Adaptive optics scanning laser ophthalmoscopy may support early diagnosis of glaucoma

Purpose: To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy (AOSLO). Methods: This was a cross-sectional pilot study with two groups: a glaucoma group with patients with moderate or severe glaucoma as per the Hodapp–Parrish–Anderson classification system and a control group with healthy individuals. The optic nerve damage in moderate glaucoma was predominantly located in only one hemisphere; the other hemisphere was un- or minimally affected on optical coherence tomography and automated perimetry and is referred to as early glaucoma. The structure of RNFL bundles and gain (%) in RNFL images with mean pixel values between 15 and 35 were analyzed. Imaging was performed one degree away from the optic disc margin at two and four cardinal clock positions in the glaucoma and control groups, respectively. The field of view was 1.3° at 2.3 ? resolution. We studied one eye per participant. Results: There were 11 glaucoma patients and 7 healthy controls. Imaging was successful at 88% of the locations in controls and early glaucoma; the reflectivity differed significantly (0.51 and 0.56, respectively, P < 0.001) but not the structure of RNFL bundles (Cohen’s Kappa 0.11) between them. In patients with moderate and severe glaucoma, imaging was successful only at 46% of the locations; RNFL bundles were not discernible, and RNFL reflectivity did not differ from those with early glaucoma (P < 0.11). Conclusion: The recorded gain (%) of RNFL images obtained using AOSLO could be an objective indicator of early glaucoma

Raman Spectroscopy of six explanted acrylic hydrophobic foldable intraocular lenses with glistening

Purpose: To study and interpret Raman spectra of six explanted acrylic hydrophobic foldable intraocular lenses (HFIOLs) with grade six microvacuoles and to understand the possible mechanism for microvacuole formation. Methods: Clinical data, slit-lamp photographs, and optical microphotographs of the explanted analytes were obtained. RS of the analytes were registered using a confocal Raman microscope (Lab RAM HR Evolution, Horiba Jobin Yvon) and Horiba Lab Space 6 Spectroscopy Suite software. Data were interpreted by identifying the functional group and fingerprint region of the spectra about the available literature. Results: IOLs were explanted for visual impairment after an average interval of 11.2 years following implantation. Each of the HFIOLs exhibited distinctive and identical Raman bands at the frequency range of 200–1,800, 2,600–3,000, and 3,200–3,700 cm?1 which were identified with those reported in the literature. The unique bands and peaks of the spectra were specific to the functional groups, its ring and other stretching variations, hydroxyl group, and water molecule. A spike at 1,640 cm?1 revealed the presence of monomer and indicated material bioincompatibility of the samples. Conclusion: Raman spectroscopy (RS) was found specific and an effective tool to detect the material change in the HFIOL and constituents of polymer biomaterial about microvacuole formation and also suggested modification and development of a more biocompatible and non-biodegradable polymer blend where RS could be a monitoring tool.

Bilateral sub-internal limiting membrane hemorrhage in a COVID-19 patient

Sub-internal limiting membrane hemorrhages, although uncommon, have been documented to occur in Valsalva retinopathy, blood dyscrasias, Terson syndrome, and ocular trauma. Due to their predilection for the macular region, they often lead to severe vision loss in young patients

Neuromyelitis optica spectrum disorder post-COVID-19 infection: A rare case report from Northeast India

Multiple sclerosis and neuromyelitis optica spectrum disorder may be seen in the acute setting of coronavirus disease 2019 (COVID-19) infection or even post-recovery. Such patients may present with optic neuropathy along with weakness in the back and lower limbs. Ascending paralysis can present with respiratory distress in acute COVID-19 infection and may even prove to be fatal. We report a unique case of a 16-year-old female with past history of COVID-19 infection having optic neuropathy, and radioimaging showing demyelinating plaques in the central nervous system with spinal cord edema. Serology showed positivity for rheumatoid arthritis, and the patient was managed with steroids and rituximab.

Transient myopia due to choroidal effusion: A novel ocular complication of COVID-19 infection

COVID-19 was declared as a global pandemic by the WHO in 2020. Although it is a respiratory virus, ocular complications and manifestations of the infection have been reported in different forms. We report a case of transient myopia and narrow angles due to choroidal effusion following infection by the SARS-COV-2 virus. We propose that the ability of the virus to incite an inflammatory response in the host body may be the mechanism behind the disease entity. This is a novel, previously undocumented ocular complication in case of a COVID-19 infection

Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India

Purpose: To assess the causes of visual impairment and blindness in children in all the schools for the blind in eight northeastern states and to determine its temporal trend, and to analyze the result with reference to various regional epidemiological data on childhood blindness in India. Methods: Children aged ?16 years, with a visual acuity of ?6/18 in the better eye, attending 17 schools for the blind were examined between November 2018 and March 2020. WHO protocol and reporting format was used for the evaluation, diagnosis, and classification of the causes. Results: Out of 465 eligible study participants, 93.76% were blind and only 12.26% of causes were avoidable. Anatomical causes of childhood blindness were whole globe (43.2%), cornea (17.20%), optic nerve (12.04%), retina (9.68%), and lens (9.46%). Etiological causes were unknown (52.69%), hereditary (26.02%), intrauterine (15.05%), and 26.08% had blinding congenital ocular abnormality (s). Regional temporal trend revealed a decrease in corneal and childhood causes and an increase in retina, optic nerve, hereditary, and intrauterine causes. Conclusion: A constellation of causes were differentiable but matched with the overall emerging trend of childhood blindness in India. Higher corneal, unavoidable, and unknown causes suggest a region?specific action plan for controlling childhood blindness as well as rehabilitation

Update on pathology of ocular parasitic disease.

Parasites are a group of eukaryotic organisms that may be free‑living or form a symbiotic or parasitic relationship with the hosts. Consisting of over 800,000 recognized species, parasites may be unicellular (Protozoa) or multicellular (helminths and arthropods). The association of parasites with human population started long before the emergence of civilization. Parasitic zoonotic diseases are prevalent worldwide including India. Appropriate epidemiological data are lacking on existing zoonotic parasitic diseases, and newer diseases are emerging in our scenario. Systemic diseases such as cysticercosis, paragonimiasis, hydatidosis, and toxoplasmosis are fairly common. Acquired Toxoplasma infections are rising in immune‑deficient individuals. Amongst the ocular parasitic diseases, various protozoas such as Cystoidea, trematodes, tissue flagellates, sporozoas etc. affect humans in general and eyes in particular, in different parts of the world. These zoonoses seem to be a real health related problem globally. Recent intensification of research throughout the world has led to specialization in biological fields, creating a conducive situation for researchers interested in this subject. The basics of parasitology lie in morphology, pathology, and with recent updates in molecular parasitology, the scope has extended further. The current review is to address the recent update in ophthalmic parasites with special reference to pathology and give a glimpse of further research in this field.

An interesting case of angiogenesis in cavernous hemangioma.

Cavernous hemangioma is the most common orbital tumor in adult. There is lot of literatures for clinicopathological features of this tumor. These tumors had been studied for the model of angiogenesis in many of the experimental setups. We present a case of 34‑year‑old male with this tumor in the left eye with computerized tomography evidence. Postsurgical laboratory findings gave interesting evidence of tumor angiogenesis with tumor endothelial cells and sprouting of the small vessels endothelial cells. Podosome rosette could be conceptualized from the characteristic patterns seen in the tumor.

IgG4‑related intraocular inflammation masquerading as ciliary body melanoma in a young girl.

Immunoglobulin G4 (IgG4‑related diseases) affects various tissues and organs of the human body. Orbital, adnexal, and scleral inflammations were already reported in the medical literature. To the best of our knowledge, we report the first case of intraocular IgG4‑associated inflammatory mass in the ciliary body mimicking as a melanoma in a 23‑year‑old female from Northeast India. Characteristic histopathology, immunohistochemistry in the tissue, protein chemistry, and raised serum IgG4 were supportive for the diagnosis. As this newly diagnosed disease has multi‑organ affection and little is known about its pathogenesis particularly in eye and adnexa, the present case will open many challenges in clinico‑pathological diagnosis and research in the future.

Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation.

We report a rare case of bilateral spontaneous anterior partial in‑the‑bag intraocular lens (IOL) dislocation in a 75‑year‑old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in‑the‑bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option.

The changing patterns of uveitis in a tertiary institute of Northeast India.

Uveitis incorporates innumerable conditions, all of which are characterized by inflammation of the uveal tract. Study of etiological factors in uveitis in the population often give important disease‑specific indications and changing pattern in subsequent studies are important to know further newer occurrences of various disease prevalence. Awareness of regional variation in disease configuration is essential to develop a region specific list of differential diagnoses and also for comparison with different sub‑population of the country and the world. We report the changing pattern of uveitis in a tertiary institute in the Northeast India and found that tubercular uveitis had increased in hospital‑based study.

Ocular involvement in tumoral calcinosis.

We report a 32-year-old male who presented with blurring of vision in the right eye since 1.5 years. He had history of swelling over the extensor surfaces of large joints which were migratory in nature. Few of them spontaneously subsided following suppuration of chalky white discharges except over the gluteal region. Ophthalmological examination revealed visual acuity of counting fi ngers (CF) at 1 m in the right eye and perilimbal conjunctival calcifi c deposits and retinal angiod streaks in both eyes. There was choroidal neovascular membrane with subretinal hemorrhage in right eye, confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). B scan ultrasonography and simultaneous vector A scan detected calcifi cation of the subretinal neovascular membrane and the adjoining sclera.

A new rosette in retinoblastoma.

Retinoblastoma, the most common primary malignant intraocular tumor of childhood is a great success story in pediatric and ocular oncology. Pathology of retinoblastoma is important to guide the treatment modalities. Diff erentiated retinoblastoma is commonly seen in younger age group. Since a hundred years, we have been observing two typical true rose􀄴 es in retinoblastoma in the form of Flexner-Wintersteiner (FW) and Homer Wright (HW) rose􀄴 es and in many occasions pseudorose􀄴 es have been documented. In the present case report, a third new type of rose􀄴 e was identifi ed in a diff erentiated retinoblastoma which had an unusual anterior segment involvement.

Liquefied after cataract and its surgical treatment.

Aims: To describe liquefi ed after cataract (LAC) and its surgical management following an uneventful phacoemulsifi cation with posterior chamber in-the-bag intraocular lens (IOL) implantation and continuous curvilinear capsulorrhexis (CCC). Design: Interventional case series. Materials and Methods: Eleven patients with LAC, following uneventful phacoemulsifi cation with CCC and in-the-bag IOL implantation were enrolled. After the basic slit lamp examination, each case was investigated with Scheimpfl ug photography and ultrasound biomicroscopy (UBM). Each case was treated with capsular lavage. Biochemical composition of the milky fl uid was evaluated and ring of anterior capsular opacity (ACO) was examined under electron microscope. Results: All 11 cases presented with blurring of vision after 6-8 years of cataract surgery with IOL implantation. All cases had IOL microvacuoles, 360° anterior capsule, and anterior IOL surface touch along with ACO, ring of Soemmering, and posterior capsule distension fi lled with opalescent milky fl uid with whitish fl oppy or crystalline deposits. Biochemically, the milky fl uid contained protein (800 mg/dl), albumin (100 mg/dl), sugar (105 mg/dl), and calcium (0.13%) and was bacteriologically sterile. Histologically, the dissected ACO showed fi brous tissue. All cases were successfully treated with capsular lavage with good visual recovery and with no complication. There was no recurrence of LAC during 2 years postoperative follow-up in any of the cases. Conclusions: LAC is a late complication of standard cataract surgery. It may be a spectrum of capsular bag distension syndrome (CBDS) without shallow anterior chamber and secondary glaucoma. Capsular bag lavage is a simple and eff ective treatment for LAC and a safe alternative to neodymium-doped y􀄴 rium aluminum garnet (Nd-YAG) capsulotomy.

Comparative analysis of use of porous orbital implant with mucus membrane graft and dermis fat graft as a primary procedure in reconstruction of severely contracted socket.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2‑4 Krishna’s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed‑up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Comparison on testability of visual acuity, stereo acuity and colour vision tests between children with learning disabilities and children without learning disabilities in government primary schools.

Context: Children with learning disabilities might have difficulties to communicate effectively and give reliable responses as required in various visual function testing procedures. Aims: The purpose of this study was to compare the testability of visual acuity using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) and Cambridge Crowding Cards, stereo acuity using Lang Stereo test II and Butterfly stereo tests and colour perception using Colour Vision Test Made Easy (CVTME) and Ishihara’s Test for Colour Deficiency (Ishihara Test) between children in mainstream classes and children with learning disabilities in special education classes in government primary schools. Materials and Methods: A total of 100 primary school children (50 children from mainstream classes and 50 children from special education classes) matched in age were recruited in this cross‑sectional comparative study. The testability was determined by the percentage of children who were able to give reliable respond as required by the respective tests. ‘Unable to test’ was defined as inappropriate response or uncooperative despite best efforts of the screener. Results: The testability of the modified ETDRS, Butterfly stereo test and Ishihara test for respective visual function tests were found lower among children in special education classes (P < 0.001) but not in Cambridge Crowding Cards, Lang Stereo test II and CVTME. Conclusion: Non verbal or “matching” approaches were found to be more superior in testing visual functions in children with learning disabilities. Modifications of vision testing procedures are essential for children with learning disabilities.