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).

Wernicke encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency. Though the classical triad of confusion, ataxia, and ophthalmoplegia is well-known, ocular presentations may be subtle or atypical.We report the case of a 49-year-old male admitted to the intensive care unit following an intra-abdominal leak post-Whipple procedure. He received total parenteral nutrition (TPN) for prolonged fasting. After a month, he developed bilateral visual blurring without pain or redness. Examination revealed horizontal gaze-evoked nystagmus, bilateral optic disc swelling, and peripapillary haemorrhages. Brain CT was normal, but neurological signs including ataxia and confusion emerged, prompting a clinical diagnosis of Wernicke encephalopathy. He received high-dose intravenous thiamine with subsequent improvement in vision and resolution of optic disc findings.Blurred vision may be an early ocular manifestation of Wernicke encephalopathy. This case highlights the need for high clinical suspicion and prompt thiamine supplementation in at-risk patients, even without full-blown encephalopathy.

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.

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.

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.

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.

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.

Purpose: To determine the effectiveness of temporary keratoprosthesis in facilitating successful combined penetrating Keratoplasty and vitreoretinal surgery. Study Design: Retrospective interventional case series. Place and Duration of Surgery: Department of Ophthalmology, Peshawar Medical College, from January 2020 and December 2023. Methods: A retrospective study was conducted which included 15 patients who underwent combined penetrating Keratoplasty and temporary keratoprosthesis-assisted vitreoretinal surgery. Data for pre and postoperative visual acuity, IOP, retinal attachment and graft status were obtained from hospital records. Surgical success was determined by the presence of a clear corneal graft, stable retinal attachment, normal intraocular pressure, and maintained or improved visual acuity. Data was analyzed using SPPS version 24. An independent test was employed to compare continuous variables between patients with successful and unsuccessful surgical outcomes. Results: A total of 15 cases with mean age of 39.27 ± 15.88 years were included in this study. Visual acuity improved in 33.3% of cases, worsened in 13.3%, and remained stable in 53.3%. Postoperative corneal opacity occurred in 73.3% of patients, while 26.7% retained a clear graft. Functional vision was achieved in approximately 40% of the cases while only 13.3% were considered surgical success. Conclusion: Complete surgical success was attained in only a minority of cases, and functional vision was achieved in less than half of the patients. Graft failure was the predominant postoperative complication, while corneal laceration with posterior segment pathology was the most frequent surgical indication.

Cataract is one of the leading causes of reversible blindness worldwide.1 In Pakistanreversible blindnessdue to cataract remains the leading cause due to increase in aging population, poverty and comparatively lesser surgical facilities.2The prevalence of cataract blindness was higher in women than men (1.80% versus 1.67%, p<0.001). The prevalence of cataract causing <6/60 in eyes was 5.0% (95% CI 4.7%, 5.2%), which projects to an estimated 3 560 000 eyes with a visual acuity of <6/60 caused by cataract in Pakistan (year 2003). This number was projected to increase to 7380 000 by the year 2020.3