Refractive surprise: twice the SMILE.

A 35-year-old man presented with decreased vision in his left eye following small incision lenticule extraction (SMILE) surgery. The refractive error after surgery was nearly twice his preoperative refractive error in the left eye. The patient was diagnosed as having a retained lenticule after SMILE surgery, which was folded on itself and was successfully managed by conversion to a flap. Postoperatively, the patient maintained good uncorrected visual acuity and a low refractive error, with the best spectacle corrected acuity of 20/20.

Role of CT Chest and Cytology in Differentiating Tuberculosis from Presumed Sarcoidosis in Uveitis.

Purpose: To report the role of CT chest and cytology in suspected tubercular and sarcoid uveitis. Methods: This is a retrospective, interventional case series of 376 uveitis patients with suspected ocular tuberculosis (TB)/sarcoidosis seen between January 2010 and April 2015 at the Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh. All underwent CT chest, and had following inclusion criteria: (1) Presence of active granulomatous anterior/intermediate/posterior uveitis or panuveitis; (2) a documented tuberculin skin test/QuantiFERON-TB Gold test; (3) all other causes of infectious/non-infectious uveitis ruled out. A total of 206 patients had abnormal CT chest, of which 147 patients with minimum four months follow up were studied. Based on CT findings and amenability of involved lymph nodes, conventional transbronchial needle aspiration (TBNA)/endobronchial ultrasoundguided TBNA (EBUS-TBNA) or fine needle aspiration cytology (FNAC) of peripheral nodes was performed by an interventional pulmonologist. All smears were subjected to cytopathological examination, and Ziehl-Neelsen staining for acid-fast bacilli (AFB). The detection of the underlying etiology (TB or sarcoidosis) was the main outcome measure. Results: CT chest demonstrated mediastinal/hilar lymph nodes in 123/147 (83.7%) patients. Twenty four (16.2%) patients with parenchymal involvement were diagnosed TB (n = 20) or sarcoidosis (n = 4). Sixty nine patients with subcentimetric lymph nodes that were not amenable to biopsy were diagnosed clinico-radiologically as TB (42) and sarcoidosis (27). Fifty-four patients underwent biopsy from various sites that diagnosed TB and sarcoidosis in 21 (38.2%) patients each. Five TBLB/EBUS TBNA smears and seven FNAC smears demonstrated AFB. Conclusions: In systemically asymptomatic individuals presenting with uveitis, CT chest helped to establish the diagnosis of TB/sarcoidosis in 71.43% cases (105 out of 147) using only the clinico-radiological criteria, while a confirmed diagnosis of TB/sarcoidosis was possible only in 42 cases (28.57%) by EBUS/TBNA guided cytological examination.

Mucormycosis Endophthalmitis in a Silicone Oil-Filled Eye of an Immunocompetent Patient.

Purpose:: Fungal endophthalmitis following pars plana vitrectomy with silicone oil tamponade is an infrequent entity. Filamentous fungi like aspergillus are generally associated with endophthalmitis. Mucor is a rarely implicated pathogen in cases of endophthalmitis with only two reported cases in medical literature. Both these cases had uncontrolled diabetes which predisposed them to develop mucor endophthalmitis.Methods: We report a non-diabetic patient who developed mucor endophthalmitis after uneventful vitreous surgery for myopia associated retinal detachment.Results: Mucor species induced endophthalmitis in a silicone oil-filled eye of a non-diabetic patient is reported. The eye went into pthisis bulbi.Conclusions: To the best of our knowledge, this is the first report of mucor endophthalmitis in a silicone oil-filled globe of an immunocompetent patient.

Toric intraocular lens implantation in children with developmental cataract and preexisting corneal astigmatism.

PURPOSE: To evaluate the effect of toric intraocular lens (IOL) implantation on the refractive outcomes in children with cataract and preexisting corneal astigmatism. METHODS: We included children between the age group of 8-14 years who were randomized into group I (toric) and group II (non-toric), in which toric and spherical IOLs were implanted, respectively, after phacoaspiration. Primary outcome measure was comparison of preoperative keratometric and postoperative refractive cylinder. Secondary outcome measure was comparison of pre- and postoperative visual outcome. RESULTS: This study included 21 eyes of 17 children with developmental cataract. The mean spherical power of the toric IOLs implanted in the group I was 22.42 ± 4.84 D (range 12.50-29.00 D) and the mean cylindrical power of toric IOL was 3.37 ± 1.43 D (range 1.50-6.00D). The mean spherical power implanted in non-toric (group II) was 20.70 ± 7.09 D (range 10-31D). Mean preoperative keratometric cylinder in group I was 2.99 ± 0.96 D (range 1.85-5.12 D) and in group II it was 3.35 ± 0.63 D (range 2.03D-4.33 D) (p = 0.31) while the mean refractive cylinder at one year postoperatively in group I was 0.50 ± 0.39 D (range 0.00-1.00 D) and in group II it was 2.05 ± 0.39 D (range 1.25D-2.50 D; p = 0.006). Twelve months postoperatively, group I had a mean spherical equivalent (SE) 0.41 ± 0.26 D (range 0.00-0.88 D) and group II had 1.8 ± 1.03 D (range 0.63-4.00 D) (p = 0.002). Uncorrected distance visual acuity (UDVA) improved from 0.94 log MAR ± 0.51 (range 0.60-2.00) to 0.43 log MAR ± 0.33 (range 0.00-1.00) in the group I at the end of 1 year and in group II, it improved from 1.52 log MAR ± 1.12 to 0.75 log MAR ± 0.70 (range 0.00-2.00) at the end of 1 year. Corrected distant visual acuity (CDVA) improved in group I from 0.72 log MAR ± 0.17 (range 0.48-1.00) to 0.19 log MAR ± 0.26 (range 0.00- 0.78) at the end of one year while in group II, it improved from 1.33 ± 1.08 (range 0.18-3.00) to 0.49 log MAR ± 0.80 (range 0.00-2.00) at the end of 1 year. CONCLUSIONS: Toric IOL implantation in children significantly reduces postoperative astigmatism and thereby improves visual outcome.