Pakistan Journal of Ophthalmology

A Case of a Non-Specific Orbital Inflammation

Adela Widi Etania — 2025-09-30

Non-specific orbital inflammation (NSOI) is a complex diagnosis marked by inflammation of ocular tissues without an identifiable etiology. This case report describes a 37-year-old female with recurrent left-sided NSOI. Her early presentation included pain, proptosis, chemosis, and limited ocular movements. Imaging showed edema of the left optic nerve, hypertrophy of the extraocular muscles, enlargement of the lacrimal gland, and periorbital soft tissue edema. Although she initially exhibited a positive response to high-dose intravenous corticosteroids, her symptoms reemerged during the tapering process, requiring extended oral corticosteroid treatment. This case highlights the significance of a multidisciplinary approach, personalized treatment, and additional study into the fundamental processes and optimal management of this condition.

The Dermis fat graft: Retrospective case series from Pakistan

Sumeya Ali Khan — 2025-09-30

The case series was conducted at Department of Orbit and Oculoplastics, Alshifa Trust Eye Hospital, Rawalpindi, from January 2023 to July 2024. It included 25 eyes of 25 patients who underwent a standardized dermis fat graft transplantation for anophthalmia. There were 15 male patients, and the mean age of study participants was 34.1±12.01. Two out of 25 patients had significant volume loss and were booked for another surgery and 3 had surgical site infection requiring a longer course of antibiotics. All patients reported satisfaction with prosthesis fitting till 6 months of followup. The superior sulcus ,lid position and prosthesis tilt was compared to the fellow eye.Dermis fat graft proved to be a good option for anophthalmic sockets. It can also be used as a primary procedure for obviously pthisical, traumatic globes

Association of Central Macular Thickness with Serum HbA1c Levels in Patients of Diabetic Retinopathy

Minahal Mateen — 2025-09-30

Purpose: To determine the association of central subfield macular thickness (CST) in patients of diabetic retinopathy with HbA1c.

Study Design: Cross sectional study.

Place and Duration of Study: Combined Military Hospital, Lahore from March 2025 to June 2025.

Methods: A total of 112 patients with diabetic retinopathy according to ETDRS classification were included and divided into two groups: patients with controlled (HbA1c≤7) and uncontrolled (HbA1c>7) diabetes. Spectral Domain OCT was done for CST and rerum HbA1c levels were recorded. Independent samples t-test was used to compare CST in groups. The results were also stratified for gender and duration of diabetes.Statistical analysis was done by using Statistical Package for Social Sciences SPSS version 23. Pearson correlation was applied to quantify the relation between HbA1c and CST.

Results: The mean age of participants was 62.08±5.97 years. There were 74.1% patients with uncontrolled HbA1c levels (>7%). The mean CST for males was 295.36 µm (SD = 37.64), and for females was 302.84±44.44.The mean CST in the controlled group was 257.62 ±19.73 while in the uncontrolled group was 311.98±35.53. CST was positively correlated with serum HbA1c levels (r=0.634). Patients with diabetes for more than 10 years had significantly higher CST (P=0.045). However, there was no gender-based difference in CST between the groups.

Conclusion: Poor glycemic control and longer duration of diabetes are associated with increased central subfield macular thickness in diabetic retinopathy.

Frequency of Retinopathy of Prematurity in Premature and Very Low Birth Weight Infants

Muhammad Asim — 2025-09-30

Purpose: To determine the prevalence of retinopathy of prematurity (ROP) in premature and very low birth weight infants.

Study Design: Descriptive Observational study.

Place and Duration of Study: Department of Pediatric Medicine at Recep Tayyip Erdogan Hospital, Muzaffargarh, from 26th November 2024 to 25th May 2025.

Methods: A total of 172 infants born at ≤ 32-weeks of gestation and weighing ≤ 1500 grams birth weight were consecutively included in the study.Data regarding age, gender, gestational age, birth weight, duration of oxygen therapy, need for surfactants and mechanical ventilation was collected. Fortnightly eye examinations were performed by ophthalmologist. Factors associated with ROP were determined through chi-square test at 5% significance level using SPSS version 27.

Results: Of all the participants, 52.3% (n=90) were males. The mean gestational age and birth weight were 29.3 ± 1.4 weeks and 1123.4 ± 131.6 grams. The surfactant therapy was required in 61% (n=105) and mechanical ventilation in 56.4% (n=97). The mean duration of oxygen therapy was 9.6 ± 5.0 days. Retinopathy of prematurity was diagnosed in 30.2% (n=52) of infants.Frequency of ROP was significantly high in infants with gestational age of < 30-weeks (40%), birth weight of ≤ 1000 grams (59.6%), infants receiving mechanical ventilation (48.5%) and oxygen therapy for > 10-days (71%).

Conclusion: Significant proportion of infants developed ROP. Lower gestational age and birth weight with need for mechanical ventilation and prolonged oxygen therapy aresignificantly associated with ROP.

Spectrum of Manifestations and Therapeutic Outcomes in Vogt–Koyanagi–Harada Syndrome

Muhammad Ali Haider — 2025-09-30

Purpose: To evaluate the clinical manifestations, management strategies, and treatment outcomes of Vogt–Koyanagi–Harada (VKH) disease in a tertiary care facility of Punjab.

Study Design: Retrospective chart review.

Place and Duration of Study: Al-Ehsan welfare eye Hospitalfrom January 2023 to December 2023.

Methods: There were 26 patients who qualified the inclusion criteria. VKH was diagnosed based on internationally updated diagnostic criteria. They underwent high dose steroids and immunomodulatory therapy. Demographic information, clinical presentations, treatment approaches, and results, such as CMT (central macular thickness) and BCVA (best-corrected visual acuity), were collected. SPSS version 22 was used for the statistical analysis, and a p-value of < 0.05 was considered significant.

Results: The mean age of patientswas 35.09 ± 8.8 years, with a predominance of females (61.5%). Treatment involved high-dose corticosteroids and immunomodulatory therapy. BCVA improved from 1.1 ± 0.86 logMAR at baseline to 0.61 ± 0.138 logMAR after 6 months (p < 0.01). Macular thickness decreased from 596 ± 247µm to 236.9 ± 27.1µm after 6 months (p < 0.01). There was a positive correlation of premature treatment termination and relapse (r = 0.490, p = 0.013).

Conclusion: Early diagnosis and treatment with corticosteroids and immunomodulatory therapy significantly improve visual and anatomical outcomes in VKH disease. The findings highlight the necessity of timely diagnosis, adherence to treatment, and a multidisciplinary approach to optimizepatient management and minimize complications.

Patterns and Outcomes of Pediatric Ocular Trauma: Experience from a Tertiary Eye Care Center in Karachi, Pakistan

Sobia Tabassum — 2025-09-30

Purpose: To determine the epidemiological patterns, clinical presentations, and visual outcomes of pediatric ocular trauma in patients aged 15 years or younger presenting to a tertiary eye care center in Karachi.

Study Design: Descriptive observational study.

Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi, from July 2021 to March 2022.

Methods: A total of 237 eyes from 232 pediatric patients were included. Data were collected using structured questionnaires and comprehensive ophthalmologic examinations. Injuries were classified using the Birmingham Eye Trauma Terminology System (BETT) and the Ocular Trauma Classification System (OTCS). Treatment outcomes were analyzed using SPSS version 22 and a p-value of <0.05 was considered significant.

Results: The mean ageat presentation was 8.28±3.52 years, with boys (M: F = 2.6:1) more frequently affected. Most injuries occurred outdoors (49.4%) and were commonly caused by wooden sticks (24.5%) and sharp objects (21.9%). Closed globe injuries (58.4%) were more prevalent than open globe injuries (32.1%). The most frequent diagnosis was traumatic cataract (28.9%). Medical management was provided in 32.9% of cases, while 67.1% underwent surgical intervention. Significant improvement in visual acuity was observed post-treatment (Wilcoxon Signed-Rank Test, p = 0.0001). Visual outcomes correlated with the Ocular Trauma Score, with poorer outcomes in lower score categories.

Conclusion: Pediatric ocular trauma remains a major cause of visual morbidity, predominantly affecting boys engaged in outdoor activities. Timely management significantly improves visual prognosis. Preventive strategies and public awareness are essential to mitigate these largely preventable injuries.

Convergence Insufficiency and Its Associated Symptoms While Reading Text from Digital Screen and Hard Copy

Nimra Gul — 2025-09-30

Purpose: To determine the asthenopic symptoms in patients reading text from digital devices versus hard copy.

Study Design: Cross sectional, observational study.

Pace and Duration of Study: The University of Faisalabad from August 2021 to August 2022.

Methods: Forty subjects of 20-30 years of age were included. After proper history of patient, visual acuity was checked using LogMAR chart. The patients were asked to read from digital screen for 20 minutes and convergence was recorded using RAF ruler, 10 minutes break was given and then patients were asked to read from hard copy for 20 minutes and convergence was checked. Asthenopic symptoms were assessed using self-designed questionnaire. Number of blinks per minute were also recorded for reading from digital screen and hard copy. Data was analyzed by using SPSS version 20.

Results: Mean convergence with reading from hard copy was 11.85±3.690 and from soft copy was 14.33±3.925(p = 0.005). Readers from digital screen caused greater frequency of asthenopic symptoms such as headache, fatigue, eye ache, tearing, diplopia, eyestrain and red eye. Most participants demonstrated blink rates of 6–10 blinks/minute in both conditions. Low blink rates (1–5 blinks/minute) were more frequent during soft copy reading, whereas intermediate rates (11–15 blinks/minute) were more common during hard copy reading.

Conclusion: Reading from digital devices is associated with higher convergence demand and greater frequency of asthenopic symptoms compared to hard copy. Soft copy reading showed a trend toward lower blink rates, which may contribute to ocular discomfort.

A Study of Visual Function Quality Along with Static and Dynamic Visual Acuity in Commercial Bus Drivers of Chandigarh, Mohali, and Panchkula

Navneet Sharma — 2025-09-30

Purpose: To evaluate the quality of visual function and visual acuity both static and dynamic in professional bus drivers in three cities of India.

Study Design: Cross sectional study.

Place and Duration of Study: Eye Clinic of Department of Optometry, Chandigarh Group of College, Jhanjeri, Mohali, Punjab, India from April, 2024 toJune, 2024.

Methods: A sample of 215 professional bus drivers aged 25 to 45 from the Tricity was selected with best corrected visual acuity of 6/6, with or without a refractive error (up to +/-3.00 spherical). The drivers with at least one year of driving experience and a minimum of five hours of daylight driving each day were included.Refractive error, static visual acuity (SVA) and dynamic visual acuity (DVA), color vision, contrast vision, glare vision and stereo vision were assessed.

Results: The mean age of participants was 32±5.9. There was a significant difference in SVA and DVA of the same person (p <0.00001). The time taken for the evaluation of the DVA was lesser as compared to the SVA.A moderate positive correlation was observed between visual acuity and stereopsis (rs=0.43) and between visual acuity and contrast sensitivity (rs=0.41), while other visual parameters showed weak or negligible associations.

Conclusion: Visual acuity and related visual qualities significantly influence driving performance, emphasizing the need to assess both static and dynamic visual acuity in professional drivers.

Surgical Outcomes of Mitomycin C Augmented Trabeculectomy in Congenital Glaucoma

Najia Uzair — 2025-09-30

Purpose: To evaluate outcomes of augmented trabeculectomy in lowering IOP in eyes with Congenital Glaucoma and to report the post-operative complications.

Study Design: Retrospective chart review.

Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi from July 2022 and April 2024.

Methods: This study evaluated the outcomes of Mitomycin C-augmented trabeculectomy in 78 children (102 eyes) under 3 years of age with primary or secondary congenital glaucoma. All patients were followed for one-year post-surgery. Intraocular pressure (IOP) was measured under sedation using a hand-held Perkins applanation tonometer at various intervals up to 12 months. Surgical success was defined as achieving an IOP of ≤19 mm Hg, categorized into absolute success (without medications) and qualified success (with medications). Failure was defined as uncontrolled IOP despite topical therapy. Data were analyzed using SPSS version 23.

Results: Of the included eyes, 59.8% had primary congenital glaucoma (PCG) and 40.2% had secondary congenital glaucoma (SCG). The mean age was 18.24 ± 9.22 months, and 41% were boys. The mean IOP at 12 months was significantly reduced compared to baseline, with no significant difference between PCG and SCG groups (p=0.76). Postoperative complications were minimal; only 11.76% required further intervention, mostly anterior chamber reformation. One case each of retinal detachment and bleb leak was successfully managed.

Conclusion: Mitomycin C-augmented trabeculectomy is a safe and effective procedure for both PCG and SCG, with comparable success rates between the two groups at one year.

Cyclosporine Eye Emulsion Vs Loteprednol Etabonate Eye Drops for the Management of Subepithelial Infiltration Linked to Adenoviral Keratoconjunctivitis

Sura Luay Kadhim — 2025-09-30

Purpose: To compare the effectiveness of cyclosporine eye emulsion versus Loteprednol etabonate eye drops in the management of subepithelial infiltrates (SEIs) secondary to adenoviral keratoconjunctivitis(AKC).

Study Design: Quasi experimental study.

Place and Duration of Study: Al-Kindy Teaching Hospital in Baghdad from January 2024 to December 2024.

Methods: Sixty-nine patients with confirmed multifocal SEIs were enrolled and assigned to either cyclosporine (n=35) or Loteprednol (n=34) group by convenient sampling. Patients were monitored over 6 months using slit-lamp biomicroscopy and non-contact tonometry to assess treatment outcomes, side effects, and recurrence. Data was analyzed using SPSS version 26. Descriptive statistics (frequency and percentage) were used for numerical data. The Chi-square test was applied to compare categorical variables such as age groups, gender distribution, side effects, and recurrence rates. Independent sample t-tests were used to compare continuous variables, including IOP between the groups. A p-value < 0.05 was considered statistically significant.

Results: Loteprednol demonstrated faster SEI clearance at 2 and 4 months (P < 0.05), with higher rates of complete corneal clarity by month 4. However, it also showed significant rise in IOP and a higher recurrence rate (20.6%) compared to cyclosporine (8.6%) at 6 months. Cyclosporine was associated with more early ocular discomfort but offered better long-term control and lower relapse.

Conclusion: Loteprednol provides faster symptomatic relief, whereas cyclosporine offers more durable outcomes with fewer recurrences. Sequential therapy, starting with corticosteroids and transitioning to cyclosporine, may optimize AKC management and further investigation warrants.

Measurement of Horizontal Fusional Reserves Among Myopic Children

Ramla Yaseen — 2025-09-30

Purpose: To investigate the horizontal fusional vergence among school going myopic children by measuring the positive fusional vergence and negative fusional vergence break point at nearby.

Study Design: Cross-sectional study

Place and Duration of Study: Fatima memorial hospital Lahore, from December 2023 to March2024.

Methods: A total of 60 school-going myopic children aged 5 to 16 years were recruited. Participants were selected using a non-probability consecutive sampling technique, based on predefined inclusion criteria. A comprehensive clinical evaluation was performed, including assessment of visual acuity, strabismus testing, and measurement of the near point of convergence (NPC) using the RAF rule. Fusional vergence ranges were measured at near using a prism bar and a near picture target. Positive fusional vergence (PFV) and negative fusional vergence (NFV) were both assessed with the prism bar. The Chi-square test was applied to determine associations between categorical variables.

Results: Among the participants, 83.3% had normal convergence amplitude, 3.3% demonstrated convergence excess, and 13.3% had convergence insufficiency. There was no statistically significant association between myopia and positive fusional vergence (p = 0.831). Divergence amplitude assessment revealed that 93.4% had normal divergence amplitude, while 6.67% exhibited divergence insufficiency; no cases of divergence excess were observed. Similarly, no statistically significant association was found between myopia and negative fusional reserve (p = 0.52).

Conclusion: Myopia appears to have minimal impact on horizontal fusional vergence in school-going children.

Clinical Staging of Retinoblastoma at Presentation: A Frequency Analysis

Farhat Khan — 2025-09-30

Purpose: To determine the frequency of different clinical stages of retinoblastoma at the time of initial presentation.

Study Design: Retrospective study.

Place and Duration of Study: Jinnah Postgraduate Medical Center, Karachi from June 2024 to February 2025.

Methods: Records of patients with confirmed diagnosis of retinoblastoma were reviewed. There were 85 patients who qualified the inclusion criteria. Data included staging of retinoblastoma at presentation using Intraocular Retinoblastoma Classification (IIRC), age at presentation, gender, laterality (unilateral or bilateral) and comprehensive ocular examination details. For patients with bilateral disease, each eye was staged individually, resulting in a total of 114 eyes for analysis. Demographic details such were also retrieved.

Results: Among 85 retinoblastoma patients (114 eyes), the most common stage at presentation was Group D (42.1%) followed by Group E (32.4%). None of the patients had Group A retinoblastoma. Groups B and C were frequent inbilateral cases (32.8%). Mean age at presentation was 2.6±1.4 years, and52.9% were male. Bilateral cases demonstrated a shorter symptom duration (6.7 vs. 9.1 weeks, p = 0.02) and a higher frequency of positive family history (24.1% vs. 3.6%, p = 0.004). No significant association was observed between gender and disease stage.

Conclusion: Most of the retinoblastoma patients presented in advanced stages (Group D and E), indicating delayed diagnosis and referral. These findings highlight the need for increased awareness, early screening, and improved access to specialized ocular oncology services.

Family Physicians’ Approach to Sight Threatening Conditions in Children: Awareness, Management, and Referral Methods

Suzan Amana Rattan — 2025-09-30

Purpose: To evaluate the knowledge and attitude of Iraqi family physicians regarding pediatric sight threatening diseases and to identify factors influencing their approaches.

Study Design: Cross sectional, Observational study.

Place and Duration of Study: Primary health care centers of Iraq, from March 2024 to March 2025.

Methods: This study included 385 family physicians working in primary health care centers. Participants completed a structured, self-administered, web-based survey distributed via social media groups. The survey included demographic questions and assessed knowledge and attitudes toward common pediatric eye disorders. Data was analyzed using SPSSversion 22.

Results: Among the participants, 55.3% were residents. Knowledge variedsignificantly with 51.6% demonstrating good knowledge, 67.5% moderate, and 81% poor. Family medicine consultants exhibited the highest knowledge levels (78.4% “good”), compared to specialists (68.1%) and residents (10.3%). Physicians with less than one year of experience showed the most significant knowledge gaps (p=0.000). Attitudes toward pediatric eye care were generally positive, but knowledge deficiencies hindered effective practice.

Conclusion: The study reveals substantial knowledge gaps among Iraqi family physicians, particularly among residents and those with limited clinical experience. Experience and professional role strongly correlated with higher knowledge levels. To address preventable childhood vision impairment, targeted educational interventions, like structured training programs, mentorship, and the integration of pediatric ophthalmology into family medicine curricula, are urgently needed. These efforts could significantly reduce the burden of preventable vision loss in children.

Central Corneal Thickness and Intraocular Pressure Changes After Phacoemulsification and Their Association with Cataract Density

Ambreen Gull — 2025-09-30

Purpose: To assess the changes in central corneal thickness and intraocular pressure following phacoemulsification and find their association with cataract density.

Study Design: Observational analytical study.

Place and Duration of Study: Benazir Bhutto Hospital, Rawalpindi Medical University, from January 2024 to December 2024.

Methods: The study was carried out on 80 eyes undergoing uneventful phacoemulsification. Preoperative and postoperative central corneal thickness(CCT) and intraocular pressure (IOP) were measured using ultrasound pachymetry and Goldmann applanation tonometry, respectively, at day 1, week 1, and week 4. Cataract density was graded using the Lens Opacification Classification System III.Visual acuity was recorded pre- and postoperatively using the decimal notation Snellen chart. Data was analyzed using paired t-tests, repeated measures ANOVA, and Spearman correlation.

Results: The mean preoperative Best corrected visual acuity (BCVA) was 0.208 ± 0.17 (range: 0.01–0.50) using the Snellen decimal notation chart. At four weeks postoperatively, the mean BCVA significantly improved to 0.823 ± 0.16. Mean CCT increased from 524.15±40.54 µm preoperatively to 574.92±44.72 µm on day 1 postoperatively, reducing to 525.89±40.50 µm by week 4. IOP showed a transient rise from 15.59±2.19 mmHg to 17.99±2.17 mmHg at week 1, returning to baseline at week 4. A significant positive correlation was found between cataract density and both postoperative day 1 CCT (ρ=0.421) and IOP (ρ=0.430).

Conclusion: Phacoemulsification results in reversible changes in CCT and IOP. Cataract density is moderately associated with early postoperative corneal edema and IOP elevation.

Epidemiology of Eye Diseases in a Community Eye Camp in Northern Pakistan

Erum Shahid — 2025-09-30

Purpose: To determine the epidemiology of eye diseases in Skardu, Gilgit-Baltistan, in the North of Pakistan.

Study Design: Cross sectional observational study.

Place and Duration of Study: Camp organized by a Private Eye Hospital in Skardu, Gilgit Baltistan from 22^nd April to 28^thApril 2024.

Methods: In this 7-day camp, outreach services were provided in Dambudas, Khaplu, and Shigar, offering routine eye examinations, treatment for minor ocular problems, and spectacles for refractive errors, while surgical cases were referred to the main hospital. Comprehensive evaluations included slit-lamp examination, visual acuity testing, fundoscopy, tonometry for glaucoma suspects, and refraction. Medicines were dispensed free, and cataract patients were counseled and scheduled for surgery. Frequencies are computed for categorical variables and means for numerical data.

Results: There were 3411 patients with mean age of 36.48±11.34 years. Males accounted for 57% of the patients. The highest percentage of patients was 61 years and above (26.53%). There were 65.79%patients with anterior segment diseases. Allergic conjunctivitis was seen in33.56%, and pterygium in 1.32% of individuals. Diabetic retinopathy was seen in 1.73%, cataracts in 7.33%, and glaucoma in 1.91%. Refractive errors were reported in 30.35% with hypermetropia (15.48%) being the most common. Medicines were prescribed to 62.22%, spectacle prescriptions to 24.89%, and surgical interventions were performed in 3.98% of patients.

Conclusion: The allergic conjunctivitis was most frequent ocular problem, followed by refractive errors (hypermetropia being the commonest). Diabetic retinopathy was the most common disease among posterior segment pathology.

Recurrence Rate of Pterygium in Suture Less Limbal Autograft Versus Bare Sclera Technique

Muhammad Ashfaque — 2025-09-30

Purpose: To compare the recurrence rate of pterygium in patients undergoing suture-less limbal autograft versus patients undergoing bare sclera surgery.

Study Design: Quasi experimental study.

Place and Duration of Study: Institute of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh from March 2021 to March 2022.

Methods: Patients of either sex, aged ≥20 years, with a diagnosis of primary pterygium were included in the study. Participants were allocated into two groups. Group A underwent pterygium excision using the bare sclera technique, whereas Group B received a suture less limbal autograft. Postoperative follow-up was conducted for three months to assess recurrence. Data were collected using a self-designed proforma and analyzed with SPSS version 20. The Chi-square test was applied to compare recurrence rates between the two groups, with a p-value <0.05 considered statistically significant.

Results: The average age of patients in group A was 49.58 ± 12.54 years, while in group B was 45.44 ± 9.67 years. Group A consisted of 17 males (47.2%) and 19 females (52.8%), whereas Group B included 19 males (52.8%) and 17 females (47.2%). At three-month follow-up, pterygium recurrence was observed in 32 cases (88.9%) in group A and in 3 cases (8.3%) of group B(p < 0.05).

Conclusion: The suture-less limbal autograft is statistically and clinically more effective in preventing recurrence than the bare sclera technique.

Honoring Visionary Voices: Reflections from the Named Award Lectures at the Lahore Ophthalmology Conference

Tayyaba Gul Malik — 2025-09-30

Unveiling the Uncommon: A Case Study on Adult-Onset Asthma Coexisting with Periorbital Xanthogranuloma

Asna Tahir — 2025-09-30

Eyelid and orbital lesions with asthma are the hallmarks of adult-onset asthma and periocular Xanthogranuloma (AAPOX). We present a rare case of an adult female diagnosed with AAPOX proven by biopsy with an elevated IgG4 serum level, showing a possible association between the two diseases. A 60-year-old female presented to the out-patient department of Khyber Teaching Hospital with the chief complaint of bilateral yellow, painless, upper eyelid swellings for the past 5 years. She had been treated for tuberculosis 15 years ago and was diagnosed with asthma 15 years ago, when she was 45 years old. She had history of chronic sinusitis. The patient had an elevated serum human IgG4 level of 874 mg/L. Anterior orbitotomy was performed. On the basis of histopathology, the diagnosis of adult-onset asthma and periocular xanthogranuloma was confirmed. AAPOX, though rare, is a significant cause of orbital lesions.

Familial POAG to Refractory Glaucoma: A Case Report on a Low-Cost Glaucoma Implant

Lydia Nuradianti — 2025-09-30

This case report presents the management of refractory glaucoma in a middle-aged patient with a familial history of primary open-angle glaucoma (POAG). The patient had previously received two trabeculectomies in the right eye with persistently elevated intraocular pressure (IOP) despite maximal medical therapy. The results showed that there was advanced glaucomatous damage and an IOP of 43.4 mmHg (NCT). Due to financial constraints, Virna Glaucoma Implant (VGI) was selected as a low-cost drainage device. Postoperative IOP on Day 18 was 10 mmHg with a best-corrected visual acuity (BCVA) of 6/7, and by Day 32, IOP was 19 mmHg with BCVA of 6/8. The patient reported symptomatic relief and tolerated the implant well without complications or the need for additional medication. This case showed the potential of low-cost glaucoma implant as an effective alternative for managing refractory glaucoma in resource-limited settings, where access to high-cost surgical devices is limited.

Percutaneous Sclerotherapy with Bleomycin for Orbital Lymphangioma: A Case Report

Tehreem Tanveer — 2025-09-30

Lymphangiomas, or lymphatic malformations, are benign, multi-cystic, hamartomas which are localized vascular malformations believed to arise during embryonic period.¹ Lymphatic malformations most frequently occur in pediatric populations in the region of head and neck and they account for about 25% of benign pediatric vascular tumors and about 4% of all vascular tumors.¹ Orbital lymphangiomas have a prevalence of 1.1 to 5.3 cases per 10,000 live births and are equally common in both males and females.²Histopathologically, lymphangiomas consist of endothelium lined, thin-walled dilated lymphatic spaces, filled with eosinophilic proteinaceous material.¹Management of lymphangiomas is challenging. We report a case of a 9-year-old female who had orbital lymphangioma and was treated with sclerotherapy. Outcomes of treatment and review of literature is presented here.