Pakistan Journal of Ophthalmology

Changing Paradigms in Cataract Surgery to optimize refractive Outcomes (Adapted from Ramzan Ali Syed Award Lecture)

Mazhar Ishaq — 2025-07-01

Cataract surgery in Pakistan has undergone a remarkable transformation over the past four decades, reflecting global advancements and local adaptations in surgical technique and intraocular lens (IOL) technology. From the early days of intracapsular cataract extraction (ICCE) with 8-0 sutures to the modern era of femtosecond laser-assisted cataract surgery (FLACS), the journey has been marked by continuous evolution, driven by both technological innovation and the changing expectations of patients. This ‘Ramzan Ali Syed Name Lecture’ traces the trajectory of cataract surgery in Pakistan, highlighting key milestones, current realities, and the promise and pitfalls of premium IOLs in meeting the complex demands of contemporary patients. Until 1980s, cataract surgery in Pakistan was a relatively basic technique of intracapsular cataract extraction (ICCE), using 8-0 sutures

Pakistan’s Journey towards the Elimination of Trachoma (Raja Mumtaz Memorial Lecture)

Asad Aslam Khan — 2025-07-01

Pakistan’s journey towards the elimination of trachoma is a remarkable example of collaborative effort, perseverance, and strategic planning in public health. The efforts began with groundbreaking impact of Hugh Taylor’s 1980 report.¹ The report estimated that the prevalence of blindness in Pakistan was around 2%, with cataract identified as the most common cause. It also highlighted a gross mismatch in human resources, noting that 45 out of 64 districts were without an ophthalmologist. Moreover, it emphasized the urban-rural imbalance, pointing out that most ophthalmologists were based in urban areas, while the burden of blindness was concentrated in rural communities. That report served as a wake-up call for Pakistan’s government, leading to major reforms in the country’s eye care delivery system.

Effect of Borish Delayed Refraction on Myopia

Renu Thakur — 2025-07-01

Purpose: To evaluate the impact of Borish Delayed Refraction on myopic refraction.

Study Design: Cross sectional study.
Methods: A total of seventy myopic individuals were selected for participation, through convenient sampling, ensuring an equitable gender distribution of 50%. After detailed history and examination, objective and then subjective refraction was performed. To relax accommodation, a modified version of Borish delayed subjective test was used. Fogging allowed prescription of plus powers exceeding +1.00D, enhancing the accuracy of the subjective refraction process.After the application of the Borish delayed method, prescriptions were provided to all seventy subjects for the continued use of corrective spectacles.

Results: The range of refractive error before the Borish Delayed Refraction Test varied from -1.00D to -5.00D, while after the test, it ranged from -0.75 D to -4.00 D. The mean refractive error before the test was -3.0143 ± 1.2D, which reduced to -2.3214 ± 0.99D after the test. A paired t-test was performed for statistical comparison, revealing a significant correlation (p = 0.00) between the pre- and post-test refractive error values.

Conclusion: The Borish Delayed Refraction is potentially useful method for managing myopia. The test offers the possibility for more precise and stable prescriptions by enabling accommodation to relax prior to subjective refraction assessment.

Keywords: Accommodation, Subjective refraction, Myopia, Borish Delayed Refraction.

Limbal Epithelial Stem Cell Transplantation for Ocular Chemical Burns: A Systematic Review

Andintia Aisyah Santoso — 2025-07-01

Ocular burns can cause limbal stem cell deficiency (LSCD), which may require limbal stem cell transplantation (LSCT) to restore corneal function. This review evaluates outcomes of different LSCT techniques for treating ocular chemical injuries. A comprehensive search ofCochrane Library, PubMed, Scopus, EBSCO, and ProQuest, was conducted for studies published between 2014 and 2024, supplemented by manual searches. Studies focusing on LSCT for chemical injuries were included. The primary outcome was achievement of a stable, completely epithelialized, avascular corneal surface. Twelve studies, encompassing 473 eyes, met the inclusion criteria. Alkali injury was reported as the most common aetiology. The cumulative surgical success rates were 74.8% for autografts, 47.6% for allografts, and 54.4% for cultivated limbal epithelial transplantation. LSCT is a safe and effective intervention for ocular burns, particularly in severe LSCD cases, offering both anatomical restoration and functional visual improvement.

Keywords: Limbal Stem Cell Deficiency, Limbal Stem Cell Transplantation, Ocular Chemical Burns.

The Effectiveness of Non-surgical Therapy for Traumatic Optic Neuropathy Patients: A Systematic Review and Meta-Analysis

Ani Talia — 2025-07-01

This systematic review examined non-surgical management of traumatic optic neuropathy including the use of corticosteroids, levodopa-carbidopa, mesenchymal stem cells, and erythropoietin. A thorough literature review was conducted across three databases: PubMed, Cochrane Library, and ScienceDirect. Clinical studies and randomized controlled trials (RCT) that were published in English and Bahasa Indonesia till June 2023 were included. The PRISMA 2020 flow diagram was utilized to guide the study selection process. Data retrieved were analyzed through random effects model to yield a comprehensive synthesis of outcomes. Eight studies were included in this review, two of which were RCTs and the other six were clinical trials. Two studies examined the use of mesenchymal stem cells, and the remaining studies examined other non-surgical approaches, including the usage of corticosteroids, erythropoietin, and levodopa-carbidopa. This review concluded that patients with TON can be effectively treated with non-surgical therapy.

Keywords: TraumaticOpticNeuropathy,Corticosteroids,Erythropoietin,MesenchymalStemCell,Levodopa-Carbidopa,VisualAcuity,VisualField.

Managing Steroid-Induced Mania after Optic Neuritis: A Case Report

Faryal Ahmed — 2025-07-01

Corticosteroids are critical in the treatment of systemic disorders such as optic neuritis, emphasizing early intervention for visual preservation. While their therapeutic effectiveness is well established, the possibility of systemic adverse effects, particularly in the neuropsychiatric domain, requires consideration. We present a case of a 42-year-old man who developed steroid-induced mania after receiving therapy for optic neuritis. This case emphasizes the need for early recognizing and addressing psychological problems in such situations. We used Risperidone to treat the psychiatric symptoms. This case report highlights the need for more study into optimizing care in similar scenarios.

Effective Chemotherapeutic Resolution of Squamous Cell Papilloma with 5FU

Nazia Qidwai — 2025-07-01

Squamous cell papilloma is a benign mass of stratified squamous epithelium of conjunctiva. It can occur in both children and adults. We present a case of a 20-year-old male patient with recurrent conjunctival mass for the last 2 years. It was surgically removed six months back, but it recurred. Excisional biopsy revealed the Squamous cell papilloma of the conjunctiva. We prescribed 5 FU drops in QID dose for a week and then stopped for 3 weeks. Six 6 such cycles were performed.Complete resolution was achieved at the end of the 6^th cycle. No side effects or recurrence were reported even after 2 years of completion of management. The patient is being observed on routine follow-up visits.

Keywords: Papilloma, conjunctiva, 5 FU.

Bilateral Choroidal Osteoma with Secondary Choroidal Neovascularization in a Teenager: A Rare Case

Ambreen Gull — 2025-07-01

Choroidal osteoma is a rare, benign ossifying tumor that may lead to vision loss due to complications such as choroidal neovascularization (CNV). While typically unilateral in young females, bilateral involvement is less common. This report presents a 16-year-old girl with gradual, painless bilateral vision loss. Her best-corrected visual acuity (BCVA) was 6/60 in the right eye and 6/36 in the left. Fundus examination revealed bilateral, orange, scalloped choroidal lesions in the macula with surface vascular networks. Fluorescein angiography confirmed CNV in both eyes. The patient received three intravitreal injections of ranibizumab (0.3 mg/0.05 ml) in each eye at four-week intervals.

Keywords: Choroidal Osteoma, Choroidal Neovascularization,Ranibizumab, Retinal detachment.

Accidental Retinal Injury by Self-Applied Cosmetic Laser: A Case Report

Gitalisa Andayani Adriono — 2025-07-01

The use of lasers for dermatological procedures is common now days. We report a case of accidental retina injury and vitreous hemorrhage due to self-applied cosmetic laser, and the aftermath of the injury. A female dermatology nurse complained of blurry vision after an Nd:YAG cosmetic laser accidentally shot at her right eye. She was applying laser to her own face without wearing protective goggles. Afterwards, she felt a black line with moving shadows concealing her vision, without any pain, foreign body sensation, orredness.Hervisualacuitywas6/45, withnormalIOPandanteriorsegment.Fundusexaminationrevealedvitreoushemorrhage, pre-retinal hemorrhage, and pallor in the peri macular area. In 10-month follow-up, the best-corrected visual acuity remained 6/6 but tractional membrane developed in the injured area. Laser injury did not directly affect the fovea, resulting in preserved vision. However, long-term follow-up is still warranted to monitorlate complications.
Keywords: Laser, Retinal hemorrhage, Vitreous hemorrhage, Nd:YAG.

Thioridazine Induced Bilateral Angle Closure and Myopic Shift

Laiba Tabassum — 2025-07-01

Drug induced angle closure is a sight threatening complication in ophthalmology which if not treated urgently can lead to perpetual vision loss. Identifying the cause of disease and timely intervention can prevent permanent damage to the eye. This case report presents a case and subsequent discussion on thioridazine induced angle closure along with transient myopia. Oral and topical pressure lowering drugs were prescribed which included oral acetazolamide 250mg QID, topical timolol, dorzolamide and brimonidine. This case report highlights some of the key issues pertaining to drug induce angle closure and the potential approach to tackling it.

Keywords: Thioridazine, Secondary Angle Closure, Myopia.

Ocular Surface Disease in a Young Boy with Laryngo-Onycho-Cutaneous Syndrome: A Case Report

Saman Gulzar — 2025-07-01

Laryngo-Onycho-Cutaneous (LOC) syndrome is a rare variant of autosomal recessive junctional epidermolysis bullosa (JEB), predominantly affecting individuals from consanguineous families within the Muslim Punjabi community. A 12-year-old boy presented with a progressive decline in visual acuity over four years, accompanied by photophobia and excessive tearing. His visual acuity was severely impaired, with light perception in the right eye and 6/60 vision in the left eye. Slit-lamp biomicroscopy revealed symblepharon in both eyes, corneal conjunctivalization, and restricted ocular motility in all directions. Systemic examination identified additional features, including nail clubbing, cheek ulcerations, stridor, hoarseness, vitiligo, and dental anomalies. The patient underwent symblepharectomy with an amniotic membrane graft. Cycloplegic refraction was performed 1 month postoperatively which resulted in considerable improvement in visual acuity and symptomatic relief

Keywords: Symblepharon;Amniotic membrane, Graft, Laryngo-Onycho-Cutaneous syndrome.

Pre-operative Risk Factors, Intraoperative Complications and Postoperative Visual Outcome in Diabetic Patients Undergoing Phacoemulsification

Suchi Paliwal — 2025-07-01

Purpose: To evaluate the effect of diabetes on phacoemulsification surgeryby analyzingrisk factors, intraoperative complications and final visual outcome.
Study Design: Case control study.
Methods: This study analyzed 100 eyes of 100 patients who underwent phacoemulsification. Data included demographic details, history of diabetes, pupillary dilatation, anterior chamber depth, lens thickness, intraoperative complications and final visual outcome.
Results: The patients had similar age distribution with female predominance in diabetic group. Diabetics had a statistically significant (p<0.05) shallower anterior chamber depth (2.92 ± 0.52 mm) compared to non-diabetics (3.12 mm ± 0.44 mm). Lens thickness was greater in diabetics but was statistically not significant. Diabetic group had 6 (12%) eyes with poor pupillary dilatation (<6 mm). Intraoperative complications were more frequent in diabetics, which included escaping capsulorhexisin 3 (6%) cases, floppy iris syndrome in one (2%) case. On the contrary, the non-diabetic group had no intraoperative complications. Out of total sample of 100, 86% patientswith diabetes and 96% patients without diabetes had postoperative visual acuity between 6/6 and 6/9, (p<0.05).
Conclusion: Diabetes can affect pupillary dilatation, anterior chamber depth, and lens thickness in patients with senile cataract. Although diabetic patients have a higher risk of intraoperative complications, their visual outcomes are comparable to those of non-diabetic patients.
Keywords: Cataract, Diabetes mellitus, Anterior chamber depth, Lens thickness, Floppy irisSyndrome.

Surgical Outcomes of Photorefractive Keratectomy, Femtosecond-LASIK, and SMILE for Myopia and Myopic Astigmatism: A Comparative Study in Babylon, Iraq

Mustafa Tawfeeq Halboos — 2025-07-01

Purpose: To compare the surgical outcomes of Photorefractive Keratectomy (PRK), Femtosecond-LASIK (FSL), and Small Incision Lenticule Extraction (SMILE) in patients with myopia and myopic astigmatism.

Study Design: Retrospective chart analysis.

Place and Duration of Study: This study was conducted with a retrospective cohort design in myopia and myopic astigmatism patients from two clinics in Babylon, Iraq between February 2021 and March 2023.

Method: Retrospective analysis of patients with myopia and myopic astigmatism who underwent kerato-refractive surgery were evaluated for pre-operative and post-operative refraction, corneal topography, and contrast sensitivity. Standardized laser protocols were used for surgery, with follow-ups at 30 days, 90 days, and 6 months.

Results: This study included 217 eyes from 109 patients who had PRK, SMILE, and FSL. The patients in FS-LASIK group were older than other groups (p = 0.013), while gendershowed insignificant difference among the three methods (P = 0.480). No statistically significant differences were observed in preoperative visual acuity (P = 0.083), sphere (P = 0.206), cylinder (P = 0.278), or spherical equivalent (P = 0.232) among the groups. After the surgery, all three groups showed significant improvements in best corrected visual acuity, spherical error, cylindrical error, and spherical equivalent (P < 0.001). Keratometry values and central corneal thickness significantly decreased in all groups (P < 0.001) after the surgery. Contrast sensitivitydeclinedone month after the surgery but improved significantly by 6 months (P < 0.001).

Conclusion: PRK, Femto-LASIK, and SMILE are all effective in managing myopia and myopic astigmatism, with significant improvements in visual acuity, refractive errors, and keratometry values across all groups.

Keywords: Refractive Surgery, Photorefractive Keratectomy, Femtosecond LASIK, Small Incision Lenticule Extraction, Visual Acuity.

Ocular Surface Changes in patients with Type 2 Diabetes Mellitus: Evidence from Palestine

Mohammed A.M Aljarousha — 2025-07-01

Purpose: To determine the ocular surface disease in patients with Type 2 diabetes mellitus (DM) by using translated and validated Arabic version of Ocular Surface Disease Index (Arab-OSDI) and the clinical measurements.

Study Design: Cross-sectional study.
Methods: A total of 30 patients with Type 2DM and 30 non-diabetic controls were included in this study. All participants, who were non-contact lens users, completed the Arab-OSDI questionnaire and underwent clinical evaluations including tear break-up time (BUT), meibomian gland assessments, tear meniscus height (TMH), Marx line (ML), Schirmer II tear test, fluorescein corneal staining (F/S), and lissamine green conjunctival staining (LGS) were recruited. Dry eye (DE) was diagnosed when Arab-OSDI scores were ≥13 and BUT was <5 seconds.

Results: The DM and non-DM groups demonstrated notable differences in the outcomes of Arab-OSDI (p = 0.017) and the evaluations of meibomian gland (p = 0.022). Within the DM group, individuals with dry eye showed significantly elevated Arab-OSDI results compared to those without dry eye (p = 0.014), whereas the other clinical parameters showed no statistically significant differences.

Conclusion: Individuals with Type-2 DM may experience damage to the lacrimal functional unit, leading to tear deficiency or evaporative DE. This altered tear composition may increase DE symptoms, as reflected in elevated Arab-OSDI scores.

Keywords: Ocular surface disease, Diabetes Mellitus, Ocular surface disease index.

Anatomical and Visual Outcomes of Pars Plana Vitrectomy with Versus Without Internal Limiting Membrane Peeling in Rhegmatogenous Retinal Detachment Associated With Macular Hole

Hafiz Ateeq Ur Rehman — 2025-07-01

Purpose: To evaluate the anatomical and visual outcomes of Parsplana vitrectomy (PPV) with and without internal limiting membrane (ILM) peeling in rhegmatogenous retinal detachment (RRD) associated with macular hole (MH).

Study Design: Interventional case series.

Place and Duration of Study: Lahore General Hospital from 1^st September 2023 to August 2024.

Methods: Eighteen patients with rhegmatogenous retinal detachment (RRD) associated with macular hole (MH) were enrolled in the study. All patients underwent a comprehensive ocular examination, including macular optical coherence tomography (OCT). Twelve patients had a macular hole size of less than 400 µm, while six had a size greater than 400 µm. Group I included nine patients who underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, whereas Group II consisted of nine patients who underwent PPV without ILM peeling.Normality assumption was checked using Shapiro-wilk test and independent t-test test was done for comparison of visual acuity between the two groups.

Results: Out of 18 patients, 10 were males (55.6%). Mean age was 55±7.1 years (range 44-60 years). In Group-I, 90% had closure of MH regardless of size while in Group-II, 40% had MH closure. Change in visual acuity was -1.0733 ± 0.26476 in Group 1 and -0.9244 ± 0.44427 in Group II (0.401).

Conclusion: Peeling of ILMas an adjunct to the PPV for surgical repair of macular hole associated with Rhegmatogenous-retinal-detachment has shown promising results in anatomical outcomes (90% closure rate compared to 40%) without a significant impact on visual acuity.

Keywords: Rhegmatogenous retinal detachment, Macular Hole, Pars Plana Vitrectomy, Internal Limiting Membrane.

Radiological Findings in Chest CT Scan forPatients with Ocular T.B.

Mohammed Suhail Najm Al-Salam — 2025-07-01

Purpose: To identifyradiological findings on chest CT scan for patients with ocular tuberculosis (TB) that may provide an important aiding diagnostic tool in diagnosing those patients.

Study Design: Descriptive observational study.

Place and duration of study:Ibn Al-Haitham Eye Teaching Hospital fromOctober 2022 to September 2024.

Methods:

This study included 32 patients with tuberculosisassociated uveitis. Patients were classified into four subtypes of uveitis based on clinical examination and anatomical location ofinflammation into anterior, intermediate, posterior and panuveitis. Each patient underwent a high-resolution chest CT scan to assess for radiological signs commonly associated with pulmonary tuberculosis. Patients with known causes of pulmonary diseases or surgeries other than tuberculosis were excluded from the study.

Results:

Out of 32 patients, 24 were males (75%) and 8 were females (25%), with mean age of 50.56±14.04 years. Chest CT indicated that 66.7% of male and 37.5% of female exhibited abnormal findings suggestive of pulmonary TB. Twenty-two patients had chronic panuveitis, 7 had intermediate uveitis, and 3 had anterior granulomatous uveitis. Chronic Tuberculous panuveitis demonstrated the highest frequency of positive pulmonary findings on CT (63.6%), followed by tubercular intermediate uveitis cases (42.9%). Conversely, no positive pulmonary findings were identified among patients with chronic granulomatous tubercular anterior uveitis.

Conclusion:

Chest CT scan should be considered in the work up for patients with suspected tuberculous uveitis. Chronic TB panuveitis and tubercular intermediate uveitis showed a higher frequency of abnormal chest CT findings, particularly fibrotic lung scarring and nodules.

Keywords:Tuberculosis, Ocular tuberculosis, Panuveitis, Pulmonary Fibrosis.

Correlation of Intraocular Pressure with Intracranial Pressure in Patients undergoing lumbar puncture

Rashida Riaz — 2025-07-01

Purpose: To determine the correlation of Intraocular Pressure with Intracranial pressure in patients with neurological diseases.

Study Design: Descriptive correlational study.

Methods: This study was conducted in neurology department of Mayo Hospital, Lahore from 13^th August 2021 to 10^th November 2021, after receiving approval from ERB. Patients who never had any kind of intracranial surgery or spinal disease but endured lumber puncture because of different neurological symptoms were recruited by purposive sampling. Patients with glaucomatous nerve damage or any other disease affecting IOP, immune compromised and uncooperative patients were excluded. Intraocular pressure (IOP) of patients with raised Intracranial pressure (ICP), was measured using Applanation Tonometer. Data was entered in SPSS-23. Correlation analysis was evaluated by Pearson, while the p value <0.05 was considered significant.

Results: Thirty patients (n=30) including 46% females and 53% males fulfilled the inclusion criteria. The mean age of individuals was 45 years. The mean IOP of right eyes and left eyes were 14.27 ± 0.832 and 13.97± 0.786, respectively. Whereas the mean ICP was 23.40± 0.923. Intracranial pressure was neither significantly correlated with right eye IOP (p=0.707, r. =0.072), nor with the left eye (p=0.535, r=0.118,). However, a strong correlation was observed between OD-IOP and OS-IOP (r= .949, p= 0.00).

Conclusion: This study found no statistically significant correlation between IOP and ICP in patients with neurological conditions undergoing lumbar puncture. While a strong inter-eye correlation of IOP was noted, IOP measurements did not reliably reflect elevated ICP levels.

Keywords: Intraocular Pressure, Eye,Intracranial pressure, Glaucoma, Lumbar puncture.

Clinical Impact of Trans-Photorefractive Keratectomy and Femtosecond Laser In-Situ Keratomileusis in patients with Myopia and Astigmatism

Muhammad Zubair Nazar — 2025-07-01

Background: Refractive surgery aims to treat refractive errors by altering the cornea's shape using excimer laser techniques, thereby reducing stromal thickness to focus light rays on the retina.

Aim: This study aimed to assess and compare Visual Acuity (VA), Contrast Sensitivity (CS), and Higher Order Aberrations (HOA) in myopic and astigmatic patients undergoing different refractive surgeries.

Methods: Conducted at the Amer Eye Hospital Network in Rawalpindi, this study comprised 60 patients (120 eyes). Two groups were examined: 30 Trans-PRK patients (15 myopic, 15 astigmatic) and 30 Femtosecond LASIK patients (15 myopic, 15 astigmatic).

Results: Significant differences (P < 0.05) were found in improving VA in both myopic and astigmatic patients’ post-surgery. Trans-PRK yielded superior results compared to Femtosecond LASIK (P < 0.05) in both cases. Contrast sensitivity decreased significantly (P > 0.05) after both surgeries in myopic and astigmatic patients, with Trans-PRK showing better results. Moreover, both operations increased HOAs significantly (P > 0.05) in myopic patients, with Trans-PRK outperforming Femtosecond LASIK.

Conclusion: While both Trans-PRK and Femtosecond LASIK improved VA, reduced CS, and increased HOAs, Trans-PRK demonstrated superior outcomes over Femtosecond LASIK in this study.

Quality of Life in Pediatric Patients after Cataract Surgery

Rabia Chaudhry — 2025-07-01

Purpose: To assess the quality of life in pediatric patients who have undergone cataract surgery and identify clinical and demographic variables that influence visual recovery and QoL outcomes.

Study Design: Descriptive observational.

Place and Duration of Study: Jinnah Postgraduate Medical Center, Karachi. From March 2021 to March 2023 Methods: A total of 230 pediatric patients who had undergone cataract surgery between the ages of 6 months and 12 years were enrolled from a tertiary eye care center. To evaluate the impact of surgery on children’s quality of life, two validated instruments were used. The Pediatric Quality of Life Inventory (PedsQL) was employed to assess general health-related quality of life across physical, emotional, social, and school-related domains.

Results: The mean post-operative best-corrected visual acuity (BCVA) improved from 1.20 ± 0.34 to 0.48 ± 0.29 logMAR (p < 0.001). Over 68% of children achieved a BCVA of 0.5 logMAR or better. The mean total PedsQL score was 74.6 ± 12.5, with highest scores in physical functioning (81.2 ± 10.3). Children who underwent bilateral surgery, intraocular lens (IOL) implantation, and good compliance to amblyopia therapy reported higher QoL scores. Significant correlations were found between better visual outcomes and improved QoL (r = -0.61, p < 0.001).

Conclusion: Cataract surgery significantly improves both visual function and quality of life in children, especially when performed early and supported by proper rehabilitation. Clinical success should be evaluated not only by visual acuity but also through QoL outcomes.

Keywords: Pediatric cataract, Visual acuity,Quality of Life, Amblyopia

Frequency of Myopia and its Associated Risk Factors among Madrassa Students in Pakistan

Saleem Khan — 2025-07-01

Purpose: To determine frequency of myopia and its associated risk factors among madrassa students in Pakistan.

Study Design: Descriptive observational.

Place and Duration of Study: The study was conducted at the Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar, from January 2023 to June 2023.

Methods: Using the two-stage sampling technique, this cross-sectional studywas conducted on 1750 students aged 6–18 years. In stage 1, by the probability proportionate to size method, 43 strata were identified. In the second stage, 44 students from each stratum were identified by a simple random sampling method. A detailed eye examination was performed by trained optometrists. Logistic regression was applied to investigate the association of myopia with outdoor activity, the distance between eyes and books, sleep duration, use of electronic gadgets, and study hours.

Results: A total of 1750 madrassa students, including 1256 (71.8%) male, were examined. Vision impairment (6/18 > VA < 6/60) was present in 14.2%. Myopia was the most common refractive error, contributing to 11.1%. The prevalence of myopia was high in female (12.8%) but not statistically significant (p = 0.096). Myopia increases with increasing age (p<0.01). The distance between eyes and book (OR=.354; 95%CI.216 to.579), sleep duration (OR=1.957; 95%CI 1.349 to 2.839), continuous use of electronic gadgets (OR=.492; 95%CI.379 to.638), and study hours in the madrassa (OR=.404; 95% CI.290 to.563) were significantly associated with myopia.

Conclusion: Myopia is the most common refractive error in Madrassa students. Near working distance, sleep duration, continuous use of electronic gadgets, and study duration were the risk factors for myopia.

Keywords: Myopia, Refractive error, Blindness, Cycloplegia, Refraction.

Outcome of Pars Plana Vitrectomy for Dropped Nucleus, Nucleus Fragment, and Intraocular Lens: A Hospital – Based Study

Sahira Wasim — 2025-07-01

Purpose: To evaluate the visual outcomes and complications of pars plana vitrectomy performed for dropped nucleus, nuclear fragments, and dislocated intraocular lenses.

Study Design: Interventional case series.

Place and Duration of Study: Layton Rahmatulla Benevolent Trust Hospital, Karachifrom January 2024 to December 2024.

Methods: A total of 50 patients of either gender, categorized into three age groups (<50 years, 50–70 years, and >70 years), were included in the study based on predefined inclusion and exclusion criteria. Frequencies and percentages were calculated for qualitative variables. The Wilcoxon signed-rank test, a non-parametric method, was used to compare paired groups. The chi-square test was employed to assess associations between categorical variables. A p-value of ≤0.05 was considered statistically significant for all analyses.

Results: The mean age of the patients was 57.20±16.27 years. The best-corrected visual acuity before and after the PPV was 1.06±0.71 (range 0.30-3.00) and 0.57±0.37 (range 0.30-2.00), respectively. The difference in best-corrected visual acuity before and after the procedure was significant (p<0.001).The results also showed that there is no significant association of post-procedure complications with age group (p=0.688), gender (p=1.000), eye laterality (p=0.324), surgical technique (p=0.999), drop of nuclear fragment, nucleus, and IOL (p=0.310), location of IOL placement (p=0.359), the timing of pars plana vitrectomy (p=0.783), nucleus removal method (p=0.977).

Conclusion: Pars plana vitrectomy significantly improves visual outcomes in patients with dropped nucleus, nuclear fragments, or dislocated intraocular lenses, with no significant association between post-procedure complications and demographic or surgical variables.

Keywords: Pars-Plana vitrectomy, Nucleus, Intraocular lens, Cataract.

Real-World Indications for Intravitreal Anti-VEGF Injections in Tertiary Eye Care Hospitals: A Multi-Center Study

Sidrah Riaz — 2025-07-01

Purpose: To evaluate the spectrum of ocular conditions requiring intravitreal anti-VEGF therapy in a hospital-based setting.

Study Design: Retrospective study.

Place and Duration: Places of study were Akhtar Saeed Medical and dental college, Lahore and Lahore Medicare Eyecenter from July 2023 to December 2023.

Methods: Medical records of patients who had intravitreal anti-VEGF injections were retrieved.Patients less than 50 years of age, patients who had retinopathy of prematurity, known case of cancer or malignant disease and any other ocular disease were excluded.Name, gender, type and indication for intravitreal injection were noted for each patient.

Results: Out of 547 patients 53.2% were females. One eye of each patient was included in the study. The most used anti VEGF was Aflibercept (46.4%), followed by Ranibizumab (30.9%) and Bevacizumab (22.7%). No major difference was observed among gender distribution regarding threeanti VEGF used. The most common indication was diabetic macular edema 146 (26.69%) eyes, followed by wet Age-related macular degeneration, 118 (21.40%) eyes and vitreous hemorrhage due to retinal vascular diseases, 118 (21.60%) eyes. Other indications were proliferative diabetic retinopathy (19.74%), Central retinal vein occlusion (5.48%) and branch retinal vein occlusion (1.28%). Three minor indications were central serous chorioretinopathy (1.09%), macular telangiectasia (0.36%) and posterior uveitis (0.36%).

Conclusion: Intravitreal anti-VEGF therapy was most indicated for diabetic macular edema, wet age-related macular degeneration, and retinal vascular complications, with Aflibercept being the most frequently used agent in this hospital-based cohort.

Keyword: Anti-Vascular Endothelial Growth Factor, Bevacizumab, Aflibercept, Ranibizumab, Choroidal Neovascularization, Age Related Macular Degeneration.

Safeguarding Scientific Legacy — The Imperative of Preserving Scientific Data by Pakistan Journal of Ophthalmology and Ophthalmological Society of Pakistan

Prof. Tayyaba Gul Malik — 2025-07-01

Science is not a momentary endeavor, but a grand edifice built upon the foundations laid by the pioneers. Every invention rests on prior work, case studies, clinical trials, and published research. Without access to historical data and peer-reviewed literature, researchers face unnecessary redundancy and inefficiencies. In clinical science, it is not just the historical context that matters, but the data itself is extremely valuable, which is painstakingly collected over years of research. Every detail, no matter how small, contributes to reproducibility, which becomes impossible if data and methodologies are lost to time or technical failure.

Secondary Sjögren’s Syndrome in Sero-Positive Rheumatoid Arthritis

Nauman Ismat Butt — 2025-07-01

We report a case of secondary Sjogren syndrome in a 46-year-old woman with a 4-month history of bilateral symmetrical joint pains, morning stiffness, dry mouth, dry eyes, fatigue, and lethargy. Examination revealed pallor, dry eyes, dry tongue and synovitis in multiple joints. Investigations showed iron deficiency anemia, positive rheumatoid factor, ANA, anti-CCP antibodies, anti-SSA/Ro and anti-SSB/La antibodies. The patient was diagnosed with Sero-positive rheumatoid arthritis complicated by secondary Sjögren's syndrome. She was started on Methotrexate, Hydroxychloroquine, oral Steroids and dietary supplements. At 8-week follow-up, her joint pains improved, steroids had been discontinued, and she was tolerating medications without adverse effects.

Keywords: Sjögren’s Syndrome, Rheumatoid Arthritis, Anti-CCP antibodies, anti-SSA/Ro and anti-SSB/La antibodies, Methotrexate, Hydroxychloroquine