An observational study on the presence of perilimbal conjunctival pigmentation in vernal keratoconjunctivitis

Purpose: To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC). Methods: A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon–Mann–Whitney U test and Chi square test. Results: Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%–61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (?2 = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12). Conclusion: Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/ limbal signs are elusive.

An inadvertent usage of the deep stromal lenticule in anterior lamellar keratoplasty – An emancipator technique

Anterior lamellar keratoplasty (ALK), of late, has gained popularity because of its prolonged graft survivability as a result of reduced endothelial cell loss. A 56-year-old female with bilateral granular corneal dystrophy was taken up for ALK in the left eye. Because of unforeseen errors during the procedure, the surgeon was obliged to customize a novel technique by using a deep stromal lenticule after removal of Descemet’s membrane. Post-op visual recovery was equivalent to conventional ALK with complete epithelization of the graft. This new or adapted technique has an added advantage for surgeons to prevent forfeiture of the valuable donor tissue. In the developing world, manual dissection is still the primary technique of lamellar keratoplasty and many precious corneas get wasted because of intra-operative unintended errors of dissection and trephination. Therefore, this novel technique holds its importance in saving the precious corneal tissue, especially in developing countries, and opens a new area for exploration.

Post-corneal transplant Candida keratitis – Incidence and outcome

Purpose: To report the risk factors, clinical characteristics, and outcomes of Candida keratitis following corneal transplantation in India. Methods: On retrospective review of medical records of 789 patients, 31 eyes developed a graft infection following corneal transplantation or keratoprosthesis and we could identify the Candida infection in only five. These cases were operated at two tertiary care centers in India. These five records were reviewed for demographics, risk factors (local and systemic) for graft infection, characteristics of infective lesion, corneal scraping results, treatment plan, and the final outcome following management. Results: The median age of the subjects with the Candida graft infection was 62.4 ± 10.33 years (range, 62–71 years). All patients were males. The predominant risk factors included repeat corneal transplantation (5/5), prolonged usage of topical steroids (5/5), and epithelial defects (4/5). The clinical characteristics included infiltrates of variable configuration like powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy. The smear showed budding yeasts in all five cases whereas culture was positive in four out of five cases. The final outcome with antifungals (systemic [4/5] and topical [5/5]) is variable. Two eyes underwent evisceration, two eyes had scar formation in the failed grafts, and one patient succumbed to the systemic disease 1?month post?corneal infection. Conclusion: Candida keratitis, in India, seems to be an emerging pathology following corneal transplantation and has a varied presentation. Though the outcomes following management seem to be grim, however, such infection can easily be avoided by a timely reduction of the risk factors.