Every eye needs a best chance to see: Just give it.

Background: Anterior staphyloma is defined as a localized defect in the anterior eye wall with protrusion of the uveal tissue due to alterations in scleral thickness and structure. The causes could be congenital, trauma, or following infection. Surgical options include staphylectomy with graft (corneal/corneoscleral), biosynthetic graft, enucleation or evisceration in a painful blind eye). Purpose: To demonstrate staphylectomy with careful preservation of ocular structures followed by optical keratoplasty in a single setting. Synopsis: A 39-year-old Asian Indian lady presented with complaints of blurring of vision and whitish opacity in both eyes since childhood, associated with progressive enlargement and protrusion of the black part of the left eye with severe pain at the time of presentation. Her clinical examination revealed leucomatous corneal opacity in both the eyes and anterior staphyloma and keratinization in the left eye. Visual acuity was counting fingers close to face in the right eye and hand movements close to face in the left eye with projection of rays being accurate in both eyes. Ultrasound B scan showed posterior staphyloma in the right eye with sub-Tenon's fluid and increased retinochoroidal thickness. The left eye posterior segment with B scan was normal. The available surgical options were evisceration with secondary orbital implant and ocular prosthesis or staphylectomy with corneal transplantation. To provide the best option for the patient in her eye with better visual potential, staphylectomy with corneal transplantation was done. Highlights: Painful blind eye is usually dealt with evisceration. This video demonstrates the technique of staphylectomy with corneal graft and restoration of structural integrity. Evisceration is a destructive procedure that involves removal of the intraocular contents. The patient will have to deal with the hassles of prosthesis maintenance and stigma of the artificial eye. Video link: https://youtu.be/VoS8Irsh1yY.

A stitch in time saves my (ne) (vision).

Background: Corneal melt with iris prolapse is a rare complication of autoimmune diseases, especially rheumatoid arthritis. Purpose: To highlight a challenging case of a peripheral ulcerative keratitis (PUK) with corneal melt and iris prolapse in a patient's only eye. Synopsis: A 56-year-old Asian Indian male presented with blurring of vision in the right eye and was diagnosed with cataract. He was a known type 2 diabetes mellitus and a rheumatoid arthritis patient and was not on treatment. He had been previously diagnosed with PUK in the left eye and was lost to follow-up due to coronavirus disease 2019 (COVID-19) after therapeutic penetrating keratoplasty and lost his vision in that eye. Cataract surgery in the right eye was done under cover of immunosuppression. Subsequently, he developed PUK and was treated with a glue and bandage contact lens. Again, he was lost to follow-up and then presented a few months later with corneal melt with iris prolapse in the right eye. We describe in the video the surgical and medical challenges and successful salvage of both the eyeball and the vision. Highlights: Highlights include the following: 1. A rare case of corneal melt with iris prolapse. 2. Demonstration of surgical technique of patch graft. 3. Anterior segment optical coherence tomography before and after the procedure. Video link: https://youtu.be/HbgixlEAYKU.

Ocular toxicity by seeds of Annona squamosa (custard apple).

Custard apple seeds have been used in native medicine from time immemorial for the management of head lice and skin exfoliation. We report six consecutive patients who developed toxic keratoconjunctivitis within 6-12 h of ocular exposure to custard apple seeds. The use of topical steroid worsens the toxicity and predisposes to the development of microbial keratitis in such cases. Patients showed a good response to primary treatment with topical fortified antibiotics and lubricants. This case series highlights the need to educate the patients regarding the potential toxic effects of the custard seeds and the treating physicians about possible deleterious effects on using topical steroid.

Evaluation of Corneas from Donors With Septicemia for Use in Corneal Transplant.

PURPOSE: To evaluate if donor corneas obtained from deaths occurring because of septicemia can be used for corneal transplantation. STUDY DESIGN: Prospective study. METHODS: Eleven septicemic donor corneas were used in the study and 10 donor corneas from deaths because of causes other than septicemia were used as controls. Blood culture reports of all patients who had donated eyes were collected, and the pathogenic organisms causing septicemia were noted. On obtaining the eyeballs, aqueous and vitreous samples were sent for polymerase chain reaction to analyze for eubacterial and panfungal genomes. Corneal and scleral tissues (3 × 3 mm) were sent for culture in brain heart infusion media. Growth from each of the samples was checked to ascertain if the same organism was isolated in all. RESULTS: One corneal and 3 scleral culture reports in the sepsis group and 1 corneal and 1 scleral culture report in the control group showed positive growth. Normal conjunctival/eyelid commensal organisms were isolated from all culture-positive samples and did not correlate with the pathogenic organism causing the septicemia. Three aqueous and vitreous samples in the sepsis group and 4 samples of aqueous and vitreous in the control group that tested positive for eubacterial genome showed no corresponding growth in the culture report of cornea and sclera. CONCLUSIONS: Corneal tissues harvested from septicemic donors do not necessarily harbor the pathogenic organisms causing the septicemia, suggesting that such corneas may be suitable for transplantation.

Sutureless femtosecond anterior lamellar keratoplasty: a 1-year follow-up study.

AIM: To study the safety and efficacy of sutureless femtosecond anterior lamellar keratoplasty (FALK) in patients with corneal stromal opacities. MATERIALS AND METHODS: Eleven eyes of 11 consecutive patients with corneal stromal opacities involving < 250 µ due to various pathologies were included in the study. Preoperatively, all underwent anterior segment imaging with spectral domain optical coherence tomography (SD-OCT) (Bioptigen Inc., Durham, North Carolina, USA) to measure the depth of the stromal opacity. All patients underwent FALK, and bandage contact lens was placed for a period of 2 weeks. Postoperatively, uncorrected visual acuity, best corrected visual acuity (BCVA), and SD-OCT evaluation were performed. RESULTS: All patients showed significant improvement in BCVA. The mean postoperative BCVA (in decimals) improved from 0.11 ± 0.06 preoperatively to 0.59 ± 0.08. There were no intraoperative or significant postoperative complications that were noticed. CONCLUSION: FALK is a safe and effective alternative to deep anterior lamellar keratoplasty or penetrating keratoplasty in the treatment of anterior stromal opacities.

Collagen crosslinking in the management of advanced non-resolving microbial keratitis.

AIM: To evaluate the efficacy and safety of corneal collagen crosslinking (CXL) in the management of culture proven microbial keratitis. METHODS: 15 eyes of 15 patients of microbial keratitis were included in the study. Nine patients had bacterial keratitis and six had fungal keratitis. All patients underwent microbiological evaluation to identify the causative organism. The depth of the infiltrate was determined clinically with slit lamp and measured manually using anterior segment optical coherence tomography. Patients were treated with antibiotics/antifungals and those who did not respond to at least 2 weeks of topical medications underwent CXL as per the standard protocol. The same preoperative topical medications were continued post-CXL. All patients were followed up every third day and observed for signs of resolution of microbial keratitis. RESULTS: Six of nine patients with bacterial keratitis and three of six patients with fungal keratitis resolved following CXL treatment. Patients with deep stromal keratitis or endothelial plaque failed to resolve. All patients had resolution of pain on the first postoperative day. There was an appearance of or increase in hypopyon in seven patients. No intraoperative or postoperative complications were noticed. CONCLUSIONS: CXL appears to be an effective procedure in the management of superficial microbial keratitis. It can be used as an adjunctive treatment in the management of non-resolving microbial keratitis.

Femtosecond laser enabled keratoplasty for advanced keratoconus.

PURPOSE: To assess the efficacy and advantages of femtosecond laser enabled keratoplasty (FLEK) over conventional penetrating keratoplasty (PKP) in advanced keratoconus. MATERIALS AND METHODS: Detailed review of literature of published randomized controlled trials of operative techniques in PKP and FLEK. RESULTS: Fifteen studies were identified, analyzed, and compared with our outcome. FLEK was found to have better outcome in view of better and earlier stabilization uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and better refractive outcomes with low astigmatism as compared with conventional PKP. Wound healing also was noticed to be earlier, enabling early suture removal in FLEK. CONCLUSIONS: Studies relating to FLEK have shown better results than conventional PKP, however further studies are needed to assess the safety and intraoperative complications of the procedure.