surgical practice.

Keywords: Pterygium, Conjunctival Autograft, Transposition Flap, Recurrence, Randomized Controlled Trial

Patterns of Posterior Capsular Opacification After Phacoemulsification with Foldable Acrylic Intraocular Lens

2025-07-26T10:28:58+00:00

Objective: To determine different patterns of posterior capsular opacification after phacoemulsification using foldable (acrylic acid) intraocular lenses. Methodology: This was cross-sectional study in which 172 patients having senile cataract undergoing phacoemulsification were selected. Patterns of posterior capsular opacification were graded using Sellmen and Lindstrom grading system in the patients who underwent phacoemulsification, using foldable intraocular lens. Examination was done on slit lamp and proforma was filled. Data were entered and analyzed by SPSS v25.0. Data were stratified for age, gender and duration of IOL. Post-stratification, Chi-square test was applied and p≤0.05 was considered significant. Results: There were 97(56.4%) males and 75(43.6%) were females. Mean age of the patients was 54.32±8.654 year. Mean duration of IOL was 14.25±3.42 months. According to posterior capsular opacification pattern distribution, 40(23.3%) had grade-I, while 73(42.4%), 50(29.1%) and 9(5.2%) had grade-II, grade-III and grade-IV respectively. According to stratification of posterior capsular opacification pattern with respect to different variables, no significant difference was observed between gender, age groups and duration IOL (p>0.05). Conclusion: Post-phacoemulsification cataract surgery posterior capsular opacification incidence can be reduced, though not totally avoided. An intraocular lens material is an important variable in the development of posterior capsule opacification. Selection of IOL material (Acrylic) goes a long way in minimizing the incidence of post-operative posterior capsular opacification.

Key words: Posterior Capsular Opacification, Phacoemulsification, Acrylic Acid.

Virtual Frontier: A New Reality

2025-08-24T10:32:10+00:00

A software generated three dimensional simulated image or an environment which apparently allows for physical interaction is virtual reality. In virtual reality environment, an individual interacts with the help of specialized input and output devices. Use of virtual reality in healthcare settings is widespread. It includes facilitation in medical education i.e. surgical training, therapeutic effects i.e. pain management and rehabilitation, and lastly patient engagement with regards to planning personalized medical and surgical treatment in addition to remote access for patients.
Likewise in ophthalmology, virtual reality has an enormous impact in facilitation and speeding up surgical training of residents in addition to screening and diagnosis of some macular disorders. A three dimensional monitor (LG CINEMA 3D monitor, 23MD53D, Seoul, South Korea) is being used for diagnosis and assessment of metamorphopsia. Polarizing glasses are used to create a stereoscopic effect to each eye followed by six picture test which included three pictures each for vertical and horizontal metamorphopsia.

Amblyopia Screening in Pakistan: A Public Health Review and Policy Perspective

2025-08-15T12:55:51+00:00

Amblyopia or “lazy eye” is a major cause of preventable eyesight deficit ailment in children aged 1-5 and accounting for 2-5% of the children’s population world over¹. In Pakistan, where children under the age of 15 amount to 40% of the whole population², it is largely inflated by the absence of reliable data and national screening programmes. Vision screening is vital at this stage because it is during this age when symptoms can be identified. A study found that self-perception of social acceptance was lower in children treated for amblyopia compared with age-matched controls³.

This article addresses issues and possibilities of commencing amblyopia screening programmes in Pakistan using successful models from foreign countries. Insufficient health care facilities and budgetary restrictions cripple the public healthcare system in Pakistan. However, recent advancements in amblyopia treatment including binocular therapy and pharmacological alternatives to traditional patching could enhance outcomes in low-resource settings like Pakistan⁴. With these measures in place, Pakistan’s growing rate of amblyopia will be controllable, and children’s visual health will positively develop.