Purpose: To compare target hyperopic refraction with achieved postoperative refractive outcomes in pediatric cataract surgery and to identify factors influencing absolute prediction error. Study Design: longitudinal cohort study. Place and Duration of Study: Mughal Eye Hospital, July 2024 to December 2024. Methods: This study included 26 eyes of children aged 1–6 years undergoing cataract surgery with intraocular lens implantation. Preoperative biometric parameters and target refraction were recorded, and postoperative achieved refraction was measured. Statistical analysis included paired t-test, Pearson correlation, and multiple linear regression to evaluate refractive prediction error (p < 0.05). Results: The mean age of the patients was 3.69 ± 1.81 years. Mean axial length was 22.56 ± 1.78 mm, and mean IOL power was 23.33 ± 5.94 D. The mean achieved postoperative refraction was 4.47 ± 1.46 D compared to target refraction of 3.76 ± 1.11 D, resulting in a mean hyperopic prediction error of +0.71 D (95% CI: 0.55–0.86; p < 0.001). Absolute prediction error was negatively correlated with age (r = −0.987, p = 0.001) and axial length (r = −0.956,p = 0.001), and positively correlated with keratometry (r = 0.986, p = 0.001) and IOL power (r = 0.982, p = 0.001). Conclusion: A consistent hyperopic overshoot relative to target refraction was observed after pediatric cataract surgery. Age and axial length were the most significant contributors to refractive prediction error, highlighting the need for individualized IOL calculations in younger children with shorter axial lengths.

Purpose: To investigate the astigmatism distribution and axis patterns among Iraqi patients and explore its associations with age and gender. Study Design: Cross-sectional observational study. Place and Duration of Study: College of Medicine, University of Fallujah, Iraqfrom January to March 2024. Methods: A total of 112 patients (224 eyes) with astigmatism were included. Data included visual acuity, auto refraction, and astigmatism axis. Astigmatism was classified by magnitude and axis orientation. Statistical analysis was done using Chi-square test and Pearson's correlation test was used to assess association with age and gender. Results: Mild astigmatism was the most common (87.5%), followed by moderate (8.5%) and severe astigmatism(4%). With-the-rule (WTR) astigmatism was the predominant axis pattern (54.9%), with against-the-rule (ATR) and oblique astigmatism accounting for 39.3% and 5.8%, respectively. WTR astigmatism occurred more frequently in younger individuals, whereas ATR predominated in older patients (p < 0.001). There was no significant association between axis type and gender (p = 0.992). Visual acuity improved in most cases after refractive correction,with 87.9% achieving normal vision. Conclusion: WTR astigmatism is more common in younger individuals, whereas ATR astigmatism becomes more prevalent with age. These findings highlight age-related changes in astigmatism patterns and provide valuable local data to guide refractive correction in Iraq.

Purpose: To report the outcomes of intralesional bleomycin injections for orbital venous malformations (OVMs) in a tertiary care setting. Study Design: Interventional case series. Place and Duration of Study: Jinnah postgraduate medical Centre Karachi from January 2020to April 2022. Methods: This case included 24 consecutive cases presenting with orbital vascular malformations, including orbital capillary hemangiomas, lymphangiomas, and orbital varices. The location, dimensions, extent of involvement, signal characteristics, and enhancement pattern following contrast administration of the lesion were determined. Intralesional bleomycin injections were given at a dose of 0.5 mg/kg body weight diluted in lidocaine. Retreatment if needed was done at an interval of 4 weeks. Follow up included measurement of proptosis and radiological measurements of tumor volume. Results: Proptosis and lid swelling were the most common presentations. An average of 2.27±1.3 injections of bleomycin were given. The mean pretreatment volume was 3.61±1.14 cm3and the post-treatment volume was1.41±1.06 cm3 with a mean reduction in tumor volume of 2.20±1.13 cm3 (t=9.52, p<0.001). There was marked improvement in clinical symptoms and the proptosis reduction averaged 7.22±2.80 mm (t= 10.95, p<0.001). Side effects included conjunctival swelling, skin hyperpigmentation around the lesion, and madarosis. Conclusion: Intralesional bleomycin injection proved to be an effective and minimally invasive treatment modality for orbital venous malformations, resulting in significant reduction in lesion volume and proptosis, along with marked symptomatic improvement. It is a valuable therapeutic option for orbital vascular malformations, particularly in cases where surgical excision is challenging.

Traumatic cataract typically results from blunt or penetrating ocular injuries. However, cataract formation due to reflexive act of self-defense is exceptionally rare. We present the case of a 16-year-old boy who sustained trauma to his left eye while shielding himself during an altercation. The injury led to rupture of the anterior lens capsule and dense cataract formation. His best corrected visual acuity (BCVA) was counting fingers in the affected eye. Examination revealed circumciliary congestion, a corneal laceration, a Grade 4 anterior chamber reaction, a ruptured anterior lens capsule, and a white, opacified lens. Lens aspiration with in-the-bag intraocular lens (IOL) implantation was performed. Postoperatively, the patient regained 6/6 visual acuity, which remained stable over monthly follow-ups. This case underscores the importance of prompt diagnosis, timely surgical intervention, and patient education in preventing vision loss due to trauma.

A 40-year-old male had recurrent episodes of optic neuritis. Best-corrected visual acuity was evaluated and Humphrey Visual Field analysis was done before and after treatment. Treatment consisted of three weekly cycles of intravenous platelet-rich plasma combined with exosomes, followed one week later by bilateral posterior sub-tenon, retrobulbar, and intravenous injections of blood-derived mononuclear cells.At 3 months of follow-up, Humphrey visual fields showed significant improvement. The patient reported subjective improvement in visual acuity. No further relapses occurred, and no steroid or other systemic therapy was required during the follow-up period.The combined approach of using autologous PRP, exosomes, and hematopoietic stem cell therapy may cause sustained visual field recovery in recurrent optic neuritis refractory to corticosteroids.

Purpose: To determine whether omega-3 supplementation can reduce malondialdehyde (MDA) levels, vascular endothelial growth factor (VEGF) expression, tumor necrosis factor-alpha (TNF-α) expression, and vascular tuft formation in oxygen-induced retinopathy (OIR) mouse models. Study Design: Controlled laboratory experimental study. Place and Duration of Study: Animal Laboratory Unit (ALU), Faculty of Medicine, Udayana University, from Methods: Thirty-six male Sprague Dawley rats, aged one week and weighing 10–12 g were included. Rats were exposed to 75 ± 5% oxygen from postnatal day 7 (P7) to P12 in a sealed oxygen chamber to induce vaso-obliteration. They were then returned to room air (20% oxygen) from P13 to P17 to allow hypoxia-driven pathological neovascularization. After that, rats were randomly assigned to either the treatment or control group. The treatment group received omega-3 fatty acids at a dose of 0.4 mg/g body weight, administered once daily via nasogastric tube from P13 to P17. Control animals did not receive supplementation and were maintained on standard laboratory diet.Retinas allocated for histological assessment were processed for immunohistochemical evaluation of VEGF, TNF-α, and vascular tuft formation. Results: There was a statistically significant reduction in MDA levels, VEGF expression and TNF-α in the treatment group receiving omega-3 supplementation. The number of vascular tufts was notably lower following omega-3 administration, implying its potential to inhibit pathological angiogenesis. Conclusion: Omega-3 unsaturated fatty acids exhibit antioxidant, anti-inflammatory, and anti-angiogenic properties that help suppress pathological neovascularization in oxygen-induced retinopathy (OIR).

Purpose: To evaluate the choroidal thickness in healthcare professionals using a surgical face mask. Study Design: Cross sectional study. Place and Duration of Study: Ittefaq Hospital, Lahore, and Sohail’s Oculab from June 2023 to July 2024. Method: Sixty healthcare professionals aged 25–45 years with best corrected visual acuity of 6/6 or 6/9 and normal intraocular pressure (12–21 mmHg) were included. Participants with any systemic or ocular pathology were excluded. The instruments used in this study included a distance Snellen chart, an air-puff tonometer (Topcon), and a swept-source OCT device (Topcon DRI OCT Triton 3D). A self-structured proforma was used for data collection. Choroidal thickness was measured after wearing a surgical face mask for at least 4 hours and again 30 minutes after mask removal using swept-source OCT. Results: The study included the right eyes of 60 participants in which there were 34 males (58.3%) and 26 females (41.7%). The mean age was 30.35 ± 4.90 years. A paired-sample t-test showed a statistically significant change in choroidal thickness between 4 hours of mask wearing and 30 minutes after mask removal (p < 0.001). Conclusion: The findings showed a significant difference in choroidal thickness when wearing a surgical face mask compared with not wearing one. Prolonged mask use may cause hypercapnia, which can increase retinal vessel diameter and blood flow, leading to increased choroidal thickness.

Purpose: To compare mean IOP changes following PPV using 1000 CST and 5000 CST silicone oil in patients with superior Rhegmatogenous Retinal Detachment (RRD). Study Design: Quasi experimental study. Place and Duration of Study: Layton Rahmatullah Benevolent Trust (LRBT) from January 2024 to June 2024. Methods: A total of 150 patients with age range of 21 to 70 years, diagnosed with superior rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR) of grade B or C, were recruited. They were divided into two groups; Group A underwent vitrectomy with 1000 centistokes (cSt) and Group B had 5000 cSt silicone oil as tamponade. Intraocular pressure (IOP) was measured before and at 6, 12, 24, and 48 hours after surgery. Independent sample t-test was used to compare the results with p-value of ≤0.05 as significant. Results: The mean age was comparable between the two groups (Group A: 44.64 ± 14.71 years; Group B: 44.76 ± 14.09 years). A postoperative increase in IOP was observed in both groups. However, at 24 and 48 hours, Group B demonstrated significantly higher IOP compared to Group A, with mean values of 19.34 ± 0.86 vs. 18.64 ± 0.61 mmHg (p = 0.001) and 19.70 ± 1.09 vs. 19.22 ± 0.92 mmHg (p = 0.004), respectively. Conclusion: Both 1000 cSt and 5000 cSt silicone oil lead to IOP elevation after PPV, but the increase is more significant and sustained in the 5000 cSt group. Careful IOP monitoring is recommended, especially in patients receiving high-viscosity silicone oil.

Purpose: To evaluate visual outcomes of traumatic cataract surgery in pediatric patients and identify preoperative, per operative and postoperative complicationsof management. Study Design: Quasi experimental study. Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi from April 2024 to September 2024. Methods: This study included 61 children (≤16 years) who underwent surgery for traumatic cataract. Patients with any pre-existing ocular pathology or follow-up <6 months were excluded. Demographic data, type of trauma, timing of surgery, Itype of intraocular lens (IOL), and complications were recorded. Visual acuity (VA) was measured at baseline and at one week, three months, and six months, converted to logMAR for analysis. Statistical tests included repeated measures ANOVA and Spearman correlation. Results: Mean age was 8.37 ± 3.62 years; 70.4% were male. Blunt and penetrating injuries were equally distributed. Foldable in-the-bag IOLs were most common (35.4%). Preoperative complications of trauma were present in 88.5%, most frequently visual axis opacification (39.3%). Postoperatively, 52.5% had no complications; others developed astigmatism (29.5%), anterior uveitis (18.0%), or IOL dislocation (9.9%). Mean LogMAR VA improved from 2.09 to 0.80 in 6 months (p < 0.001). Better outcomes were observed in older children and those without complications. Timing of surgery and trauma type did not significantly affect final VA. Conclusion: Pediatric traumatic cataract surgery offers favorable visual outcomes. Age and complication profile significantly affects prognosis. Timely intervention, individualized rehabilitation, and vigilant postoperative monitoring are essential for optimizing results and minimizing long-term sequelae.

Purpose: To determine visual outcomes and pattern of injuries among patients presented with Ocular Trauma in three major tertiary care centers of Karachi. Study Design: Cross sectional study. Place and Duration of Study: Mross-sectional study conducted at three tertiary care centers of Karachi, over a 3-month period. Methods: Patients with history and signs of recent ocular and adnexal trauma were included in the study and those with any other ocular or systemic disease were excluded from the study. Data was collected on a self-designed proforma for history and the relevant ocular and adnexal examination details. Majority of the patients presented to the Accident and Emergency department and referred to Eye clinics. Ocular Trauma Scores (OTS) were calculated with the help of OTS chart. Results: In a sample of 343 patients, 44% were presented at Jinnah Postgraduate Medical Centre (JPMC), 45% at Isra Postgraduate Institute of Ophthalmology (IPIO), and 11% at Dow International Medical College (DIMC). Most injuries occurred in males (76.7%). Accidental injuries were the commonest injuries found in DIMC, (52.63%) and IPIO, (64.52%)(n=100). Whereas in JPMC, assault was the most common (31.75%). Commonest sign of ocular trauma was lid swelling (26.23%) found in DIMC and lid tear (16.76%) in JPMC. Conclusion: Ocular trauma patterns in Karachi are closely linked to the nature of surrounding environments, including traffic density, occupational hazards, and access to emergency services. Public education, protective gear enforcement, and workplace safety policies are needed to reduce the burden of preventable vision loss.