Current Issues
Current Issues - Vol. 22, No. 2, April - June 2026
Al-Shifa Journal of Ophthalmology
Editorial:
Beyond the Slit Lamp and computers: The Healing Power of Eye Contact
Mahmood Ali
Comparison of 0.3% Nepafenac and 0.1% Nepafenac in Prevention of Cystoid Macular Edema After Uneventful Phacoemulsification
Hooria Khan, Muhammad Akmal Khan, Yaseen Lodhi, Marrium Shafi
Objective: To compare changes in mean central macular thickness (CMT) in patients receiving 0.3% nepafenac once nightly versus 0.1% nepafenac three times daily following uneventful phacoemulsification.
Methods: A randomized controlled trial was executed at the Ophthalmology Department of POF Hospital over six months from April 2025 to September 2025. A total of 130 patients, aged 50–80 years, were recruited using non-probability consecutive sampling and randomly allocated to either the 0.1% nepafenac or 0.3% nepafenac group (65 patients each). Preoperative CMT was assessed using optical coherence tomography (OCT). One group received 0.1% nepafenac three times daily, while the other received 0.3% nepafenac once nightly. Treatment began one day before surgery and continued for six weeks after uneventful phacoemulsification. Post-operative CMT was assessed by OCT at six weeks. Data were analyzed using SPSS version 25. Categorical variables were expressed as frequencies and percentages, continuous variables as mean ± standard deviation. Paired and independent sample t-tests were used, with p < 0.05 considered statistically significant.
Results: The mean age of participants was 69.61 years; 51.5% were male and 48.5% were female. Both regimens significantly reduced CMT at six weeks (mean pre-operative CMT: 235.69 μm; mean post-operative CMT: 231.17 μm; p < 0.001). However, there was no significant difference in post-operative CMT between the 0.1% nepafenac group (232.48 μm) and the 0.3% nepafenac group (229.86 μm; p = 0.848).
Conclusion: Both 0.1% and 0.3% nepafenac were equally effective in reducing CMT and preventing cystoid macular edema following uneventful phacoemulsification.
Ocular Trauma in Pakistan: Trends, Causes and Medicolegal Implications
Muhammad Imran Saleem Channar, Hafsa Malik, Maham Imran
Objective: To characterize the clinical profile and medicolegal classification of ocular trauma presenting to a tertiary care hospital in Pakistan.
Methods: A retrospective study of 340 medicolegal cases (MLCs) conducted at Bahawal Victoria Hospital, Bahawalpur, from March 2020 to August 2025. Clinical data was retrieved from electronic medical records. Injuries were classified using the Birmingham Eye Trauma Terminology (BETT) system and Section 335 of the Pakistan Penal Code (PPC). Primary outcomes included demographics, mode, severity of injury, and presenting visual acuity. Secondary outcomes were associated injuries and complications. Statistical analysis was done by SPSS version 25. The chi-square test was used to compare the categorical variables, p <0.05 was considered statistically significant.
Results: Males (mean age 35±15 years) predominated (289 cases, 85%). Fist blows were the most common mode (197 cases, 58%). Closed globe injury (CGI) occurred in 243 cases (71.5%), open globe injury (OGI) in 97 (28.5%). Associated injuries included adnexal trauma (67.1%), hyphema (32.9%), and orbital fractures (10%). Endophthalmitis developed in 31 (32%) OGI cases. Presenting visual acuity was ≥ 6/12 in 67.9% of the CGI group and 10.3% of the OGI group. Malingering was diagnosed in 24 cases (7.1%). Based on the PPC, 292 cases (85.9%) were classified as non-grievous hurt, 43 (12.6%) as Itlaf-i-salahiyyat-i-udw (permanent loss of visual function with the eyeball anatomically preserved), and 5 (1.5%) as Itlaf-i-udw (complete loss of the eyeball).
Conclusion: Assault-related ocular injuries predominantly affect young males. The high rate of endophthalmitis in open globe injuries (OGI) mandates timely referral and urgent treatment.
Frequency of Intermittent Distance Exotropia Among
Children
Amar Yasir Junejo, Ammara Zafar Taj, Atiya Fukhrul Hasan, Erum Habib, Muhammad Nizamuddin, Sidra Arshad Zaib, Salma Saleem
Objective: To determine the frequency of Intermittent Distance Exotropia (IDXT) among age groups and gender.
Methods: A retrospective cross-sectional study was conducted on all exotropic patients aged 1–15 years without prior strabismus surgery, who visited the Pediatric Ophthalmology Department of Civil Hospital Karachi from January 2021 to December 2022. Data was collected using consecutive sampling technique through manual records in which demographic data (name, visiting age, gender, family history, age of onset) and clinical details (visual acuity, Hirschberg test results, and CT outcomes) were collected to determine the frequency of IDXT. The Chi-square test and Mann-Whitney U-test were applied to analyze the data in SPSS version 25, with p < 0.05 was considered statistically significant.
Prevalence of Retinopathy of Prematurity in Premature Infants
Saad Ullah Maqsood, Faiza Anum, Mahwish Farooq, Shazra Azam
Objective: To find the prevalence of Retinopathy of Prematurity (ROP) in preterm infants and its relation to gestational age and gender.
Methods: The pediatric and ophthalmology departments of Sir Ganga Ram Hospital in Lahore worked together to carry out this descriptive cross-sectional study from July 30, 2022, to January 29, 2023. 160 preterm infants with a birth weight of less than 2000 g and a gestational age of fewer than 34 weeks were included in the study using consecutive non probability sampling. Follow-up sessions were arranged based on the severity of ROP after the initial eye test at 28 days of life. The data was analyzed in SPSS version 25. After stratification by gestational age and gender, the Chi-square test was used to find the connection, with p < 0.05 was considered statistically significant.
Results: Of the 160 preterm infants, 58 (36.3%) were female and 102 (63.7%) were male. The average gestational age was 31.5 ± 4.1 weeks, and the average birth weight was 1630 ± 13.2 g. ROP was present in 37 (23.1%) babies. No significant correlation was found between ROP and gestational age or gender.
Seal and Protect: Cefuroxime Stromal Hydration for Watertight Closure and Antibiotic Reservoir after Phacoemulsification
Zeeshan Hameed, Aqsa Baloch
Objective: To evaluate the efficacy of Cefuroxime stromal hydration over balanced salt solution (BSS) hydration for wound sealing and endophthalmitis prevention after phacoemulsification
Methods: A prospective quasi experimental study was conducted at H.M. Trust Hospital, Gujranwala from August 2025 to March 2026. 300 eyes with cataract up to NS+3 undergoing phacoemulsification were allocated 1:1 to stromal hydration with cefuroxime (Group A, n=150) or with BSS (Group B, n=150) via a prospective, consecutive non-probability sampling technique. Patients were assessed for Seidel test positivity, anterior chamber reaction, corneal haze, Toxic Anterior Segment Syndrome (TASS) and endophthalmitis. Data was analysed using SPSS version 26 using Mann-Whitney, Chi-square or Fisher exact test.
Results: Seidel positivity immediately post-surgery was in 6.0% in Group A vs. 7.3% in Group B (p=0.65). On day 1, No patient had positive Seidel in Group A vs. 3 patients in Group B (p=0.04). AC cells and flare were significantly lower in Group A on day 1, 3, 7, and 14. No TASS occurred in Group A vs. 2 cases in Group B on 1st postoperative day (p=0.16). Mean UCVA on day 7 was better in Cefuroxime group with faster speed of visual recovery. No endophthalmitis occurred in Group A vs. 1 case in Group B requiring intravitreal antibiotics (p=0.32).
Conclusion: Cefuroxime stromal hydration provides superior watertight closure and reduces postoperative inflammation. It offers a safe “Seal and Protect” dual-action alternative to BSS hydration during phacoemulsification.