Creatively tiding over the crisis

Background: A patient with a retained intraocular metallic foreign body post?trauma was taken up for vitrectomy and intraocular foreign body removal. Unfortunately, the intraocular magnet was not available at the moment on the table! How a little bit of creativity and innovative thought helped us tide over this crisis is the content of this video. Purpose: To demonstrate magnetization of a metallic surgical instrument for temporary use in the event of unavailability of the intraocular magnet for intraocular foreign body removal. Synopsis: A ferromagnetic substance can be magnetized temporarily using an existing magnet. We obtained a general?purpose magnet and wrapped it in sterile plastic, using which we magnetized normal intraocular forceps and a Micro Vitreo Retinal (MVR) blade by giving about 20–30 strokes over the magnet in a single direction. This aligned the magnetic domains in the metal in a parallel fashion. These Do It Yourself (DIY)? magnetic instruments were then effectively utilized to remove the metallic intraocular foreign body. Highlights: The video showcases effectively harnessing the available resources and tiding over the dearth of a necessary instrument, with the right use of an innovative idea and some creativity!.

Plug it, fill it and forget it!

Background: Management of posterior scleral perforation is commonly done with cryotherapy/laser or scleral patch graft depending on the size of perforation. However, for large perforations, the availability of donor sclera is always an issue. To overcome this problem, we tried using absorbable gelatin sponge to plug the perforation as an alternative. Purpose: To evaluate the efficacy of gelatin foam as an alternative to scleral patch graft in cases with perforation of posterior sclera. Synopsis: Here we report the case of a 27?year?old male, who sustained penetrating injury to right eye with two metallic intraocular foreign bodies with visual acuity of hand movement close to face. Primary wound repair was done, followed by retrieval of the first piece of metallic foreign body that measured 11X3mm in size. The second foreign body visualized at posterior pole adjascent to the disc was removed using Machemar forceps and it measured 10X3 mmin size. Leakage of PFCL at the site confirmed a posterior scleral perforation. Cryotherapy was avoided due to its proximity to optic nerve head, and donor sclera was not readily available at that moment. We managed the case by plugging the defect with absorbable gelatin foam, followed by silicone oil injection into the vitreous cavity. Post operative outcome was good with restoration of anatomical integrity of the globe along with improvement in visual acuity upto 6/18. Highlights: Gelatin foam being absorbable and inciting less reaction aids in sealing the perforation and maintenance of globe contour with the advantage being readily available, cost?effective and it can be left in situ without the need for additional surgery for its removal. This would be of use in situations where the donor sclera is not readily available, and thus can be a potential alternative. However, further studies with larger sample size need to be done to evaluate and compare its effectiveness over donor scleral grafts

Not-so-minimal for minimally invasive surgery

Sub?macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub?macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r?tPA) followed by air/SF6 injection into the sub?retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub?macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub?retinal space prior to the r?tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self?sealing properties. An air injection prior to r?tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.

Coats’ disease – Prognostic factors for globe and vision salvage in children, a long-term experience

Coats’ disease is associated with poor outcomes, and there are limited studies on long?term outcomes of Coats’ disease. The purpose of our study is to identify various predictive factors to help in prognosticating the treatment outcomes in advanced Coats’ disease in children. Methods: This is a retrospective case series from a single tertiary eye care center of children (<18 years) diagnosed with coat’s disease. Sixty?seven patients with Coat’s disease were identified from the medical records from 2009 to 2020. Patients’ demographic data, clinical presentation, stage, extent of involvement, detailed treatment history, clinical sequelae post?treatment (including complications and anatomical and functional outcomes) were noted. Binary logistic regression was performed to correlate the predictive factors for anatomical and functional improvement. Results: Of the 67 patients, 51 eyes of 51 patients were included in the study. The male to female proportion was 2.2. Mean age at presentation was 4.98 ± 3.55 years (range: 2 months–15 years). Mean duration of follow?up was 31.53 ± 26.38 months. Overall, our globe salvage rate was 92.2%. We found that vitreoretinal fibrosis (P < 0.001), subretinal gliosis (P < 0.001), vitreous hemorrhage (P = 0.02), tractional or combined retinal detachment (P < 0.001), foveal scar (P < 0.006), and cataract (P < 0.001) to be important factors to affect the outcome. Conclusion: Advanced stage of presentation (stage 3B and above), diffuse involvement, cataract, vitreoretinal fibrosis (preretinal and subretinal), vitreous hemorrhage, tractional or combined retinal detachment, and anterior hyaloid proliferation are poor prognostic factors for globe salvage in advanced disease. Subretinal gliotic nodule or scar and lack of visual rehabilitation suggest poor functional outcomes

Effect of lanosterol on human cataract nucleus.

Aim: To study the effect of lanosterol on age‑related cataractous human lens nuclei. Materials and Methods: Forty age‑related cataractous nuclei removed during manual small incision cataract surgery were obtained and randomly immersed in 25 mM lanosterol solution or in control solution and stored at room temperature for 6 days. Pre‑ and post‑immersion photographs were graded by two masked observers and collated for the regression or progression of lens opacity. Results: Both lanosterol and control groups showed progression or no change in the lens opacity at the end of 6 days. Conclusion: Lanosterol 25 mM solution did not reverse opacification of human age‑related cataractous nuclei.

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment.

Purpose: To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Design: Retrospective interventional case series. Materials and Methods: Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013. Results: Primary retinal re‑attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow‑up of 6.7 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Vascular tumors of the choroid and retina.

Vascular tumors of the retina and choroid can be seen occasionally. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.

Brachytherapy, A viable option of globe salvage in treatment of large ciliary body melanocytoma.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15‑year‑old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non‑resectable melanocytoma of the ciliary body.

Brachytherapy, A viable option of globe salvage in treatment of large ciliary body melanocytoma.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15‑year‑old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non‑resectable melanocytoma of the ciliary body.

Fundus imaging with a mobile phone: A review of techniques.

Fundus imaging with a fundus camera is an essential part of ophthalmic practice. A mobile phone with its in‑built camera and flash can be used to obtain fundus images of reasonable quality. The mobile phone can be used as an indirect ophthalmoscope when coupled with a condensing lens. It can be used as a direct ophthalmoscope after minimal modification, wherein the fundus can be viewed without an intervening lens in young patients with dilated pupils. Employing the ubiquitous mobile phone to obtain fundus images has the potential for mass screening, enables ophthalmologists without a fundus camera to document and share findings, is a tool for telemedicine and is rather inexpensive.