Pakistan Journal of Ophthalmology

Comparison between RETevalTM Hand-Held Flash VEP and Standard Pattern-Reversal VEP in Diagnosing Optic Nerve Diseases

2025-12-22T12:27:35+00:00

Purpose: To evaluate the clinical applicability of a portable, hand-held flash visual evoked potential (VEP) device in patients with optic nerve disorders.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: This study was conducted at Sardjito General Hospital, from May 2021 to May 2022.

Methods: VEP latencies were compared between two groups of patients diagnosed with optic nerve disorders. Group 1 were evaluated using the RETeval™ hand-held flash VEP device, employing the International Society for Clinical Electrophysiology of Vision (ISCEV) standard flash VEP protocol at 3 cd·s/m². Participants in Group 2 underwent assessment using conventional pattern-reversal VEP (PRVEP). The mean latency was compared between the two groups.

Results: A total of 24 eyes from 19 patients were included. In Group 1, the mean age was 40.9 ± 15.6 years and in Group 2, it was 34.3 ± 9.9 years. The mean best-corrected visual acuity in both groups was 0.9 LogMAR Group 1, mean flash VEP latency was 132.5 ± 27.6 ms. In Group 2, the mean PRVEP latency was 125.0 ± 34.2ms, also indicating delayed conduction. No statistically significant difference was observed between the mean VEP latencies of the two groups (p = 0.559).

Conclusion: The comparison between the RETeval™ hand-held flash VEP and PRVEP revealed no significant difference in VEP latencies. RETeval™ hand-held flash VEP may have potential clinical utility as a practical tool for the assessment and diagnosis of optic nerve disorders, particularly in settings where conventional VEP testing is not readily available.

Effectiveness of Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) Using the Longer Duration Protocol in Lowering IOP in Patients with Glaucoma

2026-02-22T18:14:49+00:00

Purpose: To evaluate the short-term effectiveness and associated predictors of intraocular pressure (IOP) reduction following micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with glaucoma.

Study Design: Prospective observational study.

Place and Duration of Study: Conducted at Liaquat National Hospital, Karachi, from July 12, 2024, to January 13, 2025.

Methods: Patients with uncontrolled glaucoma undergoing MP-TSCPC were enrolled. IOP was measured at baseline, 1 month, and 3 months post-procedure. Treatment effectiveness was defined as a ≥20% reduction in IOP without need for further surgical intervention. Friedman test and Wilcoxon signed-rank tests assessed changes over time. Categorical associations were examined using chi-square test, and predictors of effectiveness were analyzed via univariate and multivariable logistic regression.

Results: A total of 97 eyes were analyzed. Median baseline IOP was 20 mmHg (IQR: 17–31), which significantly reduced to 16 mmHg (IQR: 14–22) at 1 month and 14 mmHg (IQR: 11–17) at 3 months (p < 0.001). Treatment was effective in 76 eyes (78.4%). Male gender (p < 0.001), longer glaucoma duration (p = 0.03), and moderate severity (p = 0.038) were significantly associated with effectiveness. In multivariable regression, only male gender remained an independent predictor (aOR = 10.59, 95% CI: 2.11–53.21, p = 0.004).

Conclusion: MP-TSCPC significantly lowered IOP at 1 and 3 months. Approximately four-fifths of patients achieved effective outcomes, with male gender being a strong predictor of success. The procedure appears safe and beneficial for short-term glaucoma control.

Quadrant-Wise Assessment of Macular Thickness in Diabetics Without Diabetic Retinopathy and Non-Diabetic Patients Using Spectral Domain Optical Coherence Tomography

2026-01-21T12:51:32+00:00

Purpose: To measure retinal thickness across superior, inferior, nasal and temporal quadrants in diabetic patientswithout diabetic retinopathy and non-diabetic patients using spectral Domain Optical Coherence Tomography(SD-OCT).

Study Design: It is aCross-sectional observational Study.

Place and Duration of Study: Gujranwala teaching hospital, Gujranwala from October 2024 to February 2025.

Methods: The study included 60 participants: 30 patients with previously diagnosed type 2 diabetes mellitus without diabetic retinopathy, and 30 non-diabetic individuals. Participants of both genders and aged 30–70 years, were recruited. All participants underwent a comprehensive ophthalmic evaluation, including best-corrected visual acuity, slit-lamp biomicroscopy for anterior and posterior segment examination to identify features of diabetic retinopathy or other ocular pathologies, and SD-OCT (OptovueiVue 3000, Medmont) for quantitative assessment of retinal thickness in all four quadrants. Statistical analysis was performed using SPSS version 26.

Results: There were 28 (46.6%) males. The mean retinal thickness was 297 ± 18 µm in diabetics and 308 ± 15 µm in non-diabetics, while the mean foveal thickness measured by SD-OCT was 244 ± 14 µm and 237 ± 9 µm, respectively. Quadrant-wise analysis revealed that temporal retinal thickness was significantly reduced compared to the superior, inferior, and nasal quadrants in both diabetics without diabetic retinopathy and non-diabetic participants.

Conclusion: There was significant thinning across all four retinal quadrants, most marked in temporal quadrant in type 2 diabetic patients without diabetic retinopathy. These findings suggest that neurodegenerative changes in the retina may precede visible vascular changes.

Appraisal of Eye-Care Professionals’ Knowledge, Practices, and Barriers Regarding Progressive Addition Lenses: A Cross-Sectional Survey

2026-02-02T10:57:58+00:00

Purpose: To determine how eye-care professionals (ECPs)view, prescribe, and handle progressive addition lenses (PALs), paying special attention to their clinical confidence, knowledge, practical difficulties, and need for ongoing education.

Study Design: Cross-sectional survey.

Place and Duration of Study:Department of Optometry,College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabiafrom January 2025 to July 2025.

Methods: There were 212 registered ophthalmologists and optometrists who participated in the survey. While responses were summarized using descriptive analyses, relationships between knowledge, prescribing behavior, confidence, and training engagement were investigated using chi-square (χ²) testing, ordinal logistic regression, and k-means cluster analysis.

Results: Only 52.8% of respondents consistently measured all necessary biometric parameters during dispensing, even though 75% of respondents rated their knowledge of PALs as good or excellent. Longer clinical experience (≥15 years), increased participation in continuing education (≥10 hours annually), and access to digital centration technologies were all independently linked to higher prescribing confidence (52.8%). The most often mentioned barriers to PAL use were patient adaptation issues (86.8%) and lens cost (72.6%). Three different practitioner profiles were identified by cluster analysis: Occasional Prescribers (27.4%), Practical Generalists (43.4%), and Progressive Advocates (29.2%).

Conclusion: Although attitudes toward PALs are generally positive, there are still significant gaps between routine clinical implementation and perceived knowledge, especially when it comes to personalized fitting and biometric assessment. Increased access to digital dispensing tools and targeted continuing education could help convert current knowledge into more reliable prescribing procedures and better patient outcomes.

Evaluation of the Quality of YouTube Videos in Gonioscopy-Assisted Transluminal Trabeculotomy Surgery

2025-12-12T18:40:38+00:00

Purpose: To evaluate the educational quality and usefulness of YouTube videos as a resource in gonioscopy-assisted transluminal trabeculotomy (GATT) surgery.

Study Design: Descriptive observational.

Place and Duration of Study: Department of Ophthalmology, Izmir City Hospital, Turkey. The videos available until 26 June 2025 were included.

Methods: The first 50 YouTube videos found using the search term ‘gonioscopy-assisted transluminal trabeculotomy were included for the study. The steps of GATT surgery were scored (range:1–12) and standardised according to the literature. The videos were analysed using the Quality Criteria for Consumer Health Information (DISCERN) score(range:16–75), the Global Quality(GQ) score(range:0–5),and the Journal of the American Medical Association(JAMA) score (range:0–4).

Results: The mean number of views(1910.6±3221.5),likes(21.7±29.4),dislikes(0.2±0.7), comments (1.5±2.1), video duration(278.5±233.1 seconds), time since upload(45.3±38.6 months), view rate(2.2±3.7),likes rate (98.7±4.5), video power index(2.2±3.7),and interaction index(0.00025±0.00026)were calculated. The mean surgical quality score of the videos was 8.9±2.2,the DISCERN score was 35.8±9.2 (poor quality), the GQ score was1.4±0.7(insufficient quality),and the JAMA score was 1.8±0.8 (moderate quality).

Conclusion: Most of the videos examined in this study relate to surgical techniques and were produced by doctors. Although the surgical score of the videos related to surgical technique was found to be high, their quality as a resource was low according to the video quality scoring criteria used worldwide.

Cosmetic Results of Tear Trough Incision in External Dacryocystorhinostomy

2025-08-07T17:14:41+00:00

Purpose: To determine the cosmetic results of tear trough incision in patients undergoing external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction.

Study Design: Quasi experimental study.

Place and Duration of Study:Isra Postgraduate institute of Ophthalmology from May 2023 to November 2023.

Methods: This study included patients who underwent external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction (PANDO). The patientswere followed up for 4 months and scar scoring was done in the same room and light at100 cm from the patient. Grade 1 was labelled as invisible scar, Grade 2 when scar was minimally visible, Grade 3 when scar was moderately visible, and Grade 4 when scar was highly visible.

Results: A total of 50 surgeries were performed. An incision was given 5 mm medial and 1 mm above medical canthus and extended in the tear trough for 12 mm in a curved manner. Blunt dissection was conducted in horizontal plane to reach the periosteum; rest of the procedure was same as conventional DCR. Skin was closed in layers, orbicularis muscle with 6.0 vicryl suture and skin with 5.0 prolene suture. At first month follow up, ophthalmologist reported invisible scars (grade 1) in 35 out of 50 patients (70%),in the 2nd month follow up 40 out of 50 patients had invisible scar (80%). At final follow up invisible scars were observed in 89.1%(n=41) patients (p>0.05).

Conclusion: Tear trough incision produces good cosmetic results as the scar is hidden in tear trough area.

Comparison of Outcomes between Scleral Fixated Versus Anterior Chamber Intraocular Lens Implantation in Aphakic Patients

2026-01-26T14:32:41+00:00

Purpose: To compare the visual outcomes and early postoperative complications of Scleral fixated intra-ocular lens (SFIOL) implantation versus anterior chamber intra-ocular lens (ACIOL) in aphakic patients.

Study Design: Quasi-experimental study.

Place and Duration of Study: Al Shifa Trust Eye Hospital, Kohat, from February to July 2025.

Methods: This study included 59 aphakic patients, aged 18-70 years. Patients with pre-existing retinal disorders such as macular degeneration or retinal detachment, those with severe corneal opacities or glaucoma, individuals with uncontrolled systemic illnesses (such as poorly managed diabetes or hypertension), and anyone with a recent history (within the last six months) of ocular trauma or infection were excluded. The study patients were recruited and divided into either the SFIOL or ACIOL groups through convenient sampling. Complete ocular examination included Best-corrected visual acuity (BCVA converted to LogMAR), intraocular pressure, slit lamp examination, fundoscopy and post-operative complications. Data was analysed using SPSS-27. The Mann-Whitney U test and chi-square or Fisher's exact test, (considering p ≤ 0.05 as statistically significant), were applied.

Results: The median age was 62 years (IQR: 54–70), and 66.1% were male. Postoperative BCVA improved in both groups, with no statistically significant difference (p = 0.086). ACIOL was associated with higher rates of Hyphema (p = 0.011) and vitreous incarceration (p = 0.024). Severe uveitis, IOL capture, and retinal detachment showed no significant intergroup differences.

Conclusion: Both SFIOL and ACIOL are effective in restoring vision in aphakic patients. However, ACIOLs are related to a higher rate of early postoperative complications.

Surgical Outcomes of Congenital Upper Eyelid Coloboma at Tertiary Care Hospital

2026-03-28T06:53:40+00:00

Purpose: To observe surgical outcomes of patients with congenital upper eyelid coloboma.

Study Design: Retrospective case series.

Place and Duration of Study: Armed Forces Institute Of Ophthalmology, Rawalpindi April 2023 to July 2023.

Methods: A total of 06 patients who underwent surgical closure of congenital upper eyelid coloboma (CEC) were included. The data was collected from the record room of Armed Forces Institute of Ophthalmology. A Tenzel semicircular flap technique was performed to close the defects. Data analysis was done with SPSS version 22.0.

Results: Out of six patients with upper eyelid coloboma, five (83.3%) were males and one (16.7%) was female. The mean age was 20.3 ± 5.2 months. Direct closure with cantholysis was performed in the right eye of two (33.3%) patients, while four (66.7%) patients underwent repair of the left eye using a Tenzel semicircular flap. Successful outcomes were achieved in five (83.3%) patients. One patient (16.7%) required redo surgery due to wound dehiscence, which occurred because of increased skin tension during childhood growth.

Conclusion: Surgical repair of congenital upper eyelid coloboma using direct closure with cantholysis for smaller defects and the Tenzel semicircular flap for larger defects provides favorable functional and cosmetic outcomes. In this series, the majority of patients achieved successful eyelid reconstruction, with only one case requiring redo surgery due to wound dehiscence. These findings suggest that appropriate selection of surgical technique based on defect size is effective for the management of congenital upper eyelid coloboma.

Human Papillomavirus-11 as a Risk Factor for Ocular Surface Squamous Neoplasia

2026-01-29T12:27:46+00:00

Purpose:To evaluate the association between human papillomavirus type 11 (HPV-11) infection and ocular surface squamous neoplasia (OSSN).
Study Design:Analytical observational study with a case-control design.
Place and Duration of Study:Ngoerah Hospital, Bali, Indonesia, from March 2020 to March 2024.
Methods:In this study, the case group comprised 25 Histopathologically confirmed OSSN samples, while the control group consisted of 25 conjunctival autograft tissues obtained from pterygium surgeries. HPV-11 DNA detection was performed using real-time polymerase chain reaction. Descriptive statistics were used to summarize demographic and clinical characteristics. The association between HPV-11 infection and OSSN was assessed using bivariate analysis to calculate odds ratios with 95% confidence intervals. Multivariate logistic regression analysis was performed to adjust for potential confounding factors. Statistical significance was set at p < 0.05.
Results:The mean age of patients was 52.28 years in the OSSN group and 51.0 years in the control group, with males comprising 60% of the OSSN cases. HPV-11 DNA was detected in 14 OSSN samples (56%) compared with one control sample (4%). Bivariate analysis showed a strong association between HPV-11 infection and OSSN (OR = 27.00; 95% CI: 24.84–29.15). Multivariate analysis identified HPV-11 infection (adjusted OR = 17.79; 95% CI: 1.88–167.68) and outdoor occupation (adjusted OR = 7.36; 95% CI: 1.46–37.00) as significant risk factors.
Conclusion:HPV-11 infection is significantly associated with OSSN and may contribute to its pathogenesis, particularly in individuals with increased ultraviolet exposure.

Effect of Laser-Assisted in Situ Keratomileusis versus Trans Photo Refractive Keratectomy on Corneal Endothelial Cell Count

2026-02-25T21:17:56+00:00

Purpose: To compare the effect of Laser-Assisted in Situ Keratomileusis (LASIK) and Trans Photo Refractive Keratectomy Trans-PRK on Corneal Endothelial Cell Count.

Study Design: Quasi experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from January 2023 to December 2024.

Methods: A total of 150 eyes from 150 patients were divided into two groups; LASIK and Trans-PRK groups with 75 eyes each. Age range was 20-40 years with moderate refractive errors and with no previous disease or surgical history. The study excluded patients who had Fuchs' dystrophy, keratoconus, pregnancy, diabetes, glaucoma, past ocular surgery, trauma or any other corneal and ocular pathology. Endothelial cells count (ECC) was assessed at baseline and at 12 months postoperatively.

Results: The ECC in the LASIK group decreased from 2984 ± 52 cells/mm² preoperatively to 2935 ± 62 cells/mm² at 12 months (p < 0.001). In the Trans-PRK group, ECC decreased from 3011 ± 39 cells/mm² preoperatively to 2960 ± 51 cells/mm² at 12 months (p < 0.001).The mean change in endothelial cell count was -49 cells/mm2 in the LASIK group and -51 cells/mm2 in the Trans-PRK group at 12 months. There was no statistically significant difference in cell count (p = 0.86) at 12 months between the two groups.

Conclusion: Both LASIK and Trans-PRK showed a statistically significant reduction in endothelial cell count within groups at 12 months. However, no significant difference was observed between the two procedures, indicating comparable effects on endothelial cell count.

Effect of Different Soft Contact Lenses Tear Film Stability in Myopes

2025-09-20T08:23:39+00:00

Purpose: To assess the influence of soft contact lens wear on tear film stability in myopes.

Study Design: Quasi experimental study.

Place and Duration of Study: Social Security Hospital, Multan Road, Lahore, from February 2025 to May 2025.

Methods: Myopic participants with no prior experience of wearing contact lenses were chosen and were divided into two equal groups based on the type of lens: soft hydrogel; and silicone hydrogel. Patients with dry eyes, refractive errors other than myopia, or using systemic medications were excluded from the study. Tear film stability was evaluated with Tear Break-Up Time (TBUT), conducted before and after one month of lens wear. Data analysis was performed using SPSS, Version 27. A p-value < 0.05 was considered statistically significant.

Results: The study enrolled 90 myopic patients. For TBUT, soft hydrogel lenses showed a minor but significant reduction from 11.99s to 11.88s (Mean difference = -0.11s, p < 0.050), while silicone hydrogel lenses exhibited a significant improvement from 11.71s to 13.28s (Mean difference = +1.57s, p < 0.001). Independent t-test revealed that silicone hydrogel lenses had significantly greater positive changes in TBUT compared to soft hydrogels, indicating improved tear film stability after one month of lens wear.

Conclusion: This study shows that wearing soft contact lenses impacts tear film stability in myopic patients, however a positive or negative response depends on type of lens material worn.

Outcomes of Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment in a Tertiary Care Hospital of Peshawar

2026-03-17T12:26:30+00:00

Purpose: To determine the visual outcomes of Pars Plana Vitrectomy (PPV) in eyes with diabetic tractional retinal detachment (TRD) in a tertiary care center of Peshawar.

Study Design: Interventional case series.

Place and Duration of Study: Department of Ophthalmology, Hayatabad Medical Complex (HMC), Peshawar for 06 months duration.

Methods: Total of 39 patients diagnosed with TRD secondary to Proliferative Diabetic Retinopathy(PDR)were enrolled. All patients underwent standard 23-gauge vitrectomy. Snellen chart was used to evaluate the preoperative and postoperative Best-Corrected Visual Acuity (BCVA).

Results: The average age of patients was 55.2 ± 8.4 years, with all cases having type II diabetes and a mean disease duration of 11.2 ± 3.8 years. Preoperatively, only 3% patients had BCVA of 6/24 or better, whereas postoperatively, 39% achieved this visual acuity. A significant visual improvement was observed in 72% of patients, with 10% reaching 6/18 and 3% achieving 6/12. On log-MAR scale, the visual acuity improved from 1.33±0.38 before vitrectomy to 0.97±0.41 after Vitrectomy (p < 0.0001).

Conclusion: In this prospective case series, most patients demonstrated meaningful postoperative visual gain, with a substantial increase in the proportion achieving functional vision. The significant improvement in LogMAR visual acuity highlights the role of timely PPV in eyes with TRD secondary to proliferative diabetic retinopathy, even in patients with long-standing type II diabetes.

B-Scan Evaluation of Medial and Lateral Rectus Muscle Thickness in Horizontal Strabismus

2025-09-10T20:42:35+00:00

Purpose: To evaluate the Medial and Lateral Rectus Muscle Thickness in Horizontal Strabismus.

Study Design: Descriptive observational study.

Place and Duration of Study: University of Lahore hospital, Lahore from July 2025 to October 2025.

Methods: Sixty patients, above 5 years of age with horizontal strabismus were included. Patients with orbital pathology, orbital trauma, previous surgery of extraocular muscles and Thyroid eye disease were excluded. After complete history and examination, B-scan was done to evaluate medial and lateral rectus muscles. IBM SPSS version 26 was used for data analysis.

Results: There were 22 males and 38 females. The mean age was 12.5±1.8 years. Twenty-nine patients had esotropia and 31 had exotropia. Medial rectus muscle was significantly thicker in eyes with esotropia compared to those with exotropia (Mean of 3.82 ± 0.30mm vs. 2.92 ± 0.46 mm; p < 0.001). In contrast, the lateral rectus muscle was significantly thinner in esotropic eyes than in exotropic eyes (2.99 ± 0.36 mm vs. 3.85 ± 0.35 mm; p < 0.001). These findings demonstrate a clear and statistically robust pattern of rectus muscle asymmetry between the two forms of horizontal strabismus.

Conclusion: B-scan ultrasonography showed that esotropia was associated with a significant increase in medial rectus thickness, whereas exotropia was associated with increase in lateral rectus thickness. Knowledge of muscle thickness can assist surgeons in tailoring the amount of recession or resection. Thicker or hypertrophied muscles may respond differently to standard surgical resection or recessions.

Economic Evaluation in Eye Care: The Missing Link in Pakistan’s Ophthalmic Strategy

2026-03-29T12:03:38+00:00

Evidence-based medicine (EBM) is now the standard of care; however, it does not adequately address costs or the impact of interventions on patients’ quality of life. To bridge this gap, value-based medicine (VBM) has emerged as a complementary approach that integrates patient-centered outcomes with economic considerations. Within this framework, health economics provides a systematic method to evaluate the cost, efficiency, and overall value of healthcare by linking clinical outcomes with financial implications, quality of life, life expectancy, and return on investment.

Global Research Trends in Dry Eye Diagnosis Tools: A Bibliometric Analysis

2026-01-19T14:10:42+00:00

This study provides a bibliometric analysis of recent publications focused on Dry eye disease (DED) diagnostic tools.A comprehensive literature search was conducted in the Scopus database retrieved 2,625 records (2014–2024). After manual screening, 135 articles were selected. VOS viewer was used to perform co-authorship, country collaboration, and keyword co-occurrence analyses.Among 829 authors, 19 met the threshold of at least three publications. The United States, China, and Germany were leading contributors, with strong international collaboration networks. Keyword analysis from 1,576 keywords, 184 appearing ≥5 times, revealed thematic clusters around traditional diagnostic tests like the Schirmer test, modern imaging techniques like meibography, interferometry, and biochemical assessments like tear osmolarity. Overlay visualization showed a temporal shift toward more advanced and objective diagnostic methods between 2019 and 2024.The findings of the study provide valuable insights into global research trends and can guide future studies and clinical advancements in DED diagnosis.

Global Barriers to Eye Care Access: A Systematic Review and Meta-Analysis of Gender, Geographic, and Economic Disparities

2025-10-24T10:39:36+00:00

Access to eye care remains a major global challenge, particularly in low- and middle-income countries and rural areas, where financial, geographic, and awareness-related barriers contribute to preventable blindness. This systematic review and meta-analysis synthesized 45 studies from 28 countries including 1.2 million adults, following PRISMA 2020 guidelines. The pooled prevalence of financial, geographic, and awareness barriers was 58.7%, 41.2%, and 39.8%, respectively, with women, rural residents, and low-income groups disproportionately affected. Subgroup analyses confirmed significantly higher odds of access barriers in low-resource settings. Cataract and uncorrected refractive errors remained the leading global causes of blindness. Findings highlight the need for equity-focused interventions such as universal health coverage, telemedicine, mobile clinics, and community-based education. Addressing these systemic barriers is essential to achieve Vision 2030 goals and reduce avoidable blindness worldwide.

Leukemic Retinopathy in Accelerated Chronic Myeloid Leukemia: A Rare Case from Indonesia

2025-12-08T12:31:49+00:00

Leukemia retinopathy is an uncommon and severe complication in chronic myeloid leukemia. Proper handling of this complication can save the patient from blindness. A 44-year-old man with accelerated-phase Chronic Myeloid Leukemia (CML) presented with visual blurring and floatersfor the past one month associated with abdominal fullness and low-grade fever. There was splenomegaly, retinal neovascularization and Roth spots. Severe leukocytosis (658.55 × 10⁹/L), positivity for BCR-ABL p210, with additional laboratory findings were suggestive of CML. Hydroxyurea, allopurinol and tyrosine kinase inhibitors were initiated with improvement of hematological parameters but without halting the progression of vision loss. This case illustrates the need for early fundoscopy and OCT to prevent serious irreversible complications, in conjunction with other systemic therapies

Reversible Ocular Manifestations in Systemic Hypertension; Simple Answers to Complex Problems

2025-11-10T06:16:53+00:00

This case series describes five patients with hypertensive retinopathy presenting at Al-Shifa Trust Eye Hospital, Rawalpindi. The cases illustrate the spectrum of ocular involvement secondary to systemic hypertension, ranging from optic disc edema and macular edema to serous retinal detachment. Although the clinical presentations varied, all patients had markedly elevated blood pressure and were promptly referred to for systemic evaluation and management. On follow-up, significant visual improvement was observed following adequate control of systemic hypertension, highlighting the potential reversibility of hypertensive retinopathy with timely and appropriate medical treatment.

Post-Traumatic Corneal Ulcer with Hypopyon and Secondary Anterior Uveitis in an Uncontrolled Diabetic

2025-12-02T06:15:02+00:00

Corneal ulcer is a serious eye condition that can be complicated by secondary anterior uveitis, especially in patients with systemic comorbidities. A 56-year-old female with uncontrolled diabetes mellitus presented with a central corneal ulcer, stromal infiltrates, 360° neovascularization, corneal edema, and hypopyon filling half of the anterior chamber. Microscopy revealed Gram-positive bacilli with polymorphonuclear cells, indicating the presence of Bacillus cereus, though bacterial and fungal cultures were negative. The patient received intensive topical and systemic antimicrobials, but was subjected to hypopyon aspiration, intracameral antimicrobial injection, and amniotic membrane transplantation (AMT) with a bandage contact lens due to persistent hypopyon. Postoperatively, ocular surface stabilization and symptom relief were achieved, but the final visual acuity remained limited to light perception. This case highlights the importance of early suspicion of harmful organisms in post-traumatic keratitis, outlining the role of combined medical and surgical methods, including AMT, in preserving globe integrity.

Angioid Streaks with Choroidal Neovascularization: An Ophthalmic Window to the Diagnosis of Pseudoxanthoma Elasticum

2026-03-07T09:53:36+00:00

The most common systemic association of Angioid streaks is Pseudoxanthoma Elasticum (PXE), which is defined by the progressive mineralization of elastic tissue in the epidermis, eyes, and vascular system. We present the case of a 45-year-old female who presented with findings consistent with Angioid streaks complicated by choroidal neovascularization (CNV) in association with PXE. The patient presented with bilateral asymmetric painless vision loss, with an active CNV in the left eye, and a disciform scar in the right eye. Skin biopsy from neck confirmed PXE as the systemic cause. Intravitreal Ranibizumab was given in the left eye, which resulted in significant anatomical and functional improvement. This case demonstrates the need for systemic examination in Angioid streak patients, as well as the efficacy of anti-VEGF therapy in salvaging vision.