Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism.

We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.

A brief account on ocular graft versus host disease.

The incidence of ocular graft versus host disease (oGVHD) is rising due to the increasing numbers of bone marrow transplantations for various hematologic malignancies and non-malignant indications. The ophthalmic aspect of graft versus host disease (GVHD) still requires much understanding. We carried out a PubMed search of all articles using the terms "oGVHD," "dry eye + hematopoietic stem cell transplantation (HSCT)," "acute GVHD," and "Chronic GVHD." The review mainly focuses on the existing lacunae in terms of diagnostic criteria. Diagnosis of ocular involvement in GVHD follows the criteria described by the National Institute of Health Consensus Conference (NIH CC) or International Chronic oGVHD (ICCGCHD) consensus group. The severity grading of oGVHD is by Jab's or Robinson's grading for conjunctival involvement. NIH CC and ICCGVHD remain the most commonly used scoring systems. Management of ocular involvement during acute GVHD remains challenging, whereas chronic oGVHD in its milder forms mainly manifests as dry eye disease and is treated accordingly. Multiple unanswered questions remain regarding this entity's pathogenesis, diagnostic criteria, and clinical features. Large-scale prospective studies involving oncologists and ophthalmologists must answer questions and formulate guidelines.

Customized Bowman-Stromal Inlay: An Attempt to Change the Topography of the Keratoconus Cornea.

PURPOSE: The objective of this report is to describe a modification of a previously reported technique with an aim of improving the corneal topography and visual outcomes in progressive keratoconus along with stabilization of ectasia. METHOD: In a 26-year-old man with progressive keratoconus, corneal collagen cross-linking was performed in one eye. The other eye had a keratometry of 69.6 D and thinnest pachymetry of 397 µm for which a customized Bowman-stromal inlay surgery was performed. The technique involved the harvesting of Bowman-stromal inlay (anterior 180-µm human donor cornea having the Bowman's layer and anterior stroma) using the femtosecond laser and central ablation of this inlay was done on the stromal side using an excimer laser. This customized inlay was placed in the anterior stromal pocket of the patient's cornea using a regular intraocular lens injector. RESULTS: Stabilization of keratoconus could be achieved in the present case along with improvement in the corrected distance visual acuity and pachymetry. Maximum keratometry decreased from 69.6 D to 57.3 D. CONCLUSIONS: Customized Bowman-stromal inlay technique appears to be a step towards creating an ideal inlay for the keratoconus cornea.

Rhodotorula mucilaginosa Keratitis: a rare fungus from Eastern India.

Rhodotorula mucilaginosa rarely cause keratitis in immunocompromised individuals. A 30 year old male with history of minor trauma presented with cotton wool like stromal infiltration and hypopyon in left eye. Microbiological examination of corneal scraping showed fungal hyphae and yeast cells in direct smear. Molecular identification of the organism was performed which showed 100% homology with Rhodotorula mucilaginosa. Management of these cases is difficult often necessitating surgical procedures. However further reports are necessary to understand the disease and establish a treatment protocol.

Comparison of lea gratings with cardiff acuity cards for vision testing of preverbal children.

AIMS: To create a normative data for lea grating (LG) in the Indian population and to compare LG with Cardiff Acuity Card (CAC). SETTINGS AND DESIGN: Normative Data was acquired from normal children between 6 months-3 years coming to the 'Immunisation Clinic' and 'Well-Baby Clinic' at a Civil Hospital. To compare LG with CAC, normal and amblyopic children between 6 months-3 years were evaluated, MATERIALS AND METHODS: Monocular and binocular visual acuity (VA) was measured using LG and then CAC. VA and time taken to perform the test were compared. STATISTICAL ANALYSIS USED: Pearson's Correlation Coefficient to compare VA and Student paired t-test (significance P<0.005) to compare time. RESULTS: Two standard deviations of VA of 100 normal children overlapped with that published by Lea. Of the 30 amblyopic children aged 18.32 ± 10.5 months (2-36), 18 were females. VA was 0.95 ± 0.3 logMAR (0.7-1.2) and 1.0 ± 0.6 logMAR (0.5-2.1) binocularly and 1.32 ± 0.08 logMAR (0.2-0.6) and 1.15 ± 0.15 logMAR (0.88-1.48) monocularly on CAC and LG respectively. Pearson's correlation coefficient was 0.98 and 0.63 for binocular and monocular assessment respectively. Time taken to perform LG monocularly and binocularly was significantly less (P<0.001) than CAC. CONCLUSION: Normative data acquired in Indian pre-verbal children is similar to that published by Lea. Though VA by CAC is better than LG, the two tests are comparable.

Unilateral situs inversus of optic disc associated with reduced binocularity and stereoacuity resembling monofixation syndrome.

Situs inversus of the optic disc is a rare, usually bilateral, congenital embryological abnormality associated with high myopia, optic disc coloboma or tilted optic disc. It is characterized by emergence of the retinal vessels in an anomalous direction with dysversion of the optic disc. In this report we present a 13-year-old boy diagnosed with isolated, unilateral situs inversus of the optic disc associated with reduced binocularity and stereoacuity resembling a monofixation syndrome. The clinicians should be aware of this association and assess the binocularity in patients with unilateral optic disc or macular anomalies. Conversely, patients with reduced binocularity and stereoacuity should be carefully evaluated for macular or optic nerve anomalies, if not associated with strabismus, anisometropia and eccentric fixation. Typical fundus picture, optical coherence tomography and multifocal electro retinogram of the patient would be instructive to a clinician.

Resolution of recurrent conjunctival papilloma after topical and intralesional interferon alpha2b with partial excision in a child.

The human papilloma virus (HPV) is a double-stranded DNA virus that infects the epithelium of skin and mucosa. Simple treatment of conjunctival papilloma is associated with recurrences, and while most medical therapy has met with limited success, interferon alpha 2b (IFN alpha2b) may be effective. In this report, we describe a 7-year-old child with severe, recurrent conjunctival papilloma who had complete regression of the papilloma after topical and intralesional IFN alpha2b with partial excision of the lesion.