Morphometric evaluation and measurements of primary pterygium by anterior segment optical coherence tomography and its relation with astigmatism.

PURPOSE: To evaluate the relationship between measurements and various morphometric parameters of primary pterygium on anterior segment optical coherence tomography(AS-OCT) and refractive and keratometric astigmatism. METHODS: In this cross-sectional study, patients with primary pterygium were included. The AS-OCT parameters of pterygium consisting of epithelial thickness near apex(µm), apical or head thickness(µm), its thickness at limbus(µm), horizontal length of pterygium(mm), central corneal thickness (µm) and maximum pterygium thickness(mm) were evaluated. RESULTS: Sixty three patients comprising of 63 eyes with a primary pterygium were studied. The mean keratometric and refractive astigmatism were 1.69 ± 3.15 Diopter(D) and0.5 ± 1.4D, respectively. There was a significant association between pterygium grade and stocker's line with keratometric astigmatism (p = 0.02, 0.00) respectively. Vertical and horizontal length on slit lamp and horizontal length on AS-OCT showed significant association with keratometric astigmatism (p = 0.05, 0.00,0.00), respectively. Limbal thickness on AS-OCT showed significant positive correlation with refractive astigmatism (r = 0.29, p = 0.02). CONCLUSION: The pterygium grade influences the keratometric astigmatism. Increased limbal thickness of pterygium on AS-OCT leads to more refractive astigmatism.

Morphological analysis of functional filtering blebs with anterior segment optical coherence tomography: A short-term prediction for success of trabeculectomy.

PURPOSE: The aim of the study was to analyze morphological parameters of apparently functional filtering blebs with anterior segment optical coherence tomography at 1 month post trabeculectomy and to correlate these parameters with intraocular pressure at 6 months of follow-up to predict the short-term success of trabeculectomy. METHODS: In this cross-sectional, descriptive study, apparently functional blebs were evaluated using anterior segment optical coherence tomography with crossline scans after 1 month of trabeculectomy. RESULTS: A total of 55 eyes of 55 cases with mean age 49.29 ± 13.72 years were included in the study. On anterior segment optical coherence tomography examination, the mean bleb height and mean bleb wall thickness, subconjunctival fluid space, and scleral flap thickness were 1.45 ± 0.39 mm, 0.63 ± 0.25 mm, 0.64 ± 0.26 mm, and 0.45 ± 0.068 mm, respectively. There was statistically significant negative correlation between intraocular pressure at 1 month and bleb height (r = -0.25, p = 0.05). There was statistically significant negative correlation between extent of cavity and intraocular pressure at 6 months (r = -0.318, p = 0.018). Bleb height showed significant negative correlation with supra-scleral space (r = -0.31, p = 0.02). Multi reflective bleb walls showed statistically significant increased chances of successful functioning blebs at 6 months as compared to uniform wall reflectivity (p = 0.00).Bleb function was successful in 37 (67.3%) and unsuccessful in 18 (32.7%) in short term of 6 months of follow-up. CONCLUSION: Bleb walls with multiform wall reflectivity on anterior segment optical coherence tomography at 1 month post trabeculectomy show increased chances of success of functioning filtering bleb at 6 months. Bleb wall characteristics on anterior segment optical coherence tomography at 1 month can predict the short-term success of blebs at 6 months.

Morphological and functional outcome of N- butyl cyanoacrylate tissue adhesive application in corneal perforations.

INTRODUCTION: This study was conducted to characterize morphological and functional outcome of application of tissue adhesive (TA) in corneal perforations. METHODS: This is a retrospective study in which data of corneal perforations which were managed by application of TA (N- butyl cyanoacrylate) from January 2015 to April 2018 were reviewed. The final outcome of TA in corneal perforation was considered as sealed or non-sealed over a period of three months. Criteria of success of TA application included resolution of infiltrates, corneal vascularisation and scarring. Morphological outcome was considered as corneal scarring, required therapeutic penetrating keratoplasty (TPK) and loss of anatomical integrity of globe as phthisis bulbi. Functional success was considered preservation of visual function with best corrected visual acuity (BCVA). RESULTS: A total of sixty seven eyes of sixty seven patients were reviewed in the present study. The mean age of all the patients was 46.63 ±16.30 years (range: 5-81 years) with predominance of males 41(61.19%). Infective keratitis (IK) constituted major chunk of aetiology for corneal perforations 44(65.67%) with maximum 47(70.14%) of size of ≥1.5-3.0mm. 56(83.58%) cases sealed completely, rest 11(16.41%) cases failed to seal. Morphological outcome showed significant relationship with age, number of glue applications and complications with P value (0.05, 0.00, 0.00) respectively. The functional outcome showed significant relationship with age, frequency of applications, morphological outcome and complications (p value 0.02, 0.00, 0.00, 0.00) respectively. CONCLUSIONS: Infective keratitis is major cause of corneal perforations. Corneal perforations ≤3.0mm size shows healing and subsequent closure in 83.58%. Morphological and functional outcome shows significant relationship with age, number of glue applications and complications.

A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects.

Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief. Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications. Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 ± 6.51 days in Group A (median = 9.50 days, IQR = 1-7 days) vs. 18.33 ± 13.46 days (median = 19.50 days, IQR = 1-21 days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks. Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B.

Incidence and risk factors for postkeratoplasty glaucoma in tertiary care center, India.

BACKGROUND: Glaucoma is the leading cause of blindness after penetrating keratoplasty (PK) and its early diagnosis and management is mandatory to salvage the graft. AIMS: This study aimed to evaluate the incidence and risk factors for post penetrating keratoplasty glaucoma (PKG). METHODS: Data of 155 eyes of 155 patients were reviewed retrospectively who underwent PK from March 2013 to February 2016. Data were analyzed from recipient records for recipient age, sex, indications, type of PK, lens status, recipient graft size or any additional procedure. Detailed ophthalmological examination was recorded for all cases including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) by applanation tonometry or tonopen, central corneal thickness (CCT) and gonioscopy. IOP measurement records were reviewed at each visit of one week, two weeks,one, three and six months and if IOP was elevated (>22 mmHg) medical management was initiated. Uncontrolled IOP with antiglaucoma medication (AGM) required surgical management. RESULTS: Overall incidence of raised IOP after PK was 32.25%. Increase in IOP post PK was reported mainly in 32 (64%) among age group >40 years. Raised IOP showed significant association with age group, indications of PK, recipient size and CCT (P value 0.00, 0.01, 0.00, 0.00) respectively. Two weeks after PK 46 (29.67%) patients reported an increase in IOP ,47(30.32 %) after 1 months, 33 (21.29%) at 3 months and 30 (19.35%) at 6 months. In 11 (39.28%) cases cataract was major long term complication seen in PKG cases. 35 (70%) cases of PKG were treated medically and 15 (30%) patients required surgical treatment. CONCLUSION: Subjects with age group >40 years, corneal opacity, increased recepient size and increased CCT are risk factors for PKG. IOP monitoring in early post operative period especially one month after PK is mandatory to avoid graft failure due to PKG which is difficult to diagnose otherwise.

Outcome of therapeutic penetrating keratoplasty in advanced infectious keratitis.

PURPOSE: This study aimed to evaluate the anatomical, therapeutic, and functional outcome of therapeutic penetrating keratoplasty (TPK) in terms of success and failure. METHODS: In this retrospective study 57 eyes of 57 patients were reviewed. They had undergone TPK from December 2012 to June 2017. Data analyzed included the baseline demographic features and characteristics, preoperative diagnosis, and postoperative outcomes. The baseline characteristics included age, gender, laterality, indications of TPK, lens status, size of the recipient, grade of the graft, organisms identified, preoperative best corrected visual acuity (BCVA), secondary procedures, adjunctive surgical procedure, postoperative BCVA at last follow-up, intraocular pressure (IOP), and long-term complications of TPK. The ultimate outcome of TPK was observed in terms of anatomical, therapeutic, and functional outcome which indicated the success and failure. RESULTS: A total of 57 eyes of 57 with an age range of 2-76-year-old patients who underwent TPK were included in the study. Perforated corneal ulcer was a major indication of TPK in 32 (56.1%) cases. Anatomical success was obtained overall in 49 (85.96%) cases. Indications of TPK and preoperative visual acuity, complications of TPK, and ultimate graft clarity showed significant impact on the anatomical outcome (P = 0.03, P = 0.00, P = 0.00, and P = 0.05), respectively. The therapeutic and functional success was observed in 51 (89.47%) and 40 (70.17%) cases, respectively. CONCLUSIONS: Perforated corneal ulcers was the major indication for TPK. Indications and complications significantly affect the anatomical, therapeutic, and functional outcome.

Factors affecting the serological testing of cadaveric donor cornea.

PURPOSE: The purpose of this study was to evaluate the serological profile of the eye donors and to study the influence of various factors on serological test results. METHODS: A cross-sectional, observational study was conducted, and data of 509 donors were reviewed from the records of eye bank from December 2012 to June 2017. Various details of donors analyzed included the age, sex of the donor, cause of death, source of tissue, time since blood collection after death, macroscopic appearance of blood sample, and details of discarded tissues. Serological examination of blood was performed for human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus (HCV), venereal disease research laboratory (VDRL), and serology reports reactive or nonreactive were analyzed. RESULTS: Among the 509 donors, 295 (58%) were male, and 420 (82.50%) belonged to age group ≥60 years. Most donors (354, 69.5%) died due to cardiac arrest. Macroscopically, sera were normal in the majority of 488 (95.9%) cases. Among 509 donors, 475 (93.3%) were nonreactive, 12 (2.4%) donors were found to be reactive to hepatitis B surface antigen (HBsAg), and 1 (0.2%) was reactive to HCV, but no donor serology was reactive to HIV or VDRL. Twenty-one (4.12%) donors' sera were not fit for serological testing. Among all donors, 475 (93.32%) donors were accepted and 34 (6.67%) were rejected or discarded on the basis of serological testing. Cause of death and macroscopic aspect of sera influenced the serological results in a highly significant manner (P = 0.00). Acceptance or rejection of the donor was significantly influenced by the serological results of the donor (P = 0.00). CONCLUSION: The seroprevalence among eye donor for HBsAg and HCV was 12 (2.4%) and 1 (0.2%), respectively. Factors such as cause of death and macroscopic aspect of sera influence the serological results. Time since blood collection or sampling will not show any impact on viral serological results if postmortem sampling will be done in < 10 hours(h) after death which can improve the safety and utility of the donor cornea.

Unilateral lattice corneal dystrophy in a young female: A unique case report.

BACKGROUND: Unilateral lattice corneal dystrophy is a rare entity. OBJECTIVE: To highlight the evidence of unilateral lattice corneal dystrophy in a young female. CASE: A young 28 years old female presented to the outpatient department of Ophthalmology with slowly progressive diminution of vision in left eye for one month. On ophthalmological examination best corrected visual acuity (BCVA) was 20/20 and 20/40 with refractive error of plano and -0.75D Cyl @30 for right and left eye respectively. Ocular examination of right eye was unremarkable. On slit lamp examination, left eye showed multiple radial lattice lines in branching spider like pattern in the temporal cornea with pupillary margin involvement. The lattice pattern was confined to anterior to midstroma of the cornea with intact epithelium and unremarkable endothelium. The lesions did not involve the limbus. These lattice lines were prominent on retroillumination. In temporal quadrant near pupillary margin a small radial nebulomacular corneal opacity was seen without any corneal vascularisation or edema. The anterior chamber was deep and quiet. Corneal sensations were markedly reduced. Intraocular pressure was 10 and 12mmHg for right and left eye respectively with noncontact tonometry. Fundus examination was unremarkable. Family history and systemic history was negative. Optical coherence tomography(OCT) showed hyperreflective material in midstoma confirmed the diagnosis of unilateral lattice corneal dystrophy(LCD) with an apparently healthy fellow eye.

Syringocystadenoma Papilliferum of Sweat Gland of Caruncle: A Unique Case Report.

Syringocystadenoma papilliferum (SP) is a rare benign hamartomatous malformation of skin which arises from apocrine or eccrine sweat glands. Skin of the head and neck is the usual site for this but rarely involves the eyelids. It is also called as a childhood tumor since it usually appears at birth or during puberty. The diagnosis is confirmed on histopathological examination after surgical excision. We are first to report a case of SP involving the caruncle in an elderly female.

Factors associated with surface epithelial keratopathy after optical penetrating keratoplasty.

PURPOSE: The aim of the study was to evaluate the various donor and recipient factors associated with short-term prevalence of surface epithelial keratopathy after optical penetrating keratoplasty (OPK). METHODS: Preoperative and postoperative data of 91 eyes of 91 patients were reviewed retrospectively who had undergone OPK from March 2013 to February 2016. Donor and recipient data were analyzed for age and sex of the donor, cause of death, death to enucleation time (DET), death to preservation time (DPT), enucleation to utilisation time (EUT) and total time (TT), age and sex of recipient, indications of penetrating keratoplasty (PK), associated glaucoma and recipient size (RS). The presence of various epitheliopathies were recorded at various postoperative visits. RESULTS: The range of age of recipient in this study was 10-83 yrs (mean 49.19 ± 19.35 yrs). The donor age ranged in between 17 and 95 years (70.27 ± 15.11 years). Age and preoperative diagnosis of host showed significant influence on epitheliopathy till two weeks and one month post-PK (P = 0.032 and 0.05), respectively. Donor's age and gender showed significant impact on surface keratopathy (SK) till two weeks follow-up with P value of 0.04 and 0.004, respectively. DET, DPT, EUT, and TT affected the surface epithelium significantly with P value of 0.007, 0.001, 0.05, and 0.03, respectively. On first postoperative day 33 (36.26%) eyes developed epithelial defect involving >1/2 of cornea. CONCLUSION: Various donor and recipient factors showed influence on various epithelial abnormalities of surface epithelium in early postoperative period.

Monitoring the appositions of posterior graft-host junctions with anterior segment optical coherence tomogram after penetrating keratoplasty.

This study aimed to monitor the graft-host junction's (GHJ's) apposition with anterior segment optical coherence tomogram after penetrating keratoplasty (PK) and correlate the analysis with the preoperative diagnosis. Fifty-one eyes of 50 patients with various preoperative diagnosis of adherent leucoma, pseudophakic bullous keratopathy, corneal opacity or scarring, graft failure, corneal dystrophy and anterior staphyloma, who underwent PK for optical purposes were reviewed retrospectively. Based on the age, the patients were divided into groups 1 and II: those aged ≤40 and >40 years, respectively. Anterior segment optical coherence tomography was done for all these eyes to evaluate the posterior graft-host junction. All graft-host junction patterns were classified as well apposed, and malapposed with various components like hill, gap, step and tag. The comparisons of various clinical parameters were done for the various malapposed junction groups (hill, gap, step and tag). A total of 408 graft-host junction cross sections of 51 eyes were analysed. Amongst them 70 (17.15 %) sections were well apposed, and 338 (82.84 %) were malapposed. Most frequent type of malapposition was hill: 164 sections (40.19 %) followed by step: 139 sections (34.06 %). The distribution of graft-host junction alignment patterns varied amongst all the indications. Patients with preoperative diagnosis of adherent leucoma and corneal dystrophy had predominantly steps pattern in 65 (40.62 %) and 12 (75 %) sections, respectively. Hill pattern was seen predominantly in PBK, corneal opacity, graft failure and anterior staphyloma in 55 (42.96 %), 16 (40 %), 22 (45.83 %) and 8 (50 %) sections, respectively. Comparisons of various clinical characteristics like intraocular pressure, central corneal thickness, best-corrected visual acuity, astigmatism and size of graft with the various malapposed patterns showed significant differences in best-corrected visual acuity and keratometric astigmatism in the hill pattern of malapposition group with p values of .004 and .053, respectively, using independent T test. Posterior graft-host junction analysis with anterior segment optical coherence tomography is very important for post penetrating keratoplasty management. The posterior wound profile differed according to the indications of penetrating keratoplasty. Best-corrected visual acuity and keratometric astigmatism showed significant difference with the malapposition hill (pattern).

Evaluation of the Central Corneal Thickness with Anterior Segment Optical Coherence Tomogram after Penetrating Keratoplasty.

INTRODUCTION: Graft central thickness evaluates the graft quality which affects the outcome of Penetrating Keratoplasty (PK). It varies at different point of time after PK. Anterior Segment Optical Coherence Tomography (ASOCT) can measure graft's central thickness with quite high precision. AIM: The purpose of the study was to monitor the Central Corneal thickness (CCT) with ASOCT after PK and to evaluate its relationship with the pre-operative diagnosis. MATERIALS AND METHODS: This is an observational retrospective study where records of optical PK done in December 2012 and June 2015 were reviewed. Graft central thickness were analysed by ASOCT for all the patients post-operatively at first post-operative day, 3 and 6 months post PK by pachymetry scan and the images captured were analysed for CCT with inbuilt calipers. RESULTS: Fifty one eyes of 50 patients with age range of 17-80years (mean 51.64years ±SD 18.45 years) with clear grafts were reviewed in the present study. All subjects recruited were analysed for the indications of PK. Adherent leucoma 20(39.21%) was most common indication for PK. Mean CCT were 647.31±90.40, 605.31±75.08,564.66±66.26 and 537.37±64.09 respectively on first post-operative day, 1, 3 and 6 months. Graft CCT significantly decreased between first post-operative day and 1 month and it showed further decrease at 3 to 6 months post PK. The CCT at 6 month post-surgery showed a strongly positive correlation with the Intraocular Pressure (IOP) (r=0.66) and weakly positive correlation with Best Corrected Visual Acuity (BCVA) (r=0.28). CONCLUSION: Graft central thickness is considered to be quantitative method for evaluating corneal oedema post PK. CCT decreases in post-operative period irrespective of indications of PK.

Indications and Visual Outcome of Penetrating Keratoplasty in Tertiary Eye Care Institute in Uttarakhand.

INTRODUCTION: Corneal blindness forms significant proportion of visual blindness in developing countries and penetrating keratoplasty (PK) can restore vision for this. The prognosis of PK is dependent on the corneal diseases responsible for corneal blindness. AIM: To evaluate the indications and visual outcome of PK in tertiary eye care institute in Uttarakhand. MATERIALS AND METHODS: Data was reviewed from the medical records of 145 PK done in Department of Ophthalmology, Himalayan Institute of Medical Sciences from January 2012 to October 2014. Analysis of data was done for evaluation of the indications and visual outcome by Paired student's t-test for hypothesis testing of grouped values of preoperative and last follow-up best corrected visual acuity in cases of optical and therapeutic grafts. A p-value < 0.05 was considered statistically significant. RESULTS: In this study data of 145 eyes of 138 patients was reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma 48 (33.10%). Therapeutic keratoplasty was done for 33 cases with maximum 30(20.68%) cases of infectious keratitis. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (p=.0001) in best corrected visual acuity improvement from 1.39 logMAR+ 0.022(SD) preoperatively to 0.367 logMAR+0.44(SD) postoperatively and 1.4 logMAR+.000(SD) preoperatively to 0.16 logMAR+0.57(SD) postoperatively for optical and therapeutic grafts respectively. CONCLUSION: Infective keratitis either active or healed was the major indication for keratoplasty. Poor prognosis indications were most common in this part of the country. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty.

Non traumatic keratitis due to colletotrichum coccodes: a case report.

Colletotrichum species, a rare and emerging fungus is a well- known plant pathogen and an uncommon cause of human infection. It has been implicated as the etiological agent of cutaneous phaeohyphomycosis and keratitis, particularly following colonization of traumatized tissues or in immunocompromised patients. However, it has hardly ever been reported in the absence of such predisposing risk factors. Here, we report a case of keratitis with Colletotrichum coccodes occurring in a middle- aged, immunocompetent person without any history of trauma or co-morbidity. The isolate was sensitive to Amphotericin B and Voriconazole, and accordingly the patient was treated successfully with ocular administration of Amphotericin B.

Visual Fields at Presentation and after Trans-sphenoidal Resection of Pituitary Adenomas.

PURPOSE: To evaluate visual field changes in patients with pituitary adenomas following trans-sphenoidal surgery. METHODS: Eighteen patients with pituitary adenomas underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program before and after trans-sphenoidal surgical resection at the Himalayan Institute of Medical Sciences over a one year period. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects, and variables such as mean deviation and visual field index were compared. RESULTS: Thirty-six eyes of 18 patients including 10 male and 8 female subjects with mean age of 35.1±9.9 years and histologically proven pituitary adenoma were included. Mean visual acuity at presentation was 0.29 logMAR which improved to 0.21 logMAR postoperatively (P = 0.305). Of 36 eyes, 24 (66.7%) had visual field defects including temporal defects in 12 eyes (33.3%), non-specific defects in 10 eyes (27.8%), and peripheral field constriction in 2 eyes (5.6%). Mean deviation of visual fields at presentation was -14.28 dB which improved to -11.32 dB postoperatively. The visual field index improved from 63.5% to 75% postoperatively. Favorable visual field outcomes were correlated with shorter duration of symptoms and absence of optic nerve head changes at presentation. CONCLUSION: Visual field defects were present in two thirds of patients at presentation. An overall improvement in vision and visual fields was noted after surgical resection. An inverse correlation was found between the duration of symptoms and postoperative visual field recovery, signifying the importance of early surgical intervention.

The conundrum of lenticular oncology. A review.

It is a long-accepted dogma in ophthalmology that the lens is a tumour-free tissue. Yet, in the lens, there is lifelong mitotic activity in the subcapsular epithelium. Therefore, these subcapsular epithelial cells must have the potential for cellular transformation. How then can we explain the fact that no scientist has ever seen a naturally occurring primary tumour of the lens in vivo? This review discusses the early work of Mann, von Hallermann, Courtois and others who addressed the issue of tumour resistance of the lens.