Adverse ocular events on miltefosine treatment for post-kala-azar dermal leishmaniasis in India.

A 12-week course of miltefosine (MF) is recommended in India for the treatment of post-kala-azar dermal leishmaniasis (PKDL). We report a case series of four patients with PKDL, across three districts of Bihar state, who developed eye complications during treatment. They presented with acute scleritis and corneal infiltration with or without corneal ulceration. One patient solely with corneal infiltration recovered completely. The three others with corneal ulceration healed with corneal opacificity. One patient with bilateral eye involvement underwent corneal transplantation to prevent blindness. All adverse events were graded as certain using the World Health Organization-Uppsala Monitoring Centre causality assessment scale. There is need to counsel patients regarding possible adverse ocular events during MF treatment, to expand pharmacovigilance to all primary health centres in kala-azar endemic areas, and to update drug safety information considering the emerging evidence.

Long term effect of panretinal photocoagulation on retinal nerve fiber layer parameters in patients with proliferative diabetic retinopathy.

PURPOSE: This study aimed to evaluate the long-term effect of panretinal photocoagulation (PRP) on the retinal nerve fiber layer (RNFL) in patients with proliferative diabetic retinopathy (PDR). METHODS: This was a prospective longitudinal cohort study examining 42 eyes of 42 patients with PDR undergoing PRP. Peripapillary RNFL thickness (RNFLT) was measured using spectral-domain optical coherence tomography at baseline, 1 year, and 3 years following PRP. RESULTS: The mean "average RNFLT" was 89.88 ± 14.26 µm at baseline, 85.75 ± 11.36 µm at 1-year follow-up, and 83.33 ± 11.96 µm at 3-year follow-up. There was a statistically significant difference in the average RNFL thickness at baseline and 1 year and 3 years after PRP. At 1-year follow-up, superior, inferior, and nasal RNFL measurements reduced significantly from baseline (P < 0.01). The reduction in RNFL remained statistically significant for superior and inferior quadrants 3 years after PRP. CONCLUSION: PRP causes a reduction in RNFL thickness until 3 years after the procedure. Caution should be exercised while interpreting peripapillary RNFL thickness scans in patients who have undergone PRP for diabetic retinopathy.

Cortical riders of zonular cataracts as "reverse cuneiform" cataracts: A hypothesis.

Zonular cataracts are childhood cataracts involving one or more zone(s) of lens. They often show 'riders' which are wedge-shaped opacifications of inner cortex of the lens seen to radiate towards the lens equator, though little is known about the exact mechanism behind their development. Cortical riders may be described as 'reverse cuneiform' cataracts on the basis of their evolution pattern being exact opposite to that of senile cuneiform cortical cataracts.

Phacoemulsification in phakic iris-claw lens with cataract.

In this new technique of cataract surgery in patients with iris-fixated phakic intraocular lens with cataract, phakic IOL is explanted at the end of surgery. Phakic IOL remains stable and securely enclaved to the iris during phacoemulsification which is performed through a small 2.2 mm incision. Endothelial protection is provided by viscodispersive OVD above the phakic IOL and space for surgery is created by high molecular weight viscocohesive OVD beneath the phakic IOL. This technique provides significant advantages from the previously described techniques in terms of chamber stability, endothelial protection, iris trauma and surgical ease.

Pediatric cataract.

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.

Innovations in pediatric cataract surgery.

Advances in technology have made surgery in children safer and faster. The management of pediatric cataract has made rapid progress in the past decade with the availability of safer anesthesia, newer technique's, more predictable intraocular lens (IOL) power calculation, a better understanding of neurobiology, genetics, amblyopia management, improved IOL designs for preventing visual axis opacification, and adjuvant postoperative care. Modern vitrectomy machines with minimally invasive instruments, radiofrequency, diathermy, and plasma blades help immensely in complicated cases. Preoperative evaluation with ultrasound biomicroscopy and optical coherence tomography (OCT) allows better planning of surgical procedure. The future holds good for stem cell research, customized OCT, and Zepto (precision pulse capsulotomy).