Pakistan Journal of Ophthalmology

Late-Onset Capsular Block Syndrome: A One Year Follow-up Case Report

Ludovico Iannetti1 — 2024-04-01

We report a case of late Capsular Block Syndrome (CBS) in a patient who underwent cataract surgery 12 years back. It was diagnosed with slit-lamp examination and by using anterior segment optical coherence tomography (AS-OCT) that showed hyper-reflective material trapped in the capsular bag, between the IOL posterior surface and the posterior capsule. Anterior capsule fibrosis was seen in both eyes but in the left eye capsulorhexis showed irregular margins and had a smaller diameter compared to the right eye. The CBS was treated with Nd:YAG laser capsulotomy allowing rapid evacuation of liquid towards the vitreous chamber. Complete resolution of CBS was confirmed by AS-OCT. Best Corrected Visual Acuity (BCVA) of left eye improved from 0.2 logMAR before treatment to 0.0 logMAR one week after treatment. BCVA remained unchanged after one year of follow-up with no sign of new posterior capsular fibrosis.

Familial Exudative Vitreoretinopathy: A Case Report

Mashal Tayyab — 2024-04-01

Familial Exudative Vitreoretinopathy (FEVR), also known as Chriswick Schepens Syndrome is an inherited condition characterized by failure of vascularization of retinal periphery. This results in variable clinical manifestations such as telangiectasia, hemorrhage, exudation, retinal traction and detachment. Presented herein is a case of a14 year old female who exhibits decrease of vision in right eye since 6 months. Examination shows dragging of disc with tractional band at macula and telangiectatic vessels in temporal retinal periphery. Based on detailed history, clinical examination and investigations, a diagnosis of FEVR is made.

Choroidal Osteoma with Choroidal Neo Vascular Membrane

Sivaranjani — 2024-04-01

Choroidal osteoma (CO) is a rare benign tumor usually unilateral and have a female preponderance. We report a case of a 34-year-old healthy malediagnosed with unilateral Choroidal Osteoma with an associated Choroidal NeoVascularMembrane(CNVM).Thediagnosiswasconfirmedbasedonclinicalexamination, typical findings on B-scan, Fundus fluorescein angiography,Indocyanine green angiography and Optical coherence tomography. The CNVMwas treated with intravitreal Bevacizumab injections and showed a good responseinitially.TherewasarecurrenceofCNVMovertwoyearswhenpatientwaslosttofollow-up. Treatmentwith intravitreal Ranibizumab bio similar injection helpedstabilize hisvision. Regular follow-up is essential for timely treatment ofrecurrenceof CNVMand optimum visualoutcomes.

Visual Loss Due to Optic Nerve Injury with Blunt Trauma: A Case Series

Afzal Bodla — 2024-04-01

Vision impairment resulting from optic nerve damage poses a significant clinical challenge, often stemming from both direct and indirect traumatic injuries. In this article, we address the complexities involved in diagnosing and managing optic nerve damage, particularly in cases of blunt trauma-induced compression. We highlight the potential delay in diagnosis due to concurrent life-threatening conditions and the difficulties in assessing severely affected patients. Additionally, we present a case series involving three individuals who experienced vision loss secondary to optic nerve compression following blunt trauma. Through this analysis, we underscore the importance of timely recognition and appropriate management strategies in optimizing outcomes for patients with optic nerve injuries.

Comparison of α-Smooth Muscle Actin (α-SMA) and Collagen Type III Expression after Conjunctival Excision Between Platelet-Rich Fibrin (PRF) Membrane and Conjunctival Autograft Treatment: An Animal Model Experimental Study on Oryctolagus cuniculus

Indri Wahyuni — 2024-04-01

Purpose: To evaluate the impact of Platelet-Rich Fibrin (PRF) membrane and conjunctival autografts on α-Smooth Muscle Actin (α-SMA) and type III collagen expression following conjunctival excision in Oryctolagus cuniculus.

Study Design: Experimental study with a randomized post-test only design.

Place and Duration of Study: Airlangga University, Surabaya in November 2022.

Methods: Twenty rabbit eyes were categorized into two groups: those sutured with PRF membrane and those sutured with conjunctival autografts after temporal conjunctival excision. The study assessed α-SMA and type III collagen expression through the Immunoreactive Score (IRS) method.Data analysis is conducted using appropriate statistical methods, such as the t-test or Mann-Whitney U test, to compare the expression of α-SMA and collagen type III between the two groups.

Results: The data for each sample represented the average IRS value observed at 200x magnification. In the conjunctival autograft group, the mean IRS of α-SMA expression was 5.52 ± 0.84,

Effectiveness of Intracameral Tissue Plasminogen (r-tPA) Activator in Resolution of Fibrinous Reaction in Refractory Toxic Anterior Segment Syndrome (TASS)

Bilal Khan — 2024-04-01

Purpose: To evaluate the effectiveness of tissue plasminogen activator (r-tPA) in resistant toxic anterior segment syndrome (TASS) after Phacoemulsification.

Study Design: Quasi experimental.

Place and Duration of Study: Khyber Teaching Hospital, Peshawar from August 2021 to August 2023.

Methods: Forty-six patients (46 eyes) with an anterior chamber fibrin reaction after cataract surgery were treated with intra-cameral injection of t-PA (30µg/0.1cc) following failure to respond to conventional treatment with intensive topical and subconjunctival steroids. Outcome measures were best corrected visual acuity (BCVA), clearance/recurrence of the fibrin reaction and complications.

Results: Intra-cameral t-PA was injected2 to 6 weeks post Phacoemulsification in TASS cases. Mean post-operative injection time was 18.5± 10.2 days. After 1^st day post injection, we observed total abolition of fibrinous exudate in 36(78.2%) cases and subtotal resolution in 10 (21.7%) cases. After 6 weeks the TASS was completely settled in 43(93.4%)cases. Mean BCVA improved from 0.59 ± 0.40 log MAR pre-injection to 0.38 ± 0.40 log MAR at 6^th week post-injection (p=0.07). There was no statistically significant difference in BCVA and rate of fibrinolysis between the two groups after post r-tPA injections. Intra-cameral r-tPA was not associated with adverse effects like raised IOP or endophthalmitis.

Conclusion: Intra-cameral t-PA injection (30µg/0.1cc)appears to be a safe and effective treatment option for resolving anterior chamber fibrin reaction refractory to conventional steroid therapy following cataract surgery.

Supratarsal Injection of Bevacizumab in the Treatment of Vernal Kerato Conjunctivitis

Zeeshan Kamil — 2024-04-01

Purpose: To evaluate the effectiveness of supratarsal injection of Bevacizumab in the treatment of Vernal Kerato-conjunctivitis (VKC).

Study Design: Quasi experimental study.

Place and Duration of Study: LRBT Karachi from September 2022 to September 2023.

Methods: This study included 110 eyes of 60 patients with VKC and divided into two groups by convenient sampling. In one group (n=30) 0.1ml of Bevacizumab 2.5%was injected in supratarsal space with 27-gauge needle under topical anaesthesia. Other group (n=30) received conventional treatment. The sign and symptoms were checked at one week and at one month in all patients. The qualitative variables were presented as frequency and percentage while quantitative variables were shown as mean ± standard deviation. Chi square test was applied for comparison.

Results: Mean age of the patients was 12.4 +1.9 years. There were 46 (76.0%) males. Itching and photophobia was not seen in 50% of the patients treated with Bevacizumab while this percentage was 13.3% and 10% respectively in case of conventional treatment. Similarly, redness, discharge and limbal papillae were not seen in 70%, 73.3% and 83.3% respectively after Bevacizumab application. While it was 16.6%, 30% and 10% respectively after conventional treatment. Significant improvement in itching, photophobia, redness, discharge and limbal papilla was observed in the group of patients who received supratarsal Bevacizumab injection as compared to those who received conventional treatment (p<0.05).

Conclusion: Bevacizumab is a safe and effective treatment in patients of VKC refractory to conventional treatment.

Comparison of Nd: YAG Laser Iridotomy Alone Versus Sequential Argon-Nd: YAG Laser Iridotomy in Patients with Primary Angle Closure Spectrum

Paras Khan — 2024-04-01

Purpose: To compare the mean Nd: YAG energy used and mean decrease in IOP 3-hours post-laser, in Nd: YAG Laser iridotomyalone versus sequential Argon-Nd:YAGiridotomy in patients with primary angle closure spectrum.

Study Design: Quasi experimental Study.

Place and Duration of Study: Department of Ophthalmology, Allied Hospital, Faisalabad from March 2022 to August 2022.

Methods: After taking approval from Ethical review board, 70 patients with angle closure spectrumwere included in the study. Out of 70, 25 patients were primary angle closure suspect (PACS), 28 had primary angle closure (PAC) and 17 patients had primary angle closure glaucoma (PACG). We sorted patients into Group A (those who underwent sequential Argon-Nd: YAG Laser peripheral iridotomy) and Group B (those who underwent Nd: YAG laser alone). Mean Nd: YAG energy used was noted in each group and compared using SPSS version 25.0. Mean decrease in IOP 3-hours post-laser was also noted and compared.

Results: Mean decrease in IOP 3 hours post-laser was 5.46 ± 3.70 mmHg for sequential Argon-Nd: YAG LPI versus 3.46 ± 2.38 mmHg for Nd: YAG LPI alone (p-value = 0.009). Mean Nd: YAG energy used in sequential Argon-Nd: YAG LPI group was significantly lesser when compared to Nd: YAG LPI alone group (32.70 ± 38.87 versus 139.37 ± 62.32 mJ) which was found to be statistically significant (p = 0.0001).

Conclusion: Sequential Argon-Nd-YAG laser iridotomy uses significantly less Nd:YAG energy than conventional Nd:YAG only method with better IOP control.

Enhancing the Technique of Eye Drop Administration through Evaluation and Education: A Quality Improvement Initiative

Marwa Saif — 2024-04-01

Purpose: To evaluate the eye-drop administration technique and see the effect of education in improving the eye drop delivery method.

Study Design: Interventional case series.

Place and Duration of Study: Central Park Teaching Hospital Lahore from May-2022 to September-2022

Methods: This study includes 341 patients who had been self-administering eye drops as a treatment for glaucomaor any other disorder. The patients were asked to instill the drop by using a 5ml Systane bottle, as they should do at home. Two observers assessed the technique. Patients were educated about the techniques and they were re-assessed in the form of a post-test. They were evaluated by the same observers again. Data was analyzed suing Fisher’s Exact test.

Results: A significant improvement was observed in several parameters, including the mean time (in seconds) taken to instill the first drop, the number of drops squeezed, the number of drops reaching the conjunctival sac at the first attempt, hand washing, shaking the bottle before instillation, tilting the head backwards during drop instillation, and the occurrence of drops falling on the cheek (p ≤ 0.05). Conversely, statistically insignificant improvements were noted in parameters such as touching the tip of the dropper and closing the eye for a minute.

Conclusion: The findings underscore the importance of enhancing patient education regarding the correct technique for drop instillation.

Strabismus Measurements Using the Alternating and Simultaneous Prism Cover Tests

Shua Azam — 2024-04-01

Purpose: Tocomparetheangleofdeviationbyperformingsimultaneousprismcover test (SPCT) and alternate prism cover test (APCT) at near (33cm) and far (6m).

Study Design: Cross-sectional observational.

Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi from July 2021 to December 2021.

Methods: This study enrolled 32 participants diagnosed with constant esotropia, aged between 5 and 25 years, comprising 14 males and 18 females. Comprehensive ocular examinations for strabismus were performed, including simultaneous prism cover tests at both distance and near fixation, conducted with and without corrective glasses. Subsequently, an alternate prism cover test was administered at each fixation point, again both with and without glasses. Binocular single vision was evaluated using the Worth Four Dot test and the 10Δ test. Statistical analysis was conducted using SPSS version 20.0.

Results: At distance fixation, the mean deviation angle measured by the simultaneous and alternate prism cover tests exhibited a significant difference of 9.78Δ (p=<.001). Similarly, at near fixation, the mean deviation angle between the simultaneous and alternate prism cover tests showed a significant difference of 10Δ (p=<.001).

Conclusion: This study demonstrates a notable and statistically significant variance in the measured angle of deviation when employing different testing methodologies (SPCT and APCT).

Visual and Surgical Outcomes in Late Presentation of Retinal Detachment

Bibi Rafeen Talpur — 2024-04-01

Purpose: To evaluate the frequency of treatment success in terms of visual and surgical outcomes in patients with late presentation of retinal detachment.

Study Design: Quasi experimental.

Place and Duration of Study: Sindh institute of Ophthalmology and visual Sciences from June 2022 to January 2023.

Methods: A total of 50 eyes of 50 patients with delayed presentation of retinal detachment who underwent Pars Plana Vitrectomy (PPV) were included and followed up for 6 months. Preand post-surgery Best Corrected Visual Acuity (BCVA) and anatomical attachment of retina were comprehensively analyzed. Factors affecting an atomical success were also studied.

Results: Mean age of patients was 47±18 years. Twenty seven patients were (54%) were more than 45 years of age and 32(64%) were males. Thirty eight (76%) patients achieved successful anatomical attachment of retina at 6^th month follow-up. Post-operative BCVA also showed improvement in vision.Risk factors identified for poor anatomical and visual outcome following PPV for retinal detachment are; PVR advance stage, longer duration of visual symptoms and poor-presenting BCVA. Age, sex, laterality, Pre-operative BCVA, lens status, diagnosis, and type of surgery showed insignificant associations (P >0.05).

Conclusion: Anatomical failure and poor functional outcomes appear to be mostly caused by PVR. PVR, longer duration of visual symptoms and poor-presenting VA are risk factors for poor anatomical and visual outcome following PPV surgery for RD. Late presentations to clinics can decrease with mass awareness. The frequency of proliferative vitreoretinopathy would decline, and visual results would be improved.

Role of Optical Coherence Tomography Angiography in Predicting Risk of Progression of Diabetic Retinopathy

Arifa Ghazipura — 2024-04-01

Purpose: To determine the role of Optical Coherence Tomography Angiography (OCTA)in predicting risk of progression of diabetic retinopathy.

Study Design: Descriptive observational study.

Place and Duration of Study: Jinnah Post graduate Medical Center, Karachi, from June 2022 to June 2023.

Methods: Patients with type 1 or 2 diabetes were included. Base line investigations were done including Central subfield thickness and OCTA at first visit. Second visit was conducted at 6^th month and patients were followed for 24 months.OCT images of poor quality, motion artifact, inaccurate partition of tissue layers and blurry images were excluded.

Results: Among 97 enrolled patients, 88 cases finished the complete 24-months follow up. Out of 88 patients, 16 (18.18%) patients showed progression of diabetic retinopathy (DR), 9 (10.22%) patients developed DME, two showed both DR and DME .In univariate analysis, greater FAZ area, reduced FAZ circularity, Fractal dimension (FD) and vessel density (VD) of the deep capillary plexus (DCP) were significantly related to the advancement in DR. Among these, FAZ area, VD, and FD remained significant in the multivariate analysis. Whereas, only decreased VD and FD of superficial capillary plexus (SCP) were significantly related to advancement in DR and DME.

Conclusion: Changes in OCTA parameters is significantly associated with progression of diabetic ocular complications including diabetic retinopathy and diabetic macular edema. High risk subjects can be identified by this method for more rigorous treatment.

Comparison between Two Doses of Suprachoroidal Triamcinolone Acetonide among Cases of Resistant Diabetic Macular Edema

Muhammad Zunair Aziz — 2024-04-01

Purpose: To compare the effectiveness and safety of two doses of supra-choroidal Triamcinolone Acetonide (TA)in patients of resistant diabetic macular edema.

Study Design: Quasi experimental study.

Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi, from April 2023 to September 2023.

Methods: Thirty-two cases of resistant diabetic macular edema were selected using a convenient sampling technique and divided into two groups. Group A received a single suprachoroidal injection of TA at a concentration of 2 mg/0.1 ml, while Group B received the same drug via the same route at a concentration of 4 mg/0.1 ml. All cases were monitored for any serious adverse effects the following day. Follow-up checkups were conducted for all cases at 1, 3, and 6 months.

Results: Mean age of patients for group A and B was 56.24±1.2and 56.33±2.6years respectively. Both the groups were equivalent in all ophthalmological measurements best corrected visual acuity, central macular thickness and intraocular pressure (BCVA, CMT, IOP) at baseline checkups. At 6^thmonth follow up, both groups showed improved BCVA and decreased CMT compared to baseline, but group B had a significant increase in IOP (p = 0.001). Additionally, cataract progression was slower in group A.

Conclusion: Both doses of suprachoroidal TA are equally effective in cases of resistant diabetic macular edema in terms of improved BCVA and reduced CMT. However, the lower dose (2mg/0.1 ml) showed advantages in terms of fewer complications, specifically less likelihood of raised intraocular pressure and cataract formation.

Comparison of Fluorometholone 0.1% and Cyclosporine 0.05% in the Treatment of Vernal Keratoconjunctivitis

Ahmed Usman Khalid — 2024-04-01

Purpose: To compare the effectiveness of Fluorometholone 0.1% and Cyclosporine 0.05% in the treatment of vernal keratoconjunctivitis.

Study Design: Quasi experimental study.

Place and Duration of Study: Hayatabad Medical Complex, Peshawar from December 2020 to June 2021.

Methods: This study includes 104 patients divided into 2 groups. Patients in Group A were given topical Fluorometholone 0.1% while group B were given topical Cyclosporine 0.05%. Signs and symptoms were graded from scale 0-10 at the start of treatment and then at day 7,14 and 30. Drug was considered effective if the final score was equal to or less than 3 at day 30.

Results: Mean age of the patients was 9.96±2.722 years in group A and 10.02±2.790years in group B. Mean baseline score was 6.90±0.721 in group A and 5.87±0.768in group B. In group A, 45 (86.5%) patients showed effectiveness while in group B, 36 (69.2%) patients showed effective results. Fluorometholone gave superior results as compared to Cyclosporine in patients with severe disease i.e., baseline score ≥ 6.Systemic allergic associations were noted in44.2% patients in group A and 36.5% patients in group B.

Conclusion: These findings suggest that Fluorometholone may be a preferable treatment option for vernal keratoconjunctivitis, particularly in cases of more severe disease. However, considerations regarding systemic allergic associations should also be taken into account when making treatment decisions.

Correlation of Dysfunctional Lens Index with Lens Opacification System III in Age Related Cataract

Zoomar Muzammil — 2024-04-01

Purpose: Age-Related changes in crystalline lens opacity and lens density contribute to formation of higher order aberrations resulting in reduced quality of vision. Precise quantification of cataract is important for predicting phacodynamics and educating patient. The iTrace(a ray-tracing aberrometer) provides Dysfunctional Lens Index (DLI). This study from Pakistan investigates the relationship between LOCS III and DLI in senile cataract.

Study Design: Correlational study.

Place and Duration of Study: Hashmanis Hospital, Karachi from March 2021 to May 2021.

Methods: This study included 44 patients with age-related cataract. Demographic characteristics and complete ophthalmic examination of eyes including Best Corrected Visual Acuity (BCVA) and slit lamp biomicroscopy were performed. Age related cataracts were graded using the Standard technique of LOCS III. I-Trace was utilized for wave front analysis to calculate DLI.

Results: BCVA and LOCS III nuclear opalescence score had strongest positive linear correlation (r=0.433, P<0.01). DLI displayed a strong significant negative correlation to LOCS III Cortical Cataract (C) and LOCS III Posterior Sub-Capsular Cataract (P) score (r=-0.415 and r=-0.694; respectively).

Conclusion: BCVA had insignificant and small to no correlation to LOCS III C score and P score. Whereas, DLI showed the strongest significant correlation to LOCS III C score and P score. Patient's optical quality determined by visual symptoms are more closely associated to DLI parameter as compared to LOCS III classification. DLI can provide a better objective way to elevate age related cataract, monitor the progression and determine phacodynamics.

Coexistence of Diabetic Retinopathy and Diabetic Foot in Patients Admitted at Indoor Facility of a Tertiary Care Center

Afia Matloob Rana — 2024-04-01

Purpose: To determine frequency of “diabetic retinopathy (DR)” in patients admitted at a tertiary care hospital with diabetic foot.

Study Design: Cross sectional study.

Place and Duration of Study: HBS medical and dental college, Islamabad from November 2022 to November 2023.

Methods: Sixty two patients admitted with “diabetic foot ulcer”(DFU) were included in this study. Severity of DFU was assessed using . Patients were assessed for presence of “diabetic retinopathy (DR)” as well as its severity. Data was analyzed using SPSS 22.

Results: Mean age was 49.37 ± 11.02 years. There were 34 (54.84%) males and 28 (45.16%) females. Mean HbA1C% was 9.46 ± 1.11%. Mean duration of diabetes was 10.06 ± 5.53 years. Forty five percent patients had diabetic retinopathy (DR). Amongst these patients diagnosed with DR (n = 45), 6 (13.33%) had mild non-proliferative DR, 20 (44.44%) had moderate non-proliferative DR, 14 (31.11%) had severe non-proliferative DR and 5 (11.11%) had proliferative DR. According to Wagner Grade there were 32 (51.61%), patients with grade 2 DFU, 19 (30.65%) had grade 1 and 11 (17.74%) had grade 3. Coexistence of diabetic retinopathy and diabetic foot in patients admitted at indoor facility was 72.58%.

Conclusion: Prevalence of “diabetic retinopathy (DR)” in patients admitted with diabetic foot was 72.58%. Presence of diabetic foot can be considered as strong predictor of presence of concomitant “diabetic retinopathy”.

Awareness and Knowledge About RefractiveSurgery Among Medical Students in Baghdad

Suzan Amana Rattan — 2024-04-01

Purpose: Refractive error represents a common eye disorder that can significantly impact an individual's visual function and overall well-being. There are several methods of correcting refractive errors and objective of this study was to assess the awareness of refractive surgery and the preferred methods of refractive error correction among medical students in Baghdad.

Study Design: Cross sectional survey.

Place and Duration of Study: University of Baghdad Al-Kindy College of Medicinefrom November 2022 to March 2023.

Methods: Medical students from six Baghdad medical colleges with total sample size of 350 were included. Students who had undergone refractive surgeries and fifth and sixth year medical students were also excluded. Level of knowledge was categorized as; <50% (0-5) poor knowledge, 50-70% (6-8) moderate knowledge and >70% (9-12) good knowledge.

Results: Among the students with refractive errors, 82% had knowledge about their refractive error. Forty percent had myopia, 12% had astigmatism, 15 % had myopia and astigmatism, 10% had hyperopia, 5% had hyperopia and astigmatism. Among them 57.8% were not willing to undergo refractive surgery due to fear of complications. Forty eight percent had poor knowledge,43.1% had moderate and only 8.26% had a good knowledge of refractive surgeries. The majority preferred eyeglasses (82.6%) followed by both eyeglasses and contact lenses.

Conclusion: Students had good awareness about refractive surgery but their familiarity and knowledge about it remained poor because of complications. An overwhelming majority of students still preferred spectacles as the method for vision correction.

Atropine 0.01% Eye Drops for Myopia Control in a tertiary care center of Pakistan: An interventional case series

Tiabbah Saleem — 2024-04-01

Purpose: To evaluate the real time results of once-dailyAtropine 0.01% eye drops in controlling myopia.

Study Design: Interventional case series.

Place and Duration of Study: The Eye Centre, South City Hospital, Karachi from September 2020 to August 2021.

Methods: One hundred(both) eyes of 50 children were included in the study using non-probability consecutive sampling technique. Baseline spherical equivalent refraction(SER) was recorded at the initiation of treatment.The endpoint was measuring the rate of progression in SER at one year after treatment. Responders weredefined as the ones with either no progression of myopia or worsening of myopia of ≤ -0.50 SER and non-responders were defined as ones with a progression rate of myopia of greater than0.50 SER.

Results: The baseline means SER for 100 eyes was 3.25±1.37 D. On follow-up after 12 months of treatment with Atropine 0.01% eye drops, the mean SER was -3.74 ± 1.34 D. The rate of SER progression was significantly lower at one year follow-up (p-value<0.001). The percentage of responders was84%.

Conclusion: Significant reduction in myopia progression occurred after treatment with Atropine 0.01% eye drops in a greater percentage of children. This has led us to be confident in providing Atropine 0.01% eye drops along with simple spectacles as an effective treatment strategy to control myopia progression.

Immediate Effect of Intravitreal Bevacizumab Injection on Intraocular Pressure

Kanwal Zareen Abbasi — 2024-04-01

Purpose: Raised intra ocular pressure following intravitreal Bevacizumabis a potential side effect which can be clinically significant. The aim of the study was to evaluate short term changes in intraocular pressure after intravitreal Bevacizumab injection.

Study Design: Quasi experimental study.

Place and Duration of Study: Benazir Bhutto Hospital, Rawalpindi from January 2021 to July 2021.

Methods: This study includes 88 eyes of 88 patients who received intravitreal Bevacizumab injection. Both females and males between the ages of 10 and 80 years, with any indication for intravitreal Bevacizumab, were included. Intraocular pressure (IOP) was measured before injection, immediately after injection at 0 minutes, at 30 minutes and at 60 minutes. Paired t test was used to compare post injection changes in IOP from baseline.

Results: All except one eye recoded increase in IOP immediately after injection. It returned to normal range in35 (39.8%) eyes at 30 minutes and at 60 minutes 78 (88.6%) eyes had normal IOP. Highest mean IOP was recorded immediately after injection which was 30.89+5.648and that reduced to 23.08+4.516 at 30 minutes and 18.14+2.623 at 60 minutes. Paired t test showed that the changes were significantly higher from baseline 13.30+2.78 at these intervals after injection.

Conclusion: An increase in intraocular pressure after intravitreal Bevacizumab injection is a frequent occurrence; however, for the majority of patients, it is transient and returns to normal levels within one hour.

Role of Vitamin D3 Supplementation in the Treatment of Dry Eye Syndrome

Bushra Kanwal — 2024-04-01

Purpose: The aim of this study was to evaluate the role of vitamin D3 supplementation in treating non-Sjogren dry eye (NSDE) patients compared to the conventional treatment with artificial tears.

Study Design: Non-randomized controlled Trial.

Place and duration of study: Rural Health Centre (RHC) Buchaal Kalan from September 2021 to July 2022

Methods: This study allocated 108 patients with NSDE and hypovitaminosis D via two-arm parallel assignment. The sample was divided into two groups by non-probability purposive sampling. Group 1 received conventional treatment as artificial tears 4 times/day and group 2 was given oral vitamin D3 supplementation of 6000 IU daily along with artificial tears for a period of 90 days. The impact of oral vitamin D3 supplementation on NSDE was assessed by comparing means of ocular parameters of both groups over time. Tear break-up time (TBUT) in seconds and Schirmer’s test (ST) score in millimeters were primary outcome measures. The ocular surface disease index (OSDI) score and numerical pain rating scale (NPRS) were secondary outcome measures.

Results: The mean age of patients in group 1 and group 2 was 34.98±8.64 and 34.87±8.79 respectively. Similarly, the mean serum 25 (OH) D level was 15.03±3.27 in group 1 and 14.93±3.26 in group 2. Results showed that OSDI and NPRS scores were decreased in both groups, however, TBUT and ST scores were improved in group 2.

Conclusion: Oral vitamin D3 supplementation may serve as a new treatment option for NSDE patients having hypovitaminosis D.

Revolutionizing Ophthalmology: The Empowering Role of Artificial Intelligence

Zahid Kamal Siddiqui — 2024-04-01

Artificial Intelligence holds immense importance in today's world and has the potential to alter our future in various domains. The importance of AI lies in its ability to automate tasks, enhance decision-making, personalize experiences, solve complex problems, and drive innovation. Choosing not to adopt AI may result in inefficiency, missed opportunities, limited innovation, reduced insights, and higher operational costs. It won’t be long before the lives of those who benefit from AI and those who don't will diverge significantly. According to Stephen Hawking.

OrCam MyEye 2.0, A Dire Need to Revolutionize the Lives of Congenital or Acquired visually Impaired Patients in Pakistan.

Waseem Sajjad — 2024-04-01

I am writing to highlight the pressing issues in the management of congenital or acquired visually impaired patients, and to accentuate the dire need for an alternative approach and attitude towards their rehabilitation in Pakistan. To lessen the socio-emotional impacts and dependency of patients who are blind or visually impaired, as well as to improve their quality of life, ophthalmologists must pay close attention to the inadequate use of AI visual assistance systems and contemporary technology.¹