Antibiotic prophylaxis for cataract surgery - Practice patterns amongst Indian Ophthalmologists

Purpose: To assess the current trends in use of perioperative antibiotic prophylaxis, especially intracameral antibiotics (ICAB), for cataract surgery in India. Methods: This was an E?survey using a previously validated questionnaire carried out by the All India Ophthalmological Society (AIOS) in August 2022. An E?mail invitation to complete an online 40?point survey was sent to all members of the AIOS using a digital E?mail service (Survey Monkey) and social media platforms. Results: Out of 1804 total respondents, 58% (n = 1022) reported using routine ICAB prophylaxis. Of those using ICAB, 89% (n = 909) reported using it for all cases, whereas the rest used it for specific indications such as post?PC rent (n = 43), one eyed patient (n = 19), and high?risk cases (n = 50). Commercially available moxifloxacin was by far the commonest agent used for ICAB (n = 686, 67%). Eighty respondents (8%) reported noticing occasional toxic reactions and nontoxic corneal edema (n = 64, 6%) with ICAB. Surgeons with >10 years� experience especially practicing in medical colleges used fewer ICAB (OR = 0.52, 95%CI = 0.38 � 0.72, P < 0,001) compared to younger surgeons (<5?year experience) in solo clinics. The commonest reason for nonadoption of IC antibiotics was 搖nconvinced of the need to use it in my setting� (n = 296, 52% of those who answered this question). Conclusion: IC antibiotic prophylaxis for cataract surgery has significantly increased in India from 40% in 2017 to 58% in 2022. Commercially available moxifloxacin was preferred by the majority users. Intraocular inflammation may occur occasionally and needs safer formulations to avoid this

Study 3: Anterior segment optical coherence tomography-guided surgical approach in slipped medial rectus muscle

Purpose: To discuss the novel swept?source anterior segment optical coherence tomography (SS?ASOCT)?guided surgical approach in slipped medial rectus muscles. Methods: Prospectively (between February 2020 and July 2022), six patients with a clinical suspicion of slipped medial rectus muscle were recruited. After complete ophthalmic and orthoptic evaluation, the missing medial rectus muscle is screened using Anterior Segment Optical Coherence Tomography (ASOCT). In presence of a traceable muscle, its morphology, depth, and distance from a fixed anatomical landmarks were noted; in its absence, the status of other recti was noted. Intraoperatively, the features were confirmed and the intended intervention was performed. Results: The mean age of six patients was 25.66 ± 9.72 years, two with surgical trauma and four with penetrating trauma (66.66%). In five patients, the ASOCT traced the slipped medial rectus muscle successfully (83.33%); intraoperatively, the same was confirmed (within 1–2 millimeters) with favorable outcomes. ASOCT made a significant contribution in all subjects by reducing the number of interventions and muscle surgeries. Conclusions: In eyes with slipped medial rectus muscle, especially those which are within a finite distance from the angle can be traced using ASOCT. This approach impacts the outcomes in many ways

Prevention and management of childhood progressive myopia: National consensus guidelines

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.

Virological and cytological changes in tears and conjunctiva of patients with COVID-19

Purpose: To analyze the presence of severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) in tears/conjunctival epithelium and assess the cytomorphological changes in the conjunctival epithelium of coronavirus disease 2019 (COVID?19) patients. Methods: In this pilot study, patients with moderate to severe COVID?19 were recruited from the COVID ward/intensive care unit of the institute. Tears and conjunctival swabs were collected from COVID?19 patients and sent to the virology laboratory for reverse transcription polymerase chain reaction (RT?PCR) testing. Conjunctival swabs were used to prepare smears, which underwent cytological evaluation and immunocytochemistry for SARS?CoV?2 nucleocapsid protein. Results: Forty?two patients were included. The mean age of participants was 48.61 (range: 5–75) years. Seven (16.6%) patients tested positive for SARS?CoV?2 ribonucleic acid in tears samples, four (9.5%) of which were positive on conjunctival swab by RT?PCR in the first test. Cytomorphological changes were observed significantly more in smears from patients with positive RT?PCR on tear samples, including bi?/multi?nucleation (p = 0.01), chromatin clearing (p = 0.02), and intra?nuclear inclusions (p < 0.001). One case (3.2%) showed immunopositivity for SARS?CoV?2; this patient had severe disease and the lowest Ct values for tear and conjunctival samples among all positive cases. Conclusion: Conjunctival smears from patients with COVID?19 revealed cytomorphological alterations, even in the absence of clinically significant ocular infection. However, viral proteins were demonstrated within epithelial cells only rarely, suggesting that although the conjunctival epithelium may serve as a portal for entry, viral replication is possibly rare or short?lived.

Outcomes of preloaded toric intraocular lens implantation in eyes undergoing phacoemulsification

Purpose: To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. Methods: This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow?up. Results: At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow?up (P < 0.001, Wilcoxon signed?rank test). The mean refractive cylinder improved from ? 1.56 ± 1.25 D preoperatively to ? 0.12 ± 0.31 D at 3 months follow?up (P < 0.001) while the mean spherical equivalent value changed from ? 1.93 ± 3.71D preoperatively to ? 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 ?m while the average contrast sensitivity value (Pelli?Robson chart) was 1.56 ± 0.10 log unit, at the final follow?up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow?up. There were no intraoperative or postoperative complications. Conclusion: SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability

Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.

Anterior lens capsule: Biological drape

Small perforations are often managed with cyanoacrylate glue - bandage contact lens (BCL). An additional layer with substances like sterile drape often enhances the strength of the glue. Herein, we describe a novel method of using anterior lens capsule as biological drape to secure perforation. The anterior capsule was secured from femtosecond laser–assisted cataract surgery (FLACS) and placed over the perforation after folding it twice. The area was dried and a small aliquot of cyanoacrylate glue was applied over it. The BCL was applied over it after the glue was dry. In our series of five patients, none of them needed repeat surgery and all cases healed by three months without vascularization. It is a unique technique to secure small corneal perforations.

Cataract surgery outcomes in pediatric patients with systemic comorbidities

Purpose: The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Methods: Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary?care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle?corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Results: Thirty patients with a mean age of 55 months (9 months–14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary?care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down’s syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan’s syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2?year follow?up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow?up. Around 70% of the parents reported improvement in their child’s psychomotor skills. Conclusion: Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Executive function performance in middle-aged adults / Desempenho da função executiva em adultos de meia-idade

ABSTRACT. Executive functions have been widely studied in the extreme of ages, but studies in middle-aged adults remain largely neglected. Education and gender are known to influence cognitive performance; however, their effect on executive function in middle-aged adults remains unclear. Objective: The study aimed to observe the effect of hierarchy of educational qualifications (graduate, postgraduate, and PhD) and gender on various executive function tests across middle-aged adults with or without comorbidity. Methods: A total of 66 middle-aged individuals volunteered for the study (mean age=48.45±5.45 years; 20 graduates, 28 postgraduates, and 18 PhD; 36 males and 30 females; 38 healthy adults and 28 adults with comorbidities). Each subject performed a test assessing short-term memory, spatial working memory, and multitasking abilities on the Cambridge Neuropsychological Test Automated Battery with rest periods in no specific order of tests. Key parameters of cognitive tests were analyzed for differences in educational qualifications (ANOVA), gender (t-test), and the effect of comorbidity as a covariate (ANCOVA). Results: PhDs performed significantly better (p<0.05) in multitasking than graduates and had superior visuospatial working memory (fewer errors). Differences in simultaneous matching abilities, lower incongruence cost and multitasking cost were statistically significant in healthy females than in males. Conclusion: On considering adults with comorbidity, those with higher educational attainment retained the ability to multitask compared to their healthy counterparts, which was not seen in the group with lower educational attainment. Thus, higher educational attainment attenuated the influence of comorbidities and deterioration of executive functions in general in middle-aged adults.

RESUMO. As funções executivas têm sido amplamente estudadas no extremo das idades, mas os estudos na meia-idade permanecem amplamente negligenciados. Educação e gênero são conhecidos por influenciar o desempenho cognitivo, no entanto, seu efeito na função executiva em adultos de meia-idade ainda não está claro. Objetivo: O estudo teve como objetivo observar o efeito da hierarquia de qualificações educacionais (graduação, pós-graduação e doutorado) e gênero em vários testes de função executiva em adultos de meia-idade com ou sem comorbidade. Métodos: Sessenta e seis indivíduos de meia idade se voluntariaram para participar do estudo (idade média=48,45±5,45 anos, 20 graduados, 28 pós-graduados e 18 doutores; 36 homens e 30 mulheres; 38 saudáveis e 28 adultos com comorbidades). Cada sujeito realizou um teste avaliando memória de curto prazo, memória de trabalho espacial e habilidades multitarefa na Bateria Automatizada de Testes Neuropsicológicos de Cambridge (Cambridge Neuropsychological Test Automated Battery — CANTAB) com períodos de descanso em nenhuma ordem específica de testes. Os principais parâmetros dos testes cognitivos foram analisados quanto às diferenças nas qualificações educacionais (ANOVA), sexo (teste t) e efeito da comorbidade como uma covariável (ANCOVA). Resultados: Os doutores tiveram desempenho significativamente melhor (p<0,05) em multitarefa do que os graduados e tiveram memória de trabalho visual-espacial superior (menos erros). As diferenças nas habilidades de correspondência simultânea, menor custo de incongruência e custo de multitarefa foram estatisticamente significativas em mulheres saudáveis do que em homens. Conclusão: Ao considerar os adultos com comorbidade, aqueles com maior escolaridade mantiveram a capacidade de multitarefa como seus pares saudáveis, o que não foi observado no grupo com menor escolaridade. Assim, maior escolaridade atenuou a influência de comorbidades e deterioração das funções executivas em geral, em adultos de meia-idade.

Intraoperative optical coherence tomography-guided donor corneal tissue assessment and preparation

Purpose: To evaluate the role of intraoperative optical coherence tomography (i?OCT) in donor grading, selection, and preparation during different types of keratoplasty. Methods: Seventy?one consecutive donor corneas collected over 6 months, after clinical grading, were observed by an experienced corneal surgeon under an i?OCT equipped microscope. The donor preparation (manual/automated) for different types of keratoplasty procedures was also undertaken under i?OCT. Results: The mean central corneal thickness of optical and nonoptical grade tissues was 533 ± 19 and 662 ± 52 ?m, respectively. The i?OCT?based grading matched with clinical grading in 98.5% cases. Irregular thickness, anterior stromal hyperreflectivity, and previous scars were appreciated in 1.4, 1.4, and 7.04% donors, respectively. During Descemet stripping automated endothelial keratoplasty, i?OCT facilitated selection of appropriate microkeratome head for automated donor preparation in all cases, besides allowing manual dissection of partially dissected lenticule, identification of site of inadvertent perforation, and eccentric trephination in one case each. During Descemet membrane endothelial keratoplasty, i?OCT?based assessment of preexisting scar (five cases) guided careful tissue selection (2/5) and preparation. During predescemetic endothelial keratoplasty, precise needle advancement allowed successful type?1 bubble formation in all cases. All manually punched donors demonstrated an extra endothelial ledge, while those with automated preparation showed tapering donor margins. Conclusion: i?OCT might serve as a useful imaging tool for objective assessment of donor characteristics. The modality may complement clinical evaluation for donor grading, selection, and preparation.

Kissing microvitreoretinal blade technique: A novel approach for safe and effective endocapsular lens aspiration in microspherophakia

We herein describe the kissing MVR technique in cases of microspherophakia for safe and effective endocapsular lens aspiration. Microspherophakia is associated with abnormally lax and broken zonules, which pose a great challenge to the operating surgeon, especially while creating the openings in the capsular bag. In this novel technique, simultaneous use of two 23 G MVR blades reduces the above problem associated with the severely mobile lens. Here, one MVR blade stabilizes the capsular bag and, at the same time, provides counter-traction for the opposite MVR blade while puncturing the capsular bag. Furthermore, the creation of openings in the lens at the equator or just posterior to it is beneficial as the capsule is relatively thicker and stronger at this location. This also minimizes the risk of premature extension to the anterior or posterior capsule, thereby avoiding complications like dropped lens matter, vitreous prolapse, and vitreous traction.

Preferred practice pattern for Descemet membrane endothelial keratoplasty surgeries: A survey of Indian corneal surgeons

Purpose: This study aims to assess the preferred surgical technique of Descemet membrane endothelial keratoplasty (DMEK) among corneal surgeons in India, and barriers in performing DMEK surgeries amongst the non?DMEK surgeons. Methods: An online, questionnaire-based, cross-sectional survey was conducted among members of the Cornea Society of India (CSI) (n = 500). Responses on their surgical experience, preferred technique, complications, and outcome of DMEK were collected and analyzed. Barriers in performing DMEK surgeries were assessed amongst the non?DMEK surgeons. Results: A total of 100 responses were obtained and response rate for the survey was 20%. DMEK was performed by 55% of the participants of whom only 40% had formal training in this technique. Surgical video-based learning was the most often used self-training method for others. Lack of training was the most common reason for not performing DMEK by the non-DMEK surgeons. Descemet stripping endothelial keratoplasty (DSEK) was the most common endothelial keratoplasty (EK) performed by both DMEK and non-DMEK surgeons. High volume (>50 cases) DMEK surgeries were reported by limited surgeons (n = 6). Nearly all the DMEK surgeons prepared the donor tissue by themselves on the day of the surgery, and majority felt that unrolling the graft in the anterior chamber was the most difficult surgical step. Nearly 80% of the DMEK surgeons were more comfortable with DSEK or Descemet stripping automated endothelial keratoplasty (DSAEK) when compared to DMEK. Conclusion: DMEK practice in India needs improvement with increased accessibility to DMEK training programs, wet lab facilities, and better support from eye banks

Outcomes of surgical intervention in cases of ectopia lentis

Purpose: To evaluate the outcomes of surgical intervention in cases of ectopia lentis. Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra?operative and post?operative complication, and specular count were recorded. Results: Seventy?eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra?lenticular lens aspiration was the most common (n?62/78; 79.5%) surgical procedure followed by lens aspiration, intra?capsular cataract extraction, phaco?aspiration, and pars?plana lensectomy. Simultaneous intra?ocular lens (IOL) implantation was performed in 46.2% (n?32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow?up. The post?operative CDVA was significantly better in the pseudo?phakic group compared to the aphakic group (p?0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra?operative complication included vitreous hemorrhage (n?1) and lens matter drop (n?1). Post?operative complications were noted in 26.9% of the eyes (n?21/78) with a higher complication rate in the pseudo?phakic group (p?0.00). A second intervention was required in 7.7% of the eyes (n?6/78). Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.

Ocular manifestations in Kindler syndrome

We aimed describe the chronic ocular sequelae of Kindler syndrome. All cases of Kindler syndrome with ocular involvement that presented to a tertiary eye care center were included. Three cases of Kindler syndrome with ocular changes were reviewed. Case 1 (10 years, female) had recurrent epithelial breakdown with severe dry eye and corneal opacity secondary to keratitis. Case 2 (28 years, male) had symblepharon , ocular surface keratinization , and severe dry eye. Case 3 (16 years , female ) had partial limbal stem cell deficiency with dry eye. All cases were treated with topical lubricants, short course of low?potency steroids and immuno?modulators. Attention must be paid to the eye in addition to the oro?an?genital mucosa to avoid longterm ocular sequelae

Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center

Purpose: To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years. Methods: It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed. Results: Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase?negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non?fermenting gram?negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram?negative isolates were susceptible to carbapenems and polymyxin B. Conclusion: To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.

Management of descemetocele: Our experience and a simplified treatment algorithm

Purpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye?care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow?up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non?perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non?functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Validating the use of U-tool as a novel method for measuring the corneal diameter in infants screened for congenital glaucoma

Purpose: The Castroviejo caliper is routinely used for measuring the corneal diameter in patients with primary congenital glaucoma, but needs an examination under anesthesia (EUA) or sedation. A simple U?shaped tool was devised to aid in the estimation of the corneal diameters of patients in settings where an ophthalmic caliper is not available or EUA is not feasible. Methods: Infants presenting to the congenital glaucoma clinic posted for EUA were recruited. The demographic details of the patients such as age, sex, and diagnosis were noted. A simple U?shaped tool was devised using three Schirmer strips or a printable ruler. Before the patient underwent a EUA, the corneal diameters were measured using the U?tool. During EUA, corneal diameters were measured using the Castroviejo caliper. Results: The mean age of infants was 6.7 ± 3.39 months (R = 1–12). The mean corneal diameter measured using the U?tool was 13.29 ± 1.33 mm and with Castroviejo caliper was 13.18 ± 1.39 mm. The difference between the corneal diameters measured using the two techniques was ?0.114 mm with the Bland–Altman plot 95% Limits of agreement (LoA) from ?0.965 to 0.737 mm. Corneal diameters measured with both instruments had a good correlation (Pearson’s correlation coefficient = 0.95, P < 0.001). Conclusion: U?tool can be used for screening congenital glaucoma by first?contact physicians or optometrists. It can also be used by ophthalmologists when EUA is delayed

Surgical outcomes of concomitantly performed penetrating keratoplasty with intrascleral haptic fixation

Purpose: To describe the surgical results of concomitantly performed optical penetrating keratoplasty (PKP) with glued intrascleral haptic fixation (ISHF). Methods: Retrospective review of 18 patients (15–72 years) with best?corrected visual acuity (BCVA) of ?1/60 subjected to unilateral concomitant optical PKP with ISHF and followed up for 13.11 ± 5.83 months (6–26 months) was undertaken. Results: The most common diagnoses were failed PKP (9/18, 50%) followed by aphakic bullous keratopathy (5/18, 27%). Preoperative glaucoma, peripheral anterior synechiae (PAS), and deep vascularization were present in 7/18 (38.88%), 12/18 (61.11%), and 5/18 (27.77%) patients, respectively. Intraoperatively, concomitant procedures such as pupilloplasty and intraocular lens explant were undertaken in 5/18 (27.277%) patients and 1/18 patients (5.55%) experienced suprachoroidal hemorrhage. At final follow?up, BCVA was ?6/60 in 50% patients (mean astigmatism: 4.79 ± 1.68D), and 55.55% cases experienced graft failure (90% failed within one year of surgery). The most common causes of graft failure were glaucoma (50%), glaucoma with rejection (20%), rejection (10%), retinal detachment (10%), and suprachoroidal hemorrhage (10%). The ODDS ratio (OR) of having graft failure with the following factors was postoperative secondary interventions (OR: 6), postoperative complications (OR: 2.25), prior failed graft (OR: 1.8), preoperative PAS (OR: 1.75), intraoperative concomitant procedures (OR: 1.5), preoperative glaucoma (OR: 1.33), previous surgeries (OR: 1.24), and deep corneal vessels (OR: 0.66). Conclusion: All patients underlying PKP combined with glued ISHF must be counseled about suboptimal surgical outcomes. Emphasis is laid on appropriate case selection and stringent follow?up during the first year after surgery. Secondary interventions should be undertaken cautiously and judiciously in these patients

Documentation, Ethno-botanical and Ethno-medicinal Survey of Wild Leguminous Plants from Some Areas of District Rajouri, J&K State, India

Aim: To explore and collect data about ethno-botanical and ethno-medicinal uses of wild leguminous plants, growing in three tehsils of district Rajouri. Study Design: Data about the various wild leguminous plants growing in the study area was gathered from the local people with the help of a self designed questionnaire. Place and Duration of Study: Three tehsils (Nowshera, Sunderbani and Rajouri) of district Rajouri were visited for complete 2 year i.e. March 2012 to March 2014. Methodology: Periodic field trips were conducted in rural and mountainous areas of the study area. During these trips, personal interviews were conducted with locals of the study area. These included the nomads (Gujjars and Bakkarwals), livestock rears, elderly community members, traditional healers and practitioners. These people were specifically interviewed for the traditional knowledge about legumes. Results: A total of 51 species of family Fabaceae were collected from the study areas. These species cover an altitudinal gradient of 426-1015 masl and are known by different local names. Out of the 51enlisted legume species, only 43 were found to carry immense ethno-botanical and ethno-medicinal importance. Conclusion: Legumes are of huge importance to human beings. The plants species enlisted and studied in the present communication represent low priced and regionally available quality nutrition for the local people. Detailed work is needed on the same aspect that will further enhance our understanding about the medicinal and nutritional values of ethno-botanically and ethno-medicinally important plant species of the family Fabaceae.

Recent advances in diagnosis and management of Mycotic Keratitis.

Mycotic keratitis is a major cause of corneal blindness, especially in tropical and subtropical countries. The prognosis is markedly worse compared to bacterial keratitis. Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. Over the last decade, considerable progress has been made to rapidly diagnose cases with mycotic keratitis and increase the efficacy of treatment. This review article discusses the recent advances in diagnosis and management of mycotic keratitis with a brief discussion on rare and emerging organisms. A MEDLINE search was carried out for articles in English language, with the keywords, mycotic keratitis, fungal keratitis, emerging or atypical fungal pathogens in mycotic keratitis, investigations in mycotic keratitis, polymerase chain reaction in mycotic keratitis, confocal microscopy, treatment of mycotic keratitis, newer therapy for mycotic keratitis. All relevant articles were included in this review. Considering the limited studies available on newer diagnostic and therapeutic modalities in mycotic keratitis, case series as well as case reports were also included if felt important.