Pakistan Journal of Ophthalmology

The Myopia Epidemic: Pathogenesis, Risk Factors, and a Call for National Action

Mian Muhammad Shafique — Wed, 01 Jul 2026 00:00:00 +0000

Myopia has emerged as a global epidemic, which has affected populations worldwide and is believed to be driven largely by contemporary environmental factors. Pathological mechanisms include axial elongation of the globe caused by hyperopic and myopic defocus signals along with triggering retinal neuromodulators. Key environmental factors include reduced outdoor activities in children, excessive burden of near work with superadded extended screen time. Recentevidenceshows that interventions like low-dose atropine and optical strategies using peripheral myopic defocus can reduce myopia progression. There are other modalities including repeated low-level red-light therapy which offersan additional promise. This editorial is focused on an integrated and evidence-based management framework for myopia control and advocates urgentpublic health strategies on national level. School-based screening programs are the frontline strategies to address the growing burden of myopia.

Paediatric Myopia in Pakistan and its Readiness for Control–A Narrative Review

Hammaad Khalid, Mishelle Abbasi , Mohamed Mohyudin , Muhammad Amjad — Wed, 01 Jul 2026 00:00:00 +0000

This narrative review was conducted to provide evidence on paediatric myopia in Pakistan, and its risk factors, and readiness for myopia control. A search was conducted using PubMed and PakMediNet with terms that combined “Pakistan” with “myopia,” “refractive error,” “school screening,” “atropine,” “orthokeratology,” and “myopia control.” The studies indicate a substantial burden, including a 54% prevalence among adolescents in Karachi. Reported risk factors include increased near work, poor sleep quality, parental myopia, screen exposure, and reduced outdoor activity. Pakistan’s readiness for myopia control is limited due to the training gaps, inadequate monitoring, inconsistence practice, and cost barriers. Effective myopia control in Pakistan needs a multifaceted approach. Expanding prevention and detection capabilities and then a national effort on legislation and guidance, funding, work force training, and access to interventions.

Role Of Sub-Tenon Autologous Platelet Rich Plasma Injections In The Treatment Of Rp Associated Cystoid Macular Edema: Interventional Case Series

Kashif Jahangir, Muhammad Irfan Karamat, Gul E Lala, Zaigham Abbas — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: Retinitis pigmentosa (RP)is a progressive degenerative disease that may develop complications such as cystoid macular edema (CME), epiretinal membrane (ERM), and cataracts. Our study aims to use platelet-rich plasma (PRP) to resolve the cystic spaces at the macula by healing the tissue damage done by RP disease and lowering tissue compliance to limit fluid accumulation.

Study Design: Interventional Case Series.

Place and Duration of Study: Ibrahim Eye Centre, Lahore from December 2024 to March 2025.

Methods: Seven patients (12 eyes) with retinitis pigmentosa–associated CME received three sessions of autologous sub-Tenon PRP injections at 3-week intervals. Baseline evaluation included best-corrected visual acuity (BCVA), fundoscopy, optical coherence tomography (OCT), and intraocular pressure (IOP), all of which were repeated before each session. Final analysis compared pre-treatment findings with those obtained three weeks after the last injection.

Results: OCT demonstrated a statistically significant reduction in central foveal thickness (mean 289.50 ± 124.28 µm pre-treatment vs. 254.42 ± 111.67 µm post-treatment; p = 0.038). Visual outcomes showed improvement in 3 patients and stability in 4 patients, particularly in eyes with resolution of macular edema. No serious adverse events were observed; one patient developed transient IOP elevation.

Conclusion: Sub-Tenon PRP is a safe and potentially effective option for reducing macular edema in RP. However, larger studies with longer follow-up are required to confirm efficacy, evaluate durability of response, and assess the risk of recurrence or progression.

Macular Volume and Retinal Nerve Fiber Layer Thickness in Mild, Moderate, and High Myopia

Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To compare macular volume and Retinal Nerve Fiber Layer(RNFL) thickness among individuals with mild, moderate, and high myopia and to evaluate association of these parameters with severity of myopia.

Study Design: Cross-sectional study.

Place and Duration of Study: Sehat Medical Complex from January 2025 to June 2025.

Methods: One hundred and twenty-four eyes were included in the study. Based on the spherical equivalent (SE) refractive error, participants were divided into three groups: moderate myopia (from -3.00 D to -6.00D), high myopia (<-6.00 D), and mild myopia (>-3.00 D and ≤ -0.50 D).Spectral-domain optical coherence tomography was used to evaluate thickness of RNFL and macular volume. For the statistical analysis one-way ANOVA and post-hoc Tukey HSD tests were employed.

Results: There were 69 males and 55 females. Age ranged between 18 and 45 years with average age of 30.96 years.The RNFL thickness varied significantly among myopia groups, as confirmed by the F-statistic (374.129) and p-value of < 0.001. There was significant thinning of RNFL with increase in myopia. Macular volume significantly differed among the three myopia groups as confirmed by the significant finding (F = 14.323,
p < 0.001). Post-hoc analysis showed that there was significant difference between macular volume of mild and high myopia(p < 0.001). As the severity of myopia increased, macular volume gradually decreased.

Conclusion: Decrease in macular volume was a gradual structural alteration. Significant RNFL thinning was observed in cases of severe myopia.

Target-Dependent Variability in Near Point of Convergence Measurements: A Repeated-Measures Study

Shamit Pal, Priye Suman Rastogi — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To determine the test difference between the Near Point of Convergence (NPC) break and recovery distance depending upon accommodative fixation target and non-accommodative fixation target and the degree of difference that could be ascribed to the measurement method in healthy young adults that have normal binocular vision.

Study Design: A Repeated-Measures Study.

Place and Duration of Study: Teerthanker Mahaveer University, India from January 2025 to December 2025.

Methods: The study involved 130 subjects (20-26 years of age) with normal vision. RAF ruler and pencil scale push up(accommodative target) and NPC with red-filter torchlight (non-accommodative target)methodswere used for NPC break and recovery. Measurements were taken under ordinary conditions by one examiner. Descriptive statistics, ANOVA and Bonferonni adjusted post-hoc analysis were used.

Results: The three methods were found to be statistically significant in the NPC break and recovery distances (p < 0.001). The accommodation targets were much closer to NPC than the non-accommodative. The RAF ruler provided the least distance of break and recovery and was followed by the pencil push-up method and then finally, the NPC with red-filter torch-light method provided the most receded values. The size of the effect was significant that indicated that the level of influence of target type on NPC outcomes was high.

Conclusion: Accommodative and non-accommodative NPC are exhaustive of each other and NPC is a clinic-dependent strategy. NPC assessment techniques should also be used and reported consistently to achieve proper clinical interpretation and comparability of the results in research.

Combined Effect of Topical Nepafenac and Topical Anesthesia On Patients' Pain Perception During Intravitreal Anti-Vascular Endothelial Growth Factor Injection

Philumena, Sumaira Altaf, Fiza Shaheen, Sidra Balqees, Ahmad Hasan Khan Alizai — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To evaluate the effectiveness of topical Nepafenac (0.1%) eye drops as an adjunct to topical proparacaine for pain relief during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, and to compare its effect with topical proparacaine alone.

Study Design: Quasi-experimental study.

Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindifrom July 2025 to October 2025.

Methods: The study included 150 patients, 30-70 years of age, who underwent intravitreal anti-VEGF injections. Group A (n=75) was given only topical proparacaine, and Group B (n=75) was given combined topical proparacaine and topical Nepafenac (0.1%).Numeric Pain Rating Scale (NPRS) was used for pain.

Results: The mean age was 60±11years. There were 88 males (58.7%)and right eye was more commonly involved (n = 83, 55.3%). Diabetic patients (n=87, 58%), with proliferative diabetic retinopathy (n=42, 28%) being the most frequent indication for anti-VEGF. No statistically significant difference was observed (Chi-square test,
p = 0.07) regarding pain scores between the two groups. Pearson's correlation analysis revealed a very weak and non-significant association of Nepafenac (0.1%)use and pain scores (Pearson correlation coefficient = 0.182,
p = 0.26).Pain scores showed no significant association with age (p=0.53), gender (p=0.06), previous injections (p=0.10), or underlying diagnoses (p=0.20). However, a statistically significant difference in pain perception was observed between diabetic and non-diabetic patients (p = 0.015).

Conclusion: Topical Nepafenac (0.1%)does not alterthe pain perceptionduring intravitreal anti-VEGF injections.

Comparison of the Effect of Cycloplegia on Ocular Biometric Parameters in Myopic and Hypermetropic Pakistani Children Using Lenstar

Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To evaluate the effect of cycloplegia on ocular biometric parameters in children with myopia and hypermetropia.

Study Design: Cross sectional study.

Place and Duration of Study: Institute of ophthalmology LUMHS Jamshoro from September 2024 to march2025.

Methods: Thisstudy included children aged 5 to 12 years diagnosed with myopia or hypermetropia. Cycloplegic refraction was performed using 1% cyclopentolate and an autorefractor meter (Topcon KR-800). Ocular biometry measurements were obtained before and after cycloplegia using Lenstar LS 900 (HAAG-STREIT). A total of 188 eyes from 94 children (47 myopic and 47 hyperopic) were analyzed. Parameters assessed included pupil diameter (PD), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), corneal curvature (CC), and central retinal thickness (CRT). Data were analyzed using SPSS version 26.

Results: In myopic children, ACD increased from 3.63 ± 0.22 mm to 3.94 ± 0.27 mm, and PD increased from 3.83 ± 0.73 mm to 4.82 ± 0.55 mm after cycloplegia, while CC, CCT, and CRT remainedunchanged.In hypermetropic children, PD increased from 2.81 ± 0.29 mm to 4.59 ± 0.59 mm, and ACD increased from 2.79 ± 0.73 mm to 2.98 ± 0.19mm, with no significant changes observed in posterior segment parameters.

Conclusion: Cycloplegia significantly affects anterior segment parameters, particularly PD and ACD, in both myopic and hypermetropic children, while posterior segment measurements remain stable. These findings highlight the importance of cycloplegia in achieving accurate pediatric ocular assessments.

Comparison of Corneal Epithelial Thickness Mapping using Two Different Optical Coherence Tomography

Ayesha Bibi, Umair Asrar, Maria Akhtar, Waqas Ali, Arooj Zahid — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To assess agreement between corneal epithelial thickness maps obtained with MS-39 and Optovue Avanti OCT devices in healthy eyes, and to ascertain if their measures are interchangeable.

Study Design: Descriptive comparative study.

Place and Duration of Study: Amanat Eye Hospital, Rawalpindi from May 2025 to July 2025.

Methods: In this study, 123-eyes were scanned with MS-39 and Optovue. Central (0-2mm), paracentral (2-5mm) and mid-peripheral (5-7mm) epithelial thickness measurements were taken. The Shapiro-Wilk test was used to evaluate the normality of data. The pair measurements were compared using Wilcoxon signed-rank test. Reliability was determined with intraclass correlation coefficient (ICC) and agreement with Bland-Altman analysis. A p<0.05 value was considered statistically significant.

Results: Majority of variables were not normal. The Wilcoxon analysis revealed systematic differences between the devices. MS-39 recorded greater readings in paracentral and peripheral sectors, while Optovue reported higher central values. The overall agreement was good when averaging several measurements [ICC (3, K) = 0.823] and moderate for a single measurement [ICC (3,1) = 0.699]. Zone and sector-based analysis revealed highest agreement in the paracentral region, moderate agreement in the central zone, and the lowest in the mid-peripheral region.

Conclusion: Both MS-39 and Optovue provide reliable epithelial thickness measurements, but their results are not interchangeable. Optovue tends to overestimate central thickness compared to MS-39, while MS-39 yields higher peripheral values. Device-specific reference data should therefore be used in clinical practice, and switching between devices is not recommended in longitudinal follow-up or surgical planning.

Role of Family Physicians in the Early Detection and Management of Pediatric Ocular Misalignment and Visual Acuity Disorders

Suzan Amana Rattan — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To evaluate the knowledge, clinical practices, and referral approach of family physicians in Iraq regarding pediatric eye disorders, including ocular misalignments, amblyopia, and refractive errors, and to evaluate the adequacy of their training in managing these conditions.

Study Design: Cross sectional, observational study.

Place and duration of the study: Primary health care centers in Iraq, from March 2024 to March 2025

Methods: Atotal of 385 family physicians of different professional levels were enrolled in the study. They responded to a structured web-based questionnaire that addressed demographic data, clinical practice, management approaches, and self-assessment of ophthalmic training adequacy.

Results: There were 73.8% female, 55.3% medical 35.1% specialists, 35% residents and 9.7% consultants. Out of the total, 60% identified corrective glasses as treatment of refractive errors and 47.8% believed that refractive errorscan cause strabismus. Eye deviation was recognized as the key clinical indicator by 49.1% while 48.3% claimed amblyopia as the primary indicator. Glasses were selected by 57.7%as the preferred option for treating strabismus, while 5.2% believed that it can resolve spontaneously. For amblyopia, 64.2% prioritized occlusion therapy, yet only 20.8% preferred referral to an ophthalmologist.

Conclusion: Limited knowledge in the correlation between the three main pediatric eye diseases and a lack of confidence in referral and treatment decisions were observed raisingthe need for better training, confirming standardized referral pathways, and national screening programs.

Topical Beta Blockers versus Oral Beta Blockers for Treatment of Periocular Infantile Haemangioma

Zaib-un-Nisa, Humera Zafar Ali, Shabana Choudhary, Hamid Mahmood — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To determine the safety and efficacyyof topical versus systemic (oral) beta-blockersin the treatment of infantile hemangiomas involving periocular region at early proliferative stage.

Study Design: Quasi experimental study.

Place and Duration: This study was done at Paediatric Ophthalmology Department,College of AlliedVisionSciences, Mayo Hospital, Lahore from December 2020 to June 2021.

Methods: A total of 26 patients were divided into two groups. Group A was given oral beta blockers and Group B topical beta blockers for infantile hemangioma. Oral propranolol in the dose of 1mg/Kg twice daily was given to Group A and increased to 2mg/Kg twice daily after two weeks. In Group B Timolol maleate 0.05% solution was given to be rubbed on the affected skin for five seconds twice a day. Patients were monitored for any local or systemic adverse effects. Response of patients to therapy was observed for next four months. Before and after therapy,HemangiomaActivity Score was used to record the proliferative activity, change in size of lesion and color.

Results: The mean age of patients was 26.0± 14.5 months in group A and 25.4±12.0months in group B respectively. There was a significantimprovement in the Hemangioma Activity Score(P ˂ 0.001) within the same group after treatment. However, difference between the two groups was not statistically significant (P value 0.78).

Conclusion: In early proliferative stage of infantile hemangioma, oral and topical beta-blockers are equally effective.

Efficacy of topical 0.05% cyclosporine in Vernal Keratoconjunctivitis in children aged 5-15 years visiting outpatient department

Iqra Saeed; Muhammad Siddique, Hafiz Muhammad Waqas Zaman — Wed, 01 Jul 2026 00:00:00 +0000

Purpose:To assess the effectiveness and safety of short-term use of topical 0.05% cyclosporine in children with Vernal Keratoconjunctivitis (VKC).
Study Design: Quasi experimental study.

Place and Duration of Study: Sheikh Zayed Medical College and Hospital in Rahim Yar Khan from April 2025 to September 2026.

Methods: A Consecutive sampling was done to include 78 children of 5-15 years of age who had clinically identified VKC. The analysis involved one eye of each patient. They were treated with the topical cyclosporine 0.05% eye drops four times per day for one month. The severity of the disease was evaluated using a validated clinical scoring system that included symptoms and indicators at baseline and after one month. Treatment was considered effective if there was at least one point improvement in the total VKC score from baseline.

Results: There were 65.4% males. The total VKC score dropped significantly from the baseline of 10.0 [IQR: 8.0-13.0] to 4.0 [IQR: 2.0-6.0] after one month (p <0.001). Clinical improvement was noted in 69 patients (88.5%). No substantial differences in treatment response were observed based on age, gender, duration of symptoms, or daily computer usage. A mild, temporary burning sensation was observed in 7% of individuals.

Conclusion: Topical 0.05% cyclosporine provided substantial short-term therapeutic improvement and exhibited a positive safety profile in pediatric patients with VKC.Larger, randomized controlled trials with longer follow-up are needed to confirm these preliminary findings and to establish the long-term role of this treatment in VKC management.

Role of Mitomycin C in Primary Partial Nasolacrimal Duct Obstruction In A Pakistani Cohort at A Tertiary Care Hospital of Karachi

Nazia Qidwai, Muhammad Ashraf, Tauseef Mahmood, Anum Fatima, Mujahid Inam — Wed, 01 Jul 2026 00:00:00 +0000

Purpose:To assess improvement in epiphora after probing and syringing with diluted Mitomycin C in cases of primary partial NLDO at a tertiary care hospital of Karachi.

Study Design:Quasi Experimental study.

Place and Duration of Study:Isra Postgraduate Institute of Ophthalmology from January 2025 to June 2025.

Methods:Fifty patients diagnosed with primary acquired nasolacrimal duct obstruction (PANDO), aged above 18 years and of either gender, were included in the study. Probing was performed under local anesthesia using 0.5% proparacaine topical drops, followed by infiltration of 2% xylocaine with adrenaline around the medial canthus and beneath the periosteum. Patency was confirmed by syringing with normal saline. Subsequently, irrigation was conducted using 1 mL of mitomycin-C (0.2 mg/mL, single application), and nasal packing was maintained for 10 minutes to minimize systemic absorption. Follow-up examinations were conducted at 1 week, and then at 1, 2, and 3 months post-procedure.

Results: Of the 50 patients, 35 (70%) were female and 15 (30%) were male, with a mean age of 34.56 ± 6.88 years. The majority presented with grade 2 obstruction (n = 25, 50%), followed by grade 3 (n = 20, 40%). At the first-week follow-up, 8 (16%) patients showed mild improvement, 12 (24%) demonstrated moderate improvement, and 20 (40%) achieved complete relief of epiphora.

Conclusion: Probing with adjunctive mitomycin-C is a simple, cost-effective, and efficacious procedure for relieving epiphora secondary to nasolacrimal duct obstruction. It may delay the need for dacryocystorhinostomy (DCR)for a considerable period.

Evaluating the Results of Pterygium Excision with Cryotherapy

Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To evaluate the surgical outcomes, recurrence rates, and safety profile of pterygium excision combined with intraoperative cryotherapy.

Study Design: Quasi experimental study.

Place and Duration of Study: Layton Rahmatulla Benevolent Trust – LRBT, Karachibetween October 2024 and December 2025.

Methods: This study included 56 eyes of 56 patients presenting with primary or recurrent pterygium. All participants underwent surgical excision followed by application of a double freeze-thaw cryotherapy cycle to the scleral bed and exposed sclera was left uncovered for secondary healing. Visual acuity (VA) was assessed pre and postoperatively using Snellen charts and converted to LogMAR for statistical analysis. Patients were followed for a minimum of 6 months to monitor for recurrencedefined as fibrovascular regrowth >1 mm across the limbus, and other postoperative complications.

Results: The mean age of the study population was 50.27 ± 14.93 years, with a predominance of male patients (73.2%) and those residing in urban areas (80.4%). The procedure yielded a statistically significant improvement in mean LogMARVA, improving from 0.47 preoperatively to 0.45 at the 6-month follow-up (p < 0.001). The recurrence rate was 1.8% (n=1). The safety profile was 91.1%. The most common adverse event was transient inflammation (7.1%), with no incidence of severe complications such as scleral necrosis or granuloma formation.

Conclusion: Pterygium excision with adjuvant cryotherapy significantly reduces recurrence rates while improving visual outcomes. Given its low complication rate and avoidance of long-term toxicity associated with chemical antimetabolites, cryotherapy represents a valuable adjunctive treatment for ensuring ocular surface stability.

Comparison of Ocular Biometric Parameters at High Altitude vs Low Altitude

Erum Shahid, Muhammad Shahzaib, Uzma Fasih, Asad Raza Jafri — Wed, 01 Jul 2026 00:00:00 +0000

Purpose: To compare ocular biometric parameters inpatients of cataract at high and Low altitudes of Pakistan.

Study Design: Cross-sectional, comparative study.

Place and Duration of Study: KMDC, Karachi Metropolitan University from 1^stSeptember to 31^stDecember 2024.

Methods: Data of 100 patients was retrieved from a hospital 4meters above the sea Level for low altitude (Group L) and 100 from a place 2,438 meters abovethesealevelforhighaltitude(GroupH).Patientswithcornealopacities,pterygium,traumatic,andcongenitalcataractswereexcluded.Keratometryreadings(K1andK2),axiallength(AL),andintraocularlens(IOL)powerwerecomparedbetweenthetwogroupsusinganindependentsample t-test.

Results: Group H had a shorter mean AL (22.2±1.29 SD mm) compared to Group L (23.11±1.22SDmm) with a
p-value=0.000. Group L required a lower mean IOL power (21.64±3.3D) than Group H (24.69±3.61D)witha
p-valueof0.000.The mean K1 and K2 for Group H were43.14±1.8D and44.19±1.63D,respectively,while for Group L, they were 43.48±1.63D and 43.53±1.89D.FemalesexhibitedhighermeanK1andK2ascomparedto males. No significant difference was observed in mean AL and mean IOL power among genders.

Conclusion: Cataract patients at low altitude have longer AL and lower IOL power than those at high altitudes. These findings suggest that geographical altitude may influence ocular biometry and should be considered during preoperative assessment and IOL power calculation in cataract surgery.

Rhabdomyosarcoma of the Conjunctiva: A Case Report

Tanveer Chaudhry, Shaiza Qureshi, Maryam Qureshi, Waseem Asif, Neeta Maheshwary — Wed, 01 Jul 2026 00:00:00 +0000

Rhabdomyosarcoma is an uncommon, rapidly growing soft-tissue sarcoma that primarily affects the paediatric population. The most common sites of involvement are the head, neck, and orbit. Conjunctival involvement is rare. We report a 9-year-old boy who presented with a conjunctival lesion in his right eye. The lesion was surgically removed, and histopathological examination of the excisional biopsy specimen confirmed embryonal rhabdomyosarcoma. The patient subsequently received systemic chemotherapy locally and abroad. At 24 months follow-up, he showed good clinical recovery with scar tissue formation at the excision site and no evidence of recurrence. This case highlights the importance of considering rhabdomyosarcoma in the differential diagnosis of atypical conjunctival lesions in children, as prompt diagnosis and treatment may improve prognosis.

Long Standing Orbital Varix Successfully Managed with Intralesional Bleomycin Sclerotherapy: A Case Report

Anam, Anosha Khan, Marvi, P S Mahar — Wed, 01 Jul 2026 00:00:00 +0000

Varices are rare, congenital, abnormally dilated venous channels that may be found in conjunctivaor extend into the orbit. They may remain clinically silent for years before becoming symptomatic. Their management is challenging because of the lesion’s distensibility, potential for acute thrombosis, and surgical inaccessibility. We present a case of a 40-year-old male with a longstanding, progressively enlarging conjunctival mass and intermittent right-sided proptosis since childhood, exacerbated by Valsalva maneuvers. Visual acuity was 6/6 in both eyes. Slit-lampexamination revealed an irregular lobulated conjunctival lesionextending towards the superior fornix with peripheral corneal encroachment.Orbital CT demonstrated a low-flow venous malformation. Three monthly sessions of intralesional bleomycinresulted in marked reduction of lesion sizeand complete resolution of proptosis.Intralesional bleomycin sclerotherapy is a safe, minimally invasive, and effective treatment modality for orbital venous malformations, offering excellent cosmetic and functional outcomes while avoiding the morbidity of surgical excision.

Not Fungal After All: The Diagnostic Puzzle of Pythium Keratitis – First Case Report from Pakistan

Wed, 01 Jul 2026 00:00:00 +0000

Pythium keratitis, caused by the oomycete Pythium insidiosum, is a rare and emerging cause of vision-threatening corneal ulcers. Clinically, it mimics fungal keratitis but is unresponsive to conventional antifungal therapy.Microbiologically confirmed cases have been rarely reported from Pakistan. A corneal scraping from a patient under antifungal therapy for presumed fungal keratitis was submitted for microbiological evaluation. Inoculation onto blood agar and Mueller Hinton agar with 10% KOH and Lactophenol Cotton Blue (LCB) staining revealed white colonies. Microscopy demonstrated hyphae, sporangia, sporangiophores, and sporangiospores, confirming Pythium insidiosum. The corneal abscess leads to perforation for which emergency sclero-conjunctival flap was performed; however, this incidental finding highlights the importance of suspecting Pythium in refractory corneal ulcers.Ophthalmologists should consider corneal scrapings in non-responsive cases and recognize characteristic tentacle-shaped stromal infiltrates to guide early diagnosis and management.

Unilateral Absolute Open-Angle Glaucoma with Ocular Surface Disease in Juvenile Systemic Lupus Erythematosus: ACase Report

Chandra Prabaswara, Evelyn Komaratih, Yulia Primitasari, Ismi Zuhria — Wed, 01 Jul 2026 00:00:00 +0000

Systemic lupus erythematosus (SLE) is an autoimmune condition with many heterogeneous ocular manifestations while glaucoma is a rare sight-threatening disease, particularly in juvenile cases. We presenta case involving a 15-year-old girl with juvenile-onset SLE and vasculitis, developed unilateral absolute open-angle glaucoma with recurrent ocular surface disease. The patient presented with no light perception in the left eye, and severely elevated intraocular pressure (IOP) despite maximum medical therapy with her right eye unaffected. Anterior segment and retinal imaging demonstrated advanced open-angle glaucoma. The affected eye developed bullous keratopathy, recurrent hyphema, hemosiderosis, blepharitis, keratitis, and band keratopathy. Cyclocryotherapy was planned but deferred after the affected eye became painless. This is an unusual presentation of unilateral absolute glaucoma secondary to juvenile SLE, likely due to inflammatory and steroid-related effects, highlighting the need for multidisciplinary care to assist detection to avoid irreversible vision loss.

Prevalence of Refractive Errors and Amblyopia among Primary School Children in Eligible Arab Countries: A Systematic Review and Meta-analysis of Diagnostic Approaches

Marrwan Hisham Mohammed, Mustafa Tawfeeq Halboos, Noor Khamees Hamad — Wed, 01 Jul 2026 00:00:00 +0000

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Scopus, Science Direct, Embase, and Google Scholar were searched for studies published from 2016 to 2023. The search was intended to cover Arab countries; however, eligible school-based data were identified from only 10 countries. Studies including children aged 5–19 years and reporting myopia, hyperopia, astigmatism, or amblyopia were included. Data from 30 studies were analyzed. Random-effects models were used, and heterogeneity was assessed using I². The sample ranged from 276 to 444,259 children and a combined sample size of 491,985. The reported prevalence of overall refractive errors, including myopia, hyperopia, astigmatism, and amblyopia, ranged from 8.2% to 50.0%. The pooled prevalence was 6.7% for hyperopia, 8.4% for astigmatism, and 2.2% for amblyopia. Myopia ranged from 1.7% to 25.0% but was not pooled because of substantial heterogeneity in diagnostic methods, age groups, study settings, and refractive cut-off definitions.

Evaluating the Efficacy of Anti-VEGF versus Laser Therapy in Zone 1 & Zone 2 Retinopathy of Prematurity: A Systematic Review & Meta-Analysis

Fatrin Patrycia Salim, Rivaldo Steven Heriyanto, Regan Elbert — Wed, 01 Jul 2026 00:00:00 +0000

Database searches were conducted across PubMed, Science Direct, CENTRAL, and Scopus, up to December 6th, 2024, to evaluate efficacy of Anti-VEGF Versus Laser Therapy in Zone 1 & Zone 2 Retinopathy of Prematurity. Anti-VEGF treatment showed significant superiority in initial regression for zone 1 ROP (OR: 2.95; 95% CI: 1.55, 5.61; p = 0.001), however, in zone 2 ROP, there were no significant differences. (OR: 1.15 95%: 0.59, 2.24, p = 0.67). Zone 1 ROP treated with laser photocoagulation demonstrated increased odds of recurrence after initial treatment(OR: 2.23; 95% CI: 1.25, 4.00; p=0.007), compared to lower odds of recurrence in those treated with anti-VEGF in zone 2 ROP (OR: 0.73; 95% CI: 0.56, 0.94; p=0.01). There was no significant difference in favourable outcomes (OR: 0.58; 95% CI: 0.33, 1.02; p=0.06and OR: 0.54; 95% CI: 0.21, 1.40; p=0.21) in both zones.