Systemic and ocular outcomes in TB-immunoreactive patients receiving immunomodulatory therapy for non-infectious uveitis: a case-control study.

BACKGROUND: Tuberculosis (TB)-immunoreactivity, measured in vivo (tuberculin skin test (TST)) or in vitro (interferon gamma release assay (IGRA)), can be found in latent, active or even following clearance of TB infection. In this case-control study, we compared the systemic and ocular outcomes between patients with or without TB-immunoreactivity, who received immunomodulatory therapy (IMT) for non-infectious uveitis. METHODS: We retrospectively reviewed charts of patients with (cases) or without (controls) TB-immunoreactivity (TST±IGRA), who received conventional IMT for ≥6 months, for the treatment of non-infectious uveitis. Patients who received prior or concomitant anti-TB therapy were excluded. Systemic and ocular outcomes were compared between both groups. RESULTS: 36 cases and 70 controls (gender-matched and age-matched) were included. New-onset pulmonary or extrapulmonary TB developed in one case and none of the controls. Based on this outcome, the absolute risk increase for systemic TB reactivation was noted to be 0.028 (95% CI 0.005 to 0.051) and the number needed to harm was 36. The incidence of persistent or recurrent (worsening ≥2 grades) intraocular inflammation during IMT was comparable between both groups (cases 18/36, controls 35/70, p=1.0). A change in anatomical site of presentation at recurrence was not seen in any case, but in six controls (p=0.15). No new focal chorio-retinal lesions were noted in either group. CONCLUSIONS: Conventional IMT has a very low risk of systemic TB reactivation, and no additional detrimental effect on ocular outcomes, in TB-immunoreactive patients with non-infectious uveitis.

Repeatability, reproducibility and agreement between three different diagnostic imaging platforms for tear film evaluation of normal and dry eye disease.

PURPOSE: To assess the repeatability and reliability of different commercially available diagnostic platforms in the objective assessment of tear film parameters and if there exists any agreement between them. METHODS: Thirty healthy individuals (N = 60 eyes) and fifteen DED patients (N = 30 eyes) had their tear film parameters (Lipid layer thickness (LLT), Tear meniscus height (TMH), Non-invasive tear break up time (NIBUT)) assessed using three instruments - LipiView® II, IDRA ocular surface analyser (IDRA-OSA) and Oculus keratograph 5 M (K5M). Bland-Altman analysis and linear mixed effects modelling & Generalized Linear Hypothesis Test were used for analysis and coefficient of variation (CoV). RESULTS: There is poor repeatability but good reproducibility of LLT values measured with Lipiview, or IDRA. NIBUT using K5M & IDRA-OSA shows good repeatability and reproducibility in control group but poor repeatability in DED patients. TMH values obtained with K5M or IDRA-OSA had poor repeatability with high CoV. Between two observers, good reproducibility is observed for TMH and NIBUT values using both K5M & IDRA-OSA but not for LLT values. Between instruments, all the measurements (LLT, NIBUT and TMH) were significantly different on Bland Altman analysis. CONCLUSION: No two dry eye diagnostic platforms can be used interchangeably and non-invasive tear film values should be interpreted keeping in mind the individual machine's variability. The high coefficient of variation in DED patients compared to normal reflects inherent variability in tear film irrespective of the device used.

Long-term outcomes and risk factors for failure of glaucoma filtering surgery in eyes with vernal keratoconjunctivitis and steroid-induced glaucoma.

PURPOSE: To report outcomes and assess the risk factors for failure of trabeculectomy (trab), trabeculectomy with mitomycin-C (trabMMC), and combined trabeculectomy with cataract extraction (CT) in vernal keratoconjunctivitis (VKC) eyes with steroid-induced glaucoma (SIG). METHODS: Trab was performed in 45 eyes of 30 subjects, trabMMC in 36 eyes of 25 subjects, and CT in 34 eyes of 27 subjects. Success was complete when intraocular pressure (IOP) was between 6 and 21 mm Hg without anti-glaucoma medications (AGM) and qualified with AGM. RESULTS: Median age (14 vs. 16.3 and 17.4 years) was significantly less in the trab cohort (P = 0.007). Majority (88%-93%) were male (P = 0.78). Preoperatively, median duration of steroid usage was >2 years (P = 0.52), mean IOP (32, 29.4, and 28.4; P = 0.26) and median cup:disc ratio (CDR) (0.9; P = 0.27) were similar in the three groups. Complete success (76%, 71%, and 66% at 5 years; P = 0.91), and qualified success (88%, 97%, and 94% at 5 years; P = 1.0) with trab, trabMMC, and CT, respectively, were similar. Preoperative factors significantly associated with qualified failure (multiple logistic regression) were older children, longer duration of VKC, longer duration and mixed type of steroid use (all P < 0.001) and larger CDR (P < 0.02). At the last follow-up, 38% in trab, 33% in trabMMC, and 50% eyes in CT were blind (visual acuity ≤20/400 and/or visual field ≤10°) due to glaucoma (P = 0.33). CONCLUSION: The surgical success for all three types of surgery was similar at 5-years. Chronic VKC and long-term steroid use were associated with surgical failure. The majority had advanced disease and a significant proportion were blind due to glaucoma.

Estimation of Goldmann applanation tonometer intraocular pressure (IOP) from scleral Schiotz IOP values in eyes with type-1 keratoprostheses.

PURPOSE: To validate estimation of Goldmann applanation tonometer (GAT) intraocular pressure (IOP) from scleral Schiotz IOP measurements using a regression model in normal eyes and eyes with type-1 keratoprostheses. METHODS: In this prospective cross-sectional study, cohort-1 had 253 normal anterior segment eyes, and cohort-2 had 100 eyes with type-1 keratoprostheses. Scleral Schiotz IOP measurements were used (in a non-linear model) to predict GAT IOP values for these eyes. Accuracy of predicted GAT IOP values was assessed using actual GAT IOP values for normal eyes, while for type-1 keratoprosthetic eyes, finger tension (FT) IOP assessments by an experienced glaucoma specialist were used. Primary outcome was agreement between FT IOP (assessed by an experienced glaucoma specialist) and predicted GAT IOP-derived clusters. RESULTS: The actual values of GAT IOP measurements in normal eyes (n=253; mean age ±SD, 51.35±15.56 years) ranged between 6 mm Hg and 62 mm Hg (mean=22±10.05 mm Hg). Estimated and actual GAT IOP values for normal eyes were very similar (mean difference=0.05 mm Hg with limits of agreement: -5.39 to 5.5 by Bland-Altman plot). Of the 100 eyes with type-1 keratoprostheses, 68 were classified as having digitally normal IOP, 28 as borderline and 4 as high. The agreement between classification by FT assessment and model-predicted GAT IOP values was substantial (Kappa=0.81, 95% CI 0.69 to 0.93). The accuracy of the model in assessing IOP was found to be 91% (95% CI 0.84 to 0.96). CONCLUSION: Scleral Schiotz IOP values along with our predictive model can be an alternative objective method to FT IOP in assessing IOP in eyes with type-1 keratoprostheses.

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure.

PURPOSE: To evaluate the outcomes of trabeculectomy in the eyes with neovascular glaucoma (NVG), caused by proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO), and ocular ischemic syndrome (OIS). METHODS: A retrospective review of NVG eyes that underwent trabeculectomy between 1991 and 2019. Complete success was defined as intraocular pressure (IOP) between 6 and 21 mmHg without antiglaucoma medications (AGM). The risk factors were analyzed by Cox's proportional hazard model. RESULTS: The study included 100 eyes of 100 subjects with a mean age of 58 ± 9.8 years and a median follow-up of 1.27 years (interquartile range: 0.63, 2.27). The cause of NVG was PDR in 59 eyes (59%), CRVO in 25 eyes (25%), and OIS in 16 eyes (16%). Trabeculectomy with mitomycin-C was performed in 88 eyes and trabeculectomy in 12 eyes. The cumulative complete success probability of trabeculectomy in PDR was 50% (95% confidence interval [CI]: 38, 65) at 1 year, 8% (1, 46) at 3-5 years. In OIS, it was 64% (43, 96) from 1 to 5 years. In CRVO, it was 75% (59, 94) at 1 year, 45% (23, 86) from 2 to 5 years. The PDR was associated with a higher risk of surgical failure compared to OIS (P = 0.04) and CRVO (P = 0.004). Other significant risk factors were increasing age (P = 0.02), persistent neovascularization of iris (NVI) (P = 0.03), higher number of anti-vascular endothelial growth factor (VEGF) injections prior to trabeculectomy (P = 0.02), and delay in performing trabeculectomy (P = 0.02). CONCLUSION: Compared to CRVO and OIS, the eyes with NVG secondary to PDR had poor success with trabeculectomy. Older age, persistent NVI, need for a higher number of anti-VEGF injections, and delayed surgery were associated with a higher risk for trabeculectomy failure.

Safety and efficacy of paediatric silicone Ahmed glaucoma valve (AGV) in adult eyes with post-VR surgery glaucoma.

PURPOSE: To compare the safety and efficacy of the FP8 AGV (paediatric) with the standard FP7 AGV in adult post-vitreoretinal (VR) surgery glaucoma. METHODS: We included 45 consecutive eyes with post-VR surgery glaucoma implanted with either FP8 (n = 28) or FP7 (n = 17) AGV between 2008 and 2016. The data analysed included visual acuity (VA), intraocular pressure (IOP), complications, interventions, and outcomes. RESULTS: Mean age (p = 0.24), mean baseline VA (p = 0.77), preoperative IOP (p = 0.41), number of antiglaucoma medications (p = 0.92), and previous surgeries (p = 0.16) were comparable in the two groups. The number of eyes with previous belt buckle was significantly higher (p < 0.001) in the FP8 group (17/28) compared with the FP7 group (2/17), indicating space constraint and scarred conjunctiva. The median follow-up (25th, 75th percentile) was 14.7 (9.1, 25.3) months in the FP7 and 9.8 (6.4, 34.7) months in the FP8 groups (p = 0.62). Postoperatively, the median VA (p = 0.24), the mean IOP at final follow-up (p = 0.15), and median number of AGM (p = 0.99) were comparable in both the groups. The median percentage drop in IOP (95% confidence interval) with the FP7 implant was 55% (43.70%) and with FP8 implant was 53.8% (25, 73), (p = 0.20). None in the FP7 group failed, while three eyes in the FP8 group failed. During the study period, two eyes in the FP8 group had tube exposure that was surgically managed. None of the eyes had implant exposure or loss of light perception. CONCLUSION: Use of the paediatric FP8 AGV in adult post-VR surgery glaucoma eyes with severe conjunctival scarring and limited subconjunctival space resulted in reasonable IOP control compared with the standard FP7 AGV implant. There were no eyes with implant extrusion.

Comparison of peripapillary and subfoveal choroidal thickness in normal versus primary open-angle glaucoma (POAG) subjects using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT).

OBJECTIVE: To elucidate the difference between choroidal thickness (CT) in primary open-angle glaucoma (POAG) and normal subjects and to compare the CT measured using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT). METHODS AND ANALYSIS: This cross-sectional observational study included 25 eyes of 17 POAG subjects (cases) and 31 eyes of 20 normal subjects (controls). All the patients underwent complete ophthalmologic examination, enhanced depth imaging, SD-OCT and SS-OCT. In both controls and cases, the CT was measured in seven predetermined points in macular and peripapillary area and were compared. RESULTS: Choroid was significantly thicker on SS-OCT compared with SD-OCT in peripapillary and macular area in both cases and controls, except for inferior peripapillary in controls. The CT was not different from glaucoma and controls in peripapillary or macular area on SD-OCT (p>0.05), however, the CT was significantly thicker in glaucoma compared with controls in peripapillary area on SS-OCT (p<0.05) except inferior peripapillary (p=0.13). There was good intraobserver (±20 µm) and interobserver (±55 µm and ±45 µm) agreement on both SD-OCT and SS-OCT respectively.On SD-OCT, choroid was thinnest at the temporal peripapillary and thickest at subfoveal location in controls. In POAG, choroid was thinnest at inferior peripapillary region and thickest (500 µm) nasal to the fovea. On SS-OCT, choroid was thinnest at inferior peripapillary and thickest at the temporal peripapillary area in both cases and controls. CONCLUSION: CT measurements on SS-OCT were higher than the SD-OCT measurements possibly due to better delineation of the sclerochoroidal junction on SS-OCT. CT was significantly thicker in glaucoma subjects compared with controls in peripapillary area on SS-OCT but not in macular area.

Schiotz Scleral Intraocular Pressure Readings Predict Goldmann Applanation Readings Better Than Rebound Tonometry.

PURPOSE: To study the agreement between scleral intraocular pressure (IOP) measurements using the Schiotz, Icare, and Icare PRO tonometers versus Goldmann applanation tonometer (GAT) in eyes with nonscarred corneas. METHODS: This cross-sectional study included 83 eyes of 55 subjects. The order of IOP estimation was the corneal GAT, followed by ICare, ICare PRO, and Schiotz on the corneal and temporal sclera. The agreement between different tonometers and the 95% limits of agreement (LoA) were assessed using Bland-Altman plots. The repeated measures correlation coefficient was calculated between GAT IOP and scleral Schiotz IOP, and the 95% confidence intervals were calculated by the bootstrap method. The linear mixed effects model was used (adjusted for both eyes of the subjects) to generate an equation to predict GAT IOP from scleral Schiotz IOP. The prediction model was validated with new data from 60 eyes. Statistical analyses were performed using "R" software (version 3.3.2). RESULTS: Comparing the scleral IOP measurements, the mean IOP difference (95% LoA) was the lowest with Schiotz, underestimating by -1.21 mm Hg (7.32, -9.74). Both ICare and ICare PRO significantly overestimated GAT IOP: ICare, 24.6 mm Hg (53.2, -3.97); and ICare PRO, 21.56 mm Hg (52.9, -9.79). The correlation coefficient between scleral Schiotz and GAT IOP was 0.92 (95% bootstrap confidence interval: 0.89, 98). The derived predictive equation was (Equation is included in full-text article.). The mean difference between the predicted GAT IOP and the actual GAT IOP was 0.96 mm Hg with narrow LoA (+1.79, -3.71), validating the prediction model. CONCLUSIONS: Among the tonometers tested, the scleral IOP measurements with Schiotz had the best agreement with the GAT although LoA were wide. The predictive equation may have great potential to predict GAT IOP from scleral IOP readings in eyes with scarred/prosthetic corneas.

Dysbiosis in the Gut Bacterial Microbiome of Patients with Uveitis, an Inflammatory Disease of the Eye.

Uveitis (UVT), an inflammatory disease of the eye significantly contributes to vision impairment and blindness. Uveitis is associated with systemic infectious and autoimmune diseases, but in most cases, the aetiology remains unidentified. Dysbiosis in the gut microbiome has been implicated in autoimmune diseases, inflammatory diseases, cancers and mental disorders. In a mice model of autoimmune UVT, it was observed that manipulating the gut microbiome reduces the inflammation and disease severity. Further, alterations in the bacterial gut microbiome and their metabolites were reported in UVT patients from a Chinese cohort. Hence, it is worth comparing the bacterial gut microbiome of UVT patients with that of healthy controls (HC) to ascertain whether dysbiosis of the gut microbiome has implications in UVT. Our analyses showed reduced diversity of several anti-inflammatory organisms including Faecalibacterium, Bacteroides, Lachnospira, Ruminococcus and members of Lachnospiraceae and Ruminococcaceae families, and enrichment of Prevotella (proinflammatory) and Streptococcus (pathogenic) OTUs in UVT microbiomes compared to HC. In addition, decrease in probiotic and antibacterial organisms was observed in UVT compared to HC microbiomes. Heatmap and PCoA plots also indicated significant variations in the microbiomes of UVT versus HC. This is the first study demonstrating dysbiosis in the gut bacterial communities of UVT patients in an Indian cohort and suggests a role of the gut microbiome in the pathophysiology of UVT.

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months.

Purpose: To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age. Methods: This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures. Results: Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36-84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50-0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60-1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03). Conclusion: Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.

Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma.

PURPOSE: To report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma. METHODS: Lensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure. RESULTS: Median (IQR) age at lensectomy was 12 (6-18) years, and median spherical equivalent was -14.5D (-23.7to -13). Median follow-up was 30.6 (5.4-103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6-1.8) to 0.4 (0.2-1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17-31) to 14 mm Hg (11-19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2-3) to 1 (0-2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure. CONCLUSION: Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.

Effect of Adjunctive Pars Plana Vitrectomy on Focal Posterior Segment Inflammation: A Case-Control Study in Tuberculosis-Associated Uveitis.

PURPOSE: Pars plana vitrectomy (PPV) is commonly performed for managing complications of uveitis but the anti-inflammatory potential of PPV has not been extensively investigated beyond aqueous/vitreous inflammation. We studied the effect of PPV on resolution of focal posterior segment lesions in tuberculosis-associated uveitis (TBU). DESIGN: Case control study. PARTICIPANTS: Patients with bilateral TBU and active retinal/choroidal lesions in both eyes, and who received PPV in one eye were included. Fellow eyes of same patients, matched for patient characteristics and systemic therapy, were designated as controls. METHODS: Study eyes received 3-port 23-guage PPV, involving removal of nearly the entire vitreous. Part of vitreous sample was used for quantitative polymerase chain reaction (qPCR) for Mycobacterium tuberculosis. Post-operatively, anti-TB and/or systemic corticosteroid therapy was initiated depending on level of clinical suspicion of tubercular etiology, degree of intraocular inflammation and qPCR results. Focal lesions were documented in preoperative and postoperative fundus diagrams. Clinical photographs were taken whenever adequate media clarity was present. MAIN OUTCOME MEASURES: Primary outcome measures were rate of clinical resolution of focal posterior segment lesions and improvement in best-corrected visual acuity (BCVA), at 1 month post-surgery. RESULTS: Thirty-six patients with bilateral posterior segment lesions consistent with TBU were included. Possible and probable TBU (depending on radiographic evidence of TB) were diagnosed in 28 (77.7%) and 4 (11.1%) patients respectively, whereas remaining 4 patients were diagnosed only on basis of qPCR results. Focal posterior segment lesions included retinal vasculitis (n = 27), multifocal-serpigenoid choroiditis (n = 5), multifocal choroiditis (n = 3) and focal choroiditis (n = 1). At one month postvitrectomy, 28 eyes (73.7%) showed complete resolution of focal posterior segment lesions compared to 7 non-vitrectomised eyes (19.4%), while improvement in BCVA was significantly more in study eyes (0.38 logarithm of the minimum angle of resolution [logMAR], P = 0.04), compared to controls (0.12 logMAR, P = 0.17). Time to resolution following vitrectomy was unaffected by duration of disease, pre-operative systemic steroids or grade of vitritis. At 3 months, complete resolution was noted in 29 of 30 study eyes (96.7%) and 25 of 30 control eyes (83.3%). CONCLUSIONS: PPV facilitates faster resolution of focal posterior segment inflammation and BCVA improvement in TBU.

Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children.

PURPOSE: Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children. DESIGN: Retrospective observational study. METHODS: We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age. RESULTS: Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001). CONCLUSION: This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.

Differential Expression of Stem Cell Markers in Ocular Surface Squamous Neoplasia.

Ocular Surface Squamous Neoplasm (OSSN) is the neoplasia arising from the conjunctiva, cornea and limbus. OSSN ranges from mild, moderate, severe dysplasia, carcinoma in situ (CIS) to squamous cell carcinoma (SCC). Recent findings on cancer stem cells theory indicate that population of stem-like cell as in neoplasia determines its heterogeneity and complexity leading to varying tumor development of metastatic behavior and recurrence. Cancer stem cell markers are not much explored in the cases of OSSN. In the present study, we aim to evaluate the expression of stem cells using stem cell markers mainly p63, ABCG2, c-KIT (CD117) and CD44 in OSSN tissue, which could have prognostic significance. The present study tries for the first time to explore expression of these stem markers in the cases of OSSN. These cases are subdivided into two groups. One group comprises of carcinoma in situ (n = 6) and the second group comprises of invasive carcinoma (n = 6). The mean age at presentation was 52 years; with 53 years for CIS group and 52 years for SCC group. From each group section from the paraffin block were taken for the IHC staining of p63, c-Kit, ABCG2 and CD44. Our experiments show high expression of P63 and CD44 in the cases of CIN and SCC. Both CIS and SCC displayed positive staining with p63, with more than 80% cells staining positive. However minimal expression of c-kit in both CIN and SCC. But surprisingly we got high expression of ABCG2 in cases of carcinoma in situ as compared to that of invasive squamous cell carcinoma. More than 50% of cells showed CD44 positivity in both CIS and SCC groups. Our results show for the first time that these four stem cells especially the limbal epithelium stem cells play a vital role in the genesis of OSSN but we need to explore more cases before establishing its clinical and biological significance.

Choroidal Infiltration by Retinoblastoma: Predictive Clinical Features and Outcome.

PURPOSE: To identify the clinical features predictive of choroidal infiltration by retinoblastoma on histopathology and to report the outcome in these patients. METHODS: Retrospective study. RESULTS: Of the 403 patients who underwent primary enucleation for retinoblastoma, 113 patients had choroidal tumor infiltration and 290 patients had no choroidal tumor infiltration. There was a higher incidence of metastasis and related death in the choroidal tumor infiltration group compared to the no choroidal tumor infiltration group (4% vs 1%; P = .02). On multivariate analysis, the clinical features predictive of histopathologic massive choroidal infiltration included prolonged duration of symptoms for more than 6 months (hazard ratio [HR] = 3.04; P = .001) and secondary glaucoma (HR = 2.24; P = .005). CONCLUSIONS: In this study, the patients with retinoblastoma with prolonged duration of symptoms (> 6 months) had a three-fold greater risk and those with secondary glaucoma at presentation had a two-fold greater risk of massive choroidal tumor infiltration. [J Pediatr Ophthalmol Strabismus. 2016;53(6):349-356.].

Prognosis of eyelid sebaceous gland carcinoma based on the tumor (T) category of the American Joint Committee on Cancer (AJCC) classification.

The purpose of this study was to evaluate the clinical features and prognosis of eyelid sebaceous gland carcinoma (SGC) based on the T category of the American Joint Committee on Cancer (AJCC) classification (7th edition). This is a retrospective interventional case series study. Based on the T category of the AJCC classification, 191 patients with eyelid sebaceous gland carcinoma were classified as T1 (n = 1, 1 %), T2 (n = 111, 58 %), T3 (n = 76, 40 %), and T4 (n = 3, 2 %). Based on multivariate analysis, the factors predictive of regional lymph node metastasis included duration of symptoms >6 months (p = 0.04) and orbital tumor extension (p < 0.001). The factors predictive of systemic metastasis included orbital tumor extension (p < 0.001) and perivascular invasion (p = 0.007). The factor predictive of death due to systemic metastasis included orbital tumor extension (p < 0.001). Kaplan-Meier estimates of regional lymph node metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 11 and 11 % for T2, 44 and 59 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of systemic metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 6 and 6 % for T2, 35 and 35 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of death due to metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 3 and 3 % for T2, 30 and 50 % for T3, and 100 and 100 % for T4 (p < 0.001). Primary tumor (T) category of the AJCC classification predicts the prognosis of patients with eyelid SGC. The risk of systemic metastasis and death increases with increasing tumor category.

Autologous simple limbal epithelial transplantation for unilateral limbal stem cell deficiency: multicentre results.

PURPOSE: To report outcomes of autologous simple limbal epithelial transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) at multiple centres worldwide. METHODS: In this retrospective, multicentre, interventional case series, records of patients who had undergone autologous SLET for unilateral LSCD, with a minimum of 6 months of follow-up, were reviewed. The primary outcome measure was clinical success, defined as a completely epithelised, avascular corneal surface. Kaplan-Meier survival curves were constructed and survival probability was calculated. A Cox proportional hazards analysis was done to assess association of preoperative characteristics with risk of failure. Secondary outcome measures included the percentage of eyes achieving visual acuity of 20/200 or better, percentage of eyes gaining two or more Snellen lines and complications encountered. RESULTS: 68 eyes of 68 patients underwent autologous SLET, performed across eight centres in three countries. Clinical success was achieved in 57 cases (83.8%). With a median follow-up of 12 months, survival probability exceeded 80%. Presence of symblepharon (HR 5.8) and simultaneous keratoplasty (HR 10.8) were found to be significantly associated with a risk of failure. 44 eyes (64.7%) achieved a visual acuity of 20/200 or better, and 44 eyes (64.7%) gained two or more Snellen lines. Focal recurrences of pannus were noted in 21 eyes (36.8%) with clinical success. CONCLUSION: Autologous SLET is an effective and safe modality for treatment of unilateral LSCD. Clinical success rates and visual acuity improvement are equal to or better than those reported with earlier techniques.

OPTIC NERVE INFILTRATION BY RETINOBLASTOMA: Predictive Clinical Features and Outcome.

PURPOSE: To identify the clinical features predictive of any optic nerve infiltration and postlaminar optic nerve infiltration by retinoblastoma on histopathology and to report the outcome (metastasis and death) in these patients. METHODS: Retrospective study. RESULTS: Of the 403 patients who underwent primary enucleation for retinoblastoma, 196 patients had optic nerve tumor infiltration (Group 1) and 207 patients had no evidence of optic nerve tumor infiltration (Group 2). Group 1 included patients with prelaminar (n = 47; 24%), laminar (n = 74; 38%), and postlaminar tumor infiltration with or without involving optic nerve transection (n = 74; 38%). Comparing Group 1 and Group 2, the patients in Group 1 had prolonged duration of symptoms (>6 months) (16% vs. 8%; P = 0.02) and were associated with no vision at presentation (23% vs. 10%; P = 0.01), higher rates of secondary glaucoma (42% vs. 12%; P < 0.0001), iris neovascularization (39% vs. 23%; P < 0.001), and larger tumors (mean tumor thickness, 12.8 mm vs. 12 mm; P = 0.0001). There was a higher prevalence of metastasis in Group 1 than in Group 2 (4% vs. 0%; P = 0.006). On multivariate analysis, clinical features predictive of any optic nerve tumor infiltration secondary glaucoma (hazard ratio = 5.38; P < 0.001) and those predictive of postlaminar optic nerve tumor infiltration included iris neovascularization (hazard ratio = 2.66; P = 0.001) and secondary glaucoma (hazard ratio = 3.13; P < 0.001). CONCLUSION: In this study, clinical features predictive of any optic nerve tumor infiltration included secondary glaucoma and those predictive of postlaminar optic nerve tumor infiltration included iris neovascularization and secondary glaucoma. Despite adjuvant treatment in those with postlaminar optic nerve tumor infiltration, metastasis occurred in 8% of patients.

Efficacy of conjunctival resection with cyanoacrylate glue application in preventing recurrences of Mooren's ulcer.

AIM: To evaluate the role of conjunctival resection along with cyanoacrylate glue and bandage contact lens application in preventing recurrences and arresting progression in cases of Mooren's ulcer. METHOD: This retrospective interventional case series included cases of Mooren's ulcer that underwent conjunctival resection with cyanoacrylate glue and bandage contact lens application between 2011 and 2014. Systemic immunosuppression was initiated depending on the laterality and severity of disease. The primary outcome measures were clinical quiescence and recurrence-free survival. Kaplan-Meier plots were constructed and survival analysis done using the R software environment for statistical analysis. Secondary outcome measures were needed for systemic immunosuppression, change in best-corrected visual acuity and complications encountered. RESULTS: We evaluated 16 eyes of 12 patients who presented to us during the study period. The mean follow-up duration was 9.6 months. All eyes achieved clinical quiescence with a median recurrence-free survival of 141 days. The Kaplan-Meier survival curve showed probability of recurrence-free survival to be 42.5% at 1 year, which further dropped down to 21.3% at 2 years. All patients with recurrence (seven eyes of four patients) required systemic immunosuppression. CONCLUSIONS: Conjunctival resection and cyanoacrylate glue application are not effective in avoiding recurrences and halting the disease progression in cases of Mooren's ulcer. Systemic immunosuppression remains the mainstay of therapy.

Comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic Duane retraction syndrome.

BACKGROUND: Medial rectus recession (MRc) and vertical rectus transpositions are procedures used to treat esotropic Duane retraction syndrome. Recently superior rectus transposition (SRT) combined with MRc has also been shown to improve primary alignment and abduction. The purpose of this study is to compare the results of augmented (ie, with scleral fixation) SRT with or without MRc with either unilateral or bilateral MRc for treatment of esotropic Duane syndrome. METHODS: The medical records of patients who underwent surgery for esotropic Duane syndrome between May 2007 and February 2013 were retrospectively reviewed. Success was defined as alignment within 8(Δ) of orthotropia and abnormal head posture of <5°. RESULTS: There were 8 patients in the SRT group (6 of whom had additional ipsilateral MRc) and 13 in the MRc group (6 unilateral and 7 bilateral). In the SRT group, the mean preoperative deviation was 20(Δ) of esotropia; the mean postoperative deviation, 3(Δ). In the MRc group, the mean preoperative deviation was 24(Δ) of esotropia; the mean postoperative deviation, 4(Δ). The success rate was 87% in the SRT group; 77%, in MRc group (P = 0.98). Mean abduction limitation improved from -3.6 to -2.4 units in the SRT group and from -3.6 to -3.3 units in the MRc group (P = 0.003). Induced vertical deviation or subjective torsion was not seen. Three patients in each group developed adduction limitation postoperatively. CONCLUSIONS: Although both the procedures successfully correct esotropia in Duane syndrome, SRT with or without MRc has the additional advantage of improving abduction.