Corset suture: A novel technique of overlay appositional continuous sutures with air tamponade for management of large acute corneal hydrops.

Management of large acute corneal hydrops (ACH) has always been a challenge. Various medical and surgical management options have been used, such as topical steroids, cycloplegics, antiglaucoma medications, antibiotics, Descemet's membrane reposition, and pre-Descematic sutures, for the management of acute hydrops, but have shown limited benefit. We hereby describe a novel technique of appositional continuous overlay sutures along with air tamponade for surgical management of corneal edema following large ACH. In this technique, the epithelium is scraped to visualize the stromal cleft, and then corneal marking is done to locate the suture placement site. Next, a continuous overlay, 10-0 nylon suture is passed in a crisscross fashion, just like the laces of a corset. A small paracentesis is made to lower the intraocular pressure. Stromal fluid is milked out using two iris spatulas, simultaneous suture tension adjustment is done, and the knot is secured. Appropriate anterior chamber tamponade is achieved using air, paracentesis is hydrated, and a bandage contact lens is applied. We noted complete resolution of corneal edema within 2 weeks of the procedure, with significant improvement in visual acuity.

Subconjunctival dexamethasone-assisted conjunctival autograft harvesting versus normal saline during pterygium surgery - A randomized clinical trial.

PURPOSE: To evaluate the effect of subconjunctival dexamethasone compared to normal saline on conjunctival autograft harvesting in patients undergoing pterygium surgery. METHODS: Fifty-two eyes of 52 patients who underwent pterygium excision combined with autologous conjunctival graft (CAG) using releasable suture were included in this prospective interventional study. The patients were randomized into two groups of 26 patients each. Group A consisted of patients in whom CAG was harvested using subconjunctival 0.5 ml of 0.4% dexamethasone sodium phosphate and in group B patients, normal saline was used. The patients were assessed for postoperative pain, foreign body sensation, and watering as the subjective signs of inflammation and conjunctival inflammation and lid edema as the objective signs of inflammation at 12 and 24 h postsurgery. RESULTS: The mean age of group A and B patients was 47.69 + 13.09 and 46.00 + 10.76 years, respectively. The male:female ratio was 1.6:1 in group A and 1.1:1 in group B. The mean surgical time in group A was 243.96 ± 52.13 s and in group B was 258.08 ± 43.99 s. Postoperative pain, foreign body sensation, and watering were significantly lower in group A patients than in group B patients at both 12 and 24 h postoperatively (group A: 4.65 ± 1.33, 4.88 ± 1.73, and 3.85 ± 1.43, respectively, at 12 h; 1.89 ± 1.03, 1.69 ± 1.09, and 1.69 ± 0.97, respectively, at 24 h and group B: 6.42 ± 0.95, 6.65 ± 0.98, and 6.27 ± 1.40, respectively, at 12 h; 3.27 ± 1.43, 3.12 ± 1.25, 2.58 ± 1.14, respectively, at 24 h) ( P < 0.001). Conjunctival inflammation was significantly lower in group A at 12 h ( P < 0.05) and 24 h ( P < 0.05) after surgery compared to group B. Lid edema failed to show any significant ( P = 0.17) difference with respect to severity in both the groups at 12 and 24 h ( P = 0.699). CONCLUSION: Subconjunctival dexamethasone decreased patient discomfort following pterygium surgery. The dexamethasone group had reduced conjunctival inflammatory signs without any notable complications.

Microbial keratitis and antibiotic sensitivity patterns: A retrospective analysis at a tertiary center in Central India.

Purpose: To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods: The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results: Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%-75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%-70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion: This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted.

Posterior lamellar keratectomy for recalcitrant deep stromal keratitis: A case report.

PURPOSE: To describe a new technique for management of recalcitrant deep stromal keratitis using posterior lamellar keratectomy. METHODS: A 66-year-old pseudophakic male presented with deep stromal corneal infiltrates, extending from 2 to 4 o'clock in the vicinity of the limbus of the left eye, 3 months after phacoemulsification. The infiltrates failed to respond to empirical topical medications, anterior chamber wash and intrastromal injection. Posterior lamellar keratectomy was done to debulk the infectious load. In this technique the diseased posterior lamella was excised through a sclerocorneal lamellar pocket without a donor graft. RESULTS: The infection subsided within 2 weeks after posterior lamellar keratectomy. Patient achieved best corrected visual acuity (BCVA) of 20/60 with complete resolution of symptoms at 2 weeks follow up. Till the last follow-up at 6 months, the patient maintained BCVA of 20/60 with no sign of recurrence or corneal decompensation at the keratectomy site. CONCLUSION: Posterior lamellar keratectomy is a simple, effective and inexpensive technique for management of small, peripheral, deep-seated recalcitrant keratitis. It leads to radical treatment of the disease like therapeutic penetrating keratoplasty but in a less invasive manner and without a donor graft.

Checklist of Tettigoniidae (Orthoptera: Ensifera) from India.

This paper presents the known Indian Tettigoniidae (Orthoptera) as an updated checklist that includes currently valid names for the fauna with their distribution data. A total of 219 species, a few with subspecies, and 08 subfamilies were recorded to occur in India.

First report of the female Acanthogryllus asiaticus Gorochov, 1990 (Orthoptera: Gryllidae: Gryllinae) from India and updated description of two crickets of Gryllini.

The present paper reports the occurrence of female Acanthogryllus asiaticus Gorochov, 1990 from India and updates the description of Depressogryllus depressiceps (Ebner, 1935); besides, the description of Scapsipedus raychaudhurii Bhowmik, 1967, now classified into the genus Velarifictorus Randell, 1964 [Velarifictorus raychaudhurii (Bhowmik, 1967)] has been revised. Suitable plates with close-up details of the genitalia have been presented in support of the descriptions.

Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report.

PURPOSE: To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. METHODS: An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. RESULTS: After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. CONCLUSION: Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.

Record of the subgenus, Gryllitara Chopard, 1931 (Orthoptera: Gryllidae: Itarinae) and description of a new species from India.

In the present paper, we report the occurrence of the cricket subgenus Gryllitara Chopard, 1931 from India along with the description of a new species, Itara (Gryllitara) pilosa sp. nov., from the state of Kerala, South India. Suitable plates with close-up details have been presented to describe the new species, as well as for Itara (Itara) vietnamensis Gorochov being reported from North East India.

Some lesser known silent crickets (Orthoptera: Gryllidae: Euscyrtinae) from the hilly tracts of India.

The present paper deals with the revised description of some lesser known silent-slender crickets of Euscyrtinae (Orthoptera: Gryllidae) from the tropical hilly tracts of India. Besides, we describe a new species, Euscyrtus tubus sp. nov., and report the occurrence of Euscyrtodes ogatai (Shiraki, 1930) from India.

Revision in the generic name of the cricket, Luzaropsis mjobergi Chopard, 1926 of tribe Luzaropsini (Phalangopsidae: Phalangopsinae).

The present paper deals with the revision in the generic name of the phalangopsid cricket, Luzaropsis mjobergi Chopard (1926) as Paraluzaropsis, based on significant differences in certain morphological and the male genitalia characters. The male of Paraluzaropsis mjobergi (Chopard) has been described for the first time with suitable plates and line diagrams that was collected from South India. A key to the existing genera of the tribe Luzaropsini has been presented.

Notes on some lesser known crickets of the tribe Podoscirtini (Podoscirtinae: Gryllidae: Orthoptera) from India.

The present paper deals with a description of two new species of crickets of the subfamily Podoscirtinae (Orthoptera: Gryllidae), Trelleora khasiana sp. nov. and Indotrella maculata sp. nov., from India; besides, some additional morphological characteristics of the already reported species, Indotrella angusta Gorochov, 2003 is also presented. The morphological characterization of these two new species is supported with suitable line diagrams and plates. A checklist of crickets of Podoscirtinae for the Asia-tropical region is included.

Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts.

PURPOSE: To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery. METHODS: We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm 2 ) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence. RESULTS: The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm 2 ) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4). CONCLUSION: RS, by augmenting the autologous blood mechanism, may offer an easy to learn option for pterygium surgery with good stability even in large sized CAGs.

A new species of the cricket genus, Cacoplistes from Rajasthan, India (Orthoptera: Phalangopsidae: Cachoplistinae:Cachoplistini).

A new species of the phalangopsid cricket in Cacoplistes subgenus, Laminogryllus, is reported and described as Cacoplistes (Laminogryllus) latioribus sp nov., from Rajasthan, India. Description of the two existing phenotypic forms, brachypterous and macropterous is provided with suitable plates and figures.

Stenciling-Based "Prick and Print" Technique for Harvesting Shaped Corneal Grafts for Management of Peripheral Corneal Perforations.

PURPOSE: To evaluate a new surgical technique ("prick and print") for harvesting shaped donor corneal grafts in cases with perforated peripheral ulcerative keratitis (PUK). METHODS: We conducted a retrospective case series at a tertiary center. Medical records of 13 patients with perforated PUK, who underwent tectonic eccentric keratoplasty using the stenciling-based prick and print technique during the past 1 year, were reviewed. All patients (15 eyes of 13 patients) received grafts of varying sizes and shapes (14 crescentic and 1 biconvex). Factors evaluated were tectonic integrity, graft apposition, and complications, if any. Surgical success was defined as maintenance of corneal integrity and healing of PUK. RESULTS: Mean age of patients was 40.6 ± 19.4 years. Mean follow-up was 10 months. We achieved surgical success in 80% (12/15 eyes) of cases. Two eyes had graft infection, and regrafting (large circular graft) was performed for both. One eye developed new-site PUK, which was managed medically, and the graft remained viable tectonically. After surgery, 9 eyes achieved a best-corrected visual acuity of logarithm of the minimum angle of resolution +0.3 or better. No cases had graft rejection or peripheral anterior synechiae by final follow-up. CONCLUSIONS: The stenciling-based prick and print technique for making shaped donor corneal grafts may offer a simple, easy-to-learn surgical technique that can be used to make any shape or pattern of donor corneal grafts without involving the optical center, even in extensive peripheral corneal lesions.

Releasable Single Suture for Primary Pterygium Excision With a Conjunctival Autograft.

PURPOSE: To evaluate the efficacy of a releasable single suture for pterygium excision with a conjunctival autograft (CAG). METHODS: Retrospective case series at a tertiary eye care center in central India was conducted. Medical records of 150 patients, who underwent primary pterygium excision with a CAG secured by a single releasable 10-0 nylon suture in the last year were reviewed. The surgical duration was noted. The suture was released on the first postoperative day under topical anesthesia. Patients were followed up until 1 year. At each visit, factors studied were patient comfort [pain grading on a visual analog scale], graft apposition, complications, and recurrence. RESULTS: Mean age of patients was 39 ± 11 years. Most patients in our study were female (58.7%). Sixty percent of pterygia were of Tan grade 2. The mean duration of surgery was 4.8 ± 1.3 minutes. The maximum size of the CAG was 6 mm (3-6 mm). The graft retraction rate was 5.3% (1 mm retraction in the CAG more than 5.5 mm) with no event of graft loss. Four percent of patients had grade 1 recurrence. CONCLUSIONS: Releasable single suture may offer a good and simple alternative, which uses the gold standard technique of the CAG with exclusion of suture-related complications.

Highly sensitive LC-MS/MS-ESI method for simultaneous quantitation of albendazole and ricobendazole in rat plasma and its application to a rat pharmacokinetic study.

A highly sensitive and specific LC-MS/MS-ESI method was developed for simultaneous quantification of albenadazole (ABZ) and ricobendazole (RBZ) in rat plasma (50 µL) using phenacetin as an internal standard (IS). Simple protein precipitation was used to extract ABZ and RBZ from rat plasma. The chromatographic resolution of ABZ, RBZ and IS was achieved with a mobile phase consisting of 5 m m ammonium acetate (pH 6) and acetonitrile (20:80, v/v) at a flow rate of 1 mL/min on a Chromolith RP-18e column. The total chromatographic run time was 3.5 min and the elution of ABZ, RBZ and IS occurred at 1.66, 1.50 and 1.59 min, respectively. A linear response function was established for the ranges of concentrations 2.01-2007 and 6.02-6020 ng/mL for ABZ and RBZ, respectively. The intra- and inter-day precision values for ABZ and RBZ met the acceptance as per FDA guidelines. ABZ and RBZ were stable in battery of stability studies, viz. bench-top, auto-sampler and freeze-thaw cycles. The developed assay was applied to a pharmacokinetic study in rats.

Formulation development of an albendazole self-emulsifying drug delivery system (SEDDS) with enhanced systemic exposure.

The aim of the study was to develop and evaluate a self--emulsifying drug delivery system (SEDDS) formulation to improve solubility and dissolution and to enhance systemic exposure of a BCS class II anthelmetic drug, albendazole (ABZ). In the present study, solubility of ABZ was determined in various oils, surfactants and co-surfactants to identify the microemulsion components. Pseudoternary phase diagrams were plotted to identify the microemulsification existence area. SEDDS formulation of ABZ was prepared using oil (Labrafac Lipopfile WL1349) and a surfactant/co-surfactant (Tween 80/PEG 400) mixture and was characterized by appropriate studies, viz., microemulsifying properties, droplet size measurement, in vitro dissolution, etc. Finally, PK of the ABZ SEDDS formulation was performed on rats in parallel with suspension formulation. It was concluded that the SEDDS formulation approach can be used to improve the dissolution and systemic exposure of poorly water-soluble drugs such as ABZ.