Myopic shift, refractive, and visual outcomes after 5 years of infantile cataract surgery: Our experience and review of literature.

PURPOSE: After infantile cataract surgery, axial elongation, induces a myopic shift that cannot be fully compensated by corneal flattening and the rate is unpredictable owing to the non-linear growth of the eye. The current prospective study assesses the myopic shift and visual outcomes in children undergoing cataract surgery in infancy over a follow-up period of 5 years. MATERIALS AND METHODS: A prospective study conducted at a tertiary eye care center to evaluate the five-year myopic shift, refractive and visual outcomes in infants, who underwent surgery for congenital cataract in infancy. The visual acuity, myopic shift and biometric changes are compared between the aphakia and pseudophakia group. RESULTS: The mean best-corrected visual acuity (BCVA) recorded in logMAR at 5 years for aphakia group was 0.92±0.44 and for pseudophakia group was 0.66±0.42. (pvalue: 0.002102). The myopic shift was noted to be -5.9+/-5.16 in the aphakia group whereas it was -9.01+/- 3.11 in the pseudophakia group (P value= 0.002101) at 5 years after surgery for infantile cataract. CONCLUSION: IOL implantation in eyes of infants undergoing cataract surgery is feasible in eyes that strictly satisfy the pre-operative inclusion criteria and the visual outcomes in these eyes are better compared to aphakia group at 5 years follow up. Eyes with primary IOL implantation had a higher myopic shift compared to ones without primary IOL implantation. Eyes undergoing primary IOL implantation, need higher under correction compared to the current available formulae.

Paracentral acute middle maculopathy in a patient with Myelin Oligodendrocyte glycoprotein antibody associated optic neuritis.

Purpose: There is insufficient literature reporting the concurrent occurrence of retinal ischemic lesions with optic neuritis. In this case report, we present a distinctive instance of Optic Neuritis with a positive Myelin Oligodendrocyte glycoprotein (MOG) antibody, accompanied by retinal ischemia manifesting as paracentral acute middle maculopathy (PAMM) lesions. Observations: Our patient is a 25-year-old female who tested positive for MOG antibodies and exhibited retinal PAMM lesions without any apparent underlying ischemic cause. She received intravenous pulse steroid therapy, and her symptoms and signs completely resolved one month later. Conclusion: PAMM can serve as an initial manifestation of Myelin Oligodendrocyte glycoprotein Antibody Associated Disease (MOGAD). This case has the potential to contribute to the existing literature, facilitating a deeper exploration of the pathophysiology of retinal ischemia in MOG associated optic neuritis.

Facial dysmorphism in congenital rubella syndrome.

PURPOSE: To investigate the dysmorphic facial features in congenital rubella syndrome (CRS) and describe their associations with ocular and systemic features. METHODS: The medical records of children diagnosed with CRS between 2016 and 2021 were retrospectively reviewed for ocular and systemic features. CRS was diagnosed either on the basis of positive serology for rubella antibodies or with the classic triad of congenital cataract, sensorineural hearing loss, and congenital heart defect. Children with photographic documentation of the face were analyzed independently by three experienced investigators for facial dysmorphic features (triangular face, microcephaly, broad forehead, low anterior hairline, whorl on the anterior hairline, prominent nose, micrognathia). The dysmorphic feature was recorded as present only when at least two of the three examiners confirmed its existence. RESULTS: CRS was diagnosed in 237 children: mean age at presentation, 5.45 ± 4.5 years; 126 males (53%); bilateral cataract, 176 (75%). Positive serology for rubella antibodies was noted in 153 children (65%). Photographic record of facial features was documented in 127 (54%). The most common dysmorphic facial feature was wide forehead (82 [65%]), followed by low anterior hairline with whorl (41 [32%]). However, microcornea (P = 0.9801), cataract (P = 0.8342), pupillary sphincter atrophy (P = 0.7421), and salt and pepper retinopathy (P = 0.8803) were not significantly associated with the presence of facial dysmorphism. Congenital heart disease was significantly associated with facial dysmorphism (P = 0.0308). Sensorineural hearing loss was not associated with the presence of facial dysmorphism (P = 0.8463). CONCLUSIONS: Facial dysmorphism is common in children with CRS, but it was not predictive of the presence of ocular manifestations of CRS in this cohort.

Different strokes for anterior capsulorhexis in pediatric cataract.

Background: A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. Purpose: This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. Synopsis: The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue-rhexis), or by coaxial illumination (4. Coaxial-rhexis) or by just the sheen of capsule (5. Sheen-rhexis). The anterior chamber can be maintained using ophthalmic visco-elastic device (Visco-rhexis) or by irrigation fluid (6. Hydro-rhexis). A speed-breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque-rhexis) or by a vitrector (vitrectorhexis) or a pair of micro-scissors (8. Scissor rhexis). Above all, the technology of femto-second-laser-assisted (9. Femto-rhexis) and zepto-pulse-precision capsulotomy (10. Zepto-rhexis) is also illustrated. Highlights: This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery. Video Link: https://youtu.be/TgDrk5RYdbI.

Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation.

OBJECTIVE: To study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia. DESIGN: Retrospective, comparative, non-randomised interventional study. METHODS: All consecutive children with microspherophakia who satisfied the inclusion criteria were included. The eyes that underwent in-the-bag IOL implantation and those that were left aphakic were included in groups A and B, respectively. The postoperative visual outcomes, IOL stability and complications during the follow-up period were studied. RESULTS: 22 eyes (13 patients, male 76%), of which 12 eyes were in group A and 10 eyes in group B. The mean±SE of age at surgery was 9.4±1.4 and 7.3±0.9 years in group A and group B, respectively (p value 0.18). The mean follow-up of group A was 0.9±0.4 years (median 0.5 years; Q1 0.04, Q3 2.16) and group B was 1.3±0.9 years (median 0.147 years; Q1 0.08, Q3 0.39) (p value 0.76). All the baseline biometric variables including best-corrected visual acuity (BCVA) were comparable in each group. The final BCVA in logMAR adjusted for follow-up was comparable in both group A (0.29±0.06) and group B (0.52±0.09) (p value 0.06). Mean predictive error of IOL power in microspherophakia was 0.17±0.43.The most common complication in group A was visual axis opacification of two eyes (16.7%, 95% CI 2.9% to 49.1%), of which one eye (8.3%, 95% CI 0.4% to 40.2%) needed membranectomy. Vitreous in anterior chamber was the most common complication in group B, seen in two eyes (20%, 95% CI 3.5% to 55.8%), of which one eye (10%, 95% CI 0.5% to 45.9%) underwent YAG laser vitreolysis. The survival analysis (p value 0.18) was comparable in each group. CONCLUSION: In-the-bag IOL is an option, which can be considered in selected cases of microspherophakia in developing nations where regular follow-up and economic constraints are a major concern.

Unraveling congenital ptosis with the aid of the pediatric perimeter device.

Background: Ocular morbidity with an early onset can have a significant impact on the long-term development of an individual. Hence, careful assessment of visual functions early on is very important. However, testing infants always poses a challenge. Standard tools to assess infants' visual acuity, ocular motility, and so on rely on the clinician's quick subjective judgments of an infant's looking behavior. Eye movements are usually observed from head rotations or spontaneous eye movements in infants. Judging eye movements in the presence of strabismus is even more challenging. Purpose: This video shows a 4-month-old infant's viewing behavior captured during a visual field screening study. The recorded video aided in the examination of this infant that was referred to a tertiary eye care clinic. The additional information captured through the perimeter testing is discussed. Synopsis: The Pediatric Perimeter device was developed to address visual field extent and gaze reaction time assessment in the pediatric population. As a part of a large-scale screening study, infants' visual fields were tested. During this screening, a 4-month-old infant presented with a ptosis in the left eye. The infant was consistently missing the light stimuli presented in the left upper quadrant in the binocular visual field testing. The infant was referred to a tertiary eye care center to a pediatric ophthalmologist for further examination. During clinical examination, the infant was suspected to either have congenital ptosis or monocular elevation deficit. But the diagnosis of the eye condition was unsure owing to the poor cooperation of the infant. With the aid of Pediatric Perimeter, the ocular motility was consistent with limitation of elevation in abduction, indicating a possible monocular elevation deficit with congenital ptosis. The infant was also noted to have Marcus Gunn jaw-winking phenomenon. The parents were assured and asked for a review in 3 months. In the subsequent follow-up, the Pediatric Perimeter testing was performed, and the recording showed a full extraocular motility in both eyes. Hence, the diagnosis was changed to only congenital ptosis. The probable explanation for missing the target in the left upper quadrant in the first visit is postulated further. The left upper quadrant is the superotemporal visual field of the left eye and the superonasal visual field of the right eye. As the left eye had ptosis, the superotemporal visual field could have been obstructed and hence the stimuli missed. The normative extent for the nasal and superior visual field is just about 30° for a 4-month-old infant. Hence, the right eye also perhaps missed the stimuli in its superonasal visual field extent. This video highlights the utility of the Pediatric Perimeter device in providing a magnified view of the infant's face along with greater visibility of ocular features from the infrared video imaging. This can potentially help the clinician to easily observe different ocular/facial abnormalities such as extraocular motility disorders, lid functions, and in identifying unequal pupil size, media opacities, and nystagmus. Highlights: The presence of congenital ptosis in younger infants might predispose as superior visual field defect and could also masquerade as a limitation in elevation. Video link: https://youtu.be/Lk8jSvS3thE.

Inside-out and outside-in: Tips and tricks in posterior lenticonus.

Background: Posterior lenticonus is a congenital condition characterized by the thinning and bowing of posterior lenticular capsule. Cataract develops when normal intra-lenticular pressure bulges the posterior capsule at the circumscribed portion of inherent thin posterior lens capsule, leading to derangement of lamellar lens fibers. This condition poses a surgical challenge as the presentation varies from thin, bulging posterior capsule to large, pre-existing posterior capsular dehiscence. Purpose: This video highlights the tips for the surgical management of various scenarios of posterior lenticonus. Synopsis: In this video, tips for surgical management of various scenarios of posterior lenticonus are illustrated. Intraoperatively, ruptured posterior capsule is suspected by the presence of a fish-tail sign. The anterior capsulotomy is relatively easier in a flatter anterior lens capsule, owing to reduced intra-lenticular pressure. Hydro-dissection is avoided to prevent extension of pre-existing posterior capsular dehiscence or creation of rupture in a thinned-out capsule. The peripheral lens cortex aspiration is initiated first, followed by in each quadrant. In a presence of ruptured posterior capsule by vigilant inspection at this stage, the surgeon should change the direction of lens matter aspiration by aspirating the central lenticular matter first, followed by peripheral cortex like "inside-out". In absence of posterior capsule dehiscence, peripheral cortex is aspirated first, followed by central lens matter aspiration like "outside-in". Adequate anterior vitrectomy is performed until there are no vitreous tags. Highlights: In the presence of pre-existing posterior capsular defect, the lens matter is aspirated from the center (inside-out), whereas in the absence of capsular defect, the lens matter is aspirated from the periphery (outside-in). Online Video link: https://youtu.be/8G6BCbFwr8Q.

Virtual bedside clinics in pediatric ophthalmology and strabismus - An innovation in education and learning.

We piloted an innovation in teaching by conducting live virtual bedside clinics and evaluated the effectiveness compared to conventional bedside clinics. The purpose is to report the methodology and survey results of this innovation in teaching. A virtual bedside clinic was set up utilizing multiple audio-visual aids at a tertiary eye care facility. The bedside clinic was conducted and streamed live to pre-registered participants across the globe using the Zoom platform. The online survey was conducted comparing its effectiveness with conventional bedside clinics. A total of five sessions were conducted. A total of 2058 participants registered (411/session), of which 938 (45.57%) attended (187/session). A total of 287 participants (30.6%) responded to the survey. The respondents included ophthalmology residents (43.4%), fellows (19%), sub-specialty ophthalmologists (15.4%), general ophthalmologists (12%), and optometrists (9%). More than 95% of the respondents felt that these clinics were equally effective/better in imparting the following: physical examination 97%, clinical knowledge 99.3%, clinical reasoning 98.3%, procedural skills 95%, and communication skills 96.5%. Respondents suggested that these clinics were better/equally effective in the following techniques: general examination (96%), ocular motility (93.3%), nystagmus evaluation (93.3%), and anterior (80%) and posterior segment examination (73.3%). The hybrid mode presentation (97.3%) and discussion with the panel (100%) were reported to be equally effective/much better. Live virtual bedside clinics are a novel and effective way of continuing quality teaching and impactful learning. Most of the bedside manners, procedural skills, and examination techniques can be effectively taught through this virtual platform with a scope to improve anterior and posterior segment examination skills.

Optic chiasm, optic tract and deep white demyelination: an unusual distribution of myelin oligodendrocyte glycoprotein-associated demyelination (MOGAD), case report and review of literature.

A preschool girl presented with sudden-onset bilateral painless loss of vision from 2 days prior. Child's examination showed light perception vision, sluggishly reacting pupils, otherwise normal anterior segment, healthy optic disc and retina in both eyes. MRI of brain and orbit with contrast revealed thickened left part of the optic chiasm with contrast enhancement extending proximally to bilateral optic tract and hyperintensities in the left thalamus and periventricular white mater. Considering the topographical distribution of lesions in the brain, neuromyelitis optica spectrum disorder was suspected. The child was started on intravenous methylprednisolone followed by tapering oral steroids. Serological testing was positive for myelin oligodendrocyte glycoprotein (MOG) and negative for aquaporin-4 antibodies. This case represents an unusual case of MOG associated demyelination disorder where the distribution of lesions showed chiasmal involvement along with optic tract, thalamus and deep white mater lesions.

Visual outcomes and complications in infantile cataract surgery: a real - world scenario.

Objective: To evaluate visual outcomes and complications of infantile cataract surgery through a 1-year follow-up period in a real world scenario. Methods and analysis: Prospective observational study evaluating infants with cataract undergoing surgery. Results: We analysed 173 eyes of 97 infants (76 bilateral); median age 18.7 weeks, (IQR: 11-33.9 weeks). Toxoplasmosis, rubella, cytomegalovirus and herpes infection was the most common aetiology in both unilateral 10 (47.6%) and bilateral 43 (55.1%) cases, followed by familial and syndromic cases. Fifty-four eyes (29.5%) received primary intraocular lens (IOL) implantation.Seventy-five infants (76%) were less than 6 months of age. At 1-year follow-up, mean log MAR best-corrected visual acuity was 1.00±0.08 and 1.21±0.03 in unilateral and bilateral cases respectively (p=0.012), which was not statistically significant. At 1-year follow-up, pseudophakic(1.09±0.05) eyes had a better mean log MAR visual acuity comparing aphakes(1.24±0.04) clinically but was not statistically significant after the application of Bonferroni correction (p=0.012). The mean myopic shift of -2.9 D±0.39 and -4.53 D±0.55 over 1 year was noted in aphakes and pseudophakes, respectively (p=0.016). Visual axis opacification and glaucoma were the most common complications noted in pseudophakes and aphakes, respectively. Conclusion: Primary IOL implantation in selected cases of infantile cataract is a feasible option, particularly in cases when optimal aftercare and refractive rehabilitation of aphakia are not possible.

Clinical profile, diagnostic challenges, and outcomes in subacute/chronic cerebral sinus venous thrombosis.

PURPOSE: To report clinical profile, diagnostic challenges, and outcomes in cases of subacute/chronic cerebral sinus venous thrombosis (CSVT) presenting to neuro-ophthalmologists/neurologists. METHODS: This was a multicentric, retrospective, observational study. Records of patients with neuroimaging proven subacute/chronic CSVT seen the from January 1, 2016 to March 31, 2020 were analyzed. Data collected included duration of symptoms, diagnosing physician, ophthalmological vs. focal/generalized neurological symptoms, optic disc examination, perimetry, and neuroimaging findings. Statistical analysis was performed using STATA software. RESULTS: Forty-three patients with subacute (30)/chronic (13) CSVT were identified (32 males, 11 females). Median age was 37 (IQR 27-47) years. The presenting complaints were blurred vision 34 (79%), headaches in 25 (58%), vomiting 12 (28%), and diplopia 11 (26%). Eleven patients had associated sixth cranial nerve palsy. All but two patients had either disc edema/optic atrophy; four had unilateral disc edema at presentation. Ophthalmologists and neurologists diagnosed/suspected CSVT correctly in 13/29 (45%) and 11/14 (78.5%) patients, respectively. Most common initial alternate diagnosis was idiopathic intracranial hypertension in 12 (28%). Female gender, age ≤36, unilateral papilledema, not obtaining venogram at initial workup increased chances of initial alternate diagnosis. Median follow-up duration was 21 days. Average visual function remained stable in majority of patients at last follow-up. In total, 47.6% of patients had best-corrected visual acuity ≥20/30 at the final follow-up. CONCLUSION: In our series, subacute or chronic CSVT presented presented primarily with symptoms of intracranial hypertension. Unilateral papilledema, middle-aged patients, female gender, lack of focal/generalized neurological symptoms created diagnostic dilemma. Visual function remained stable in majority of patients.

Comparison of Loading Doses of Ziv-Aflibercept and Aflibercept in Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this study was to compare outcomes of 3 loading doses of ziv-aflibercept and aflibercept in treatment-naïve neovascular age-related macular degeneration (nAMD). DESIGN: Retrospective, nonrandomized, comparative study. METHODS: This was a retrospective chart review which included cases with treatment-naïve nAMD. The patients were divided into 2 groups (group 1, ziv-aflibercept; group 2, aflibercept). Groups 1 and 2 received 1.25 mg/0.05 mL of intravitreal ziv-aflibercept and 2 mg/0.05 mL aflibercept, respectively every month for 3 months. Best-corrected visual acuity (BCVA) in Snellen and logarithm of minimum angle of resolution (logMAR), central subfoveal thickness (CSFT), subretinal hyperreflective material height, neurosensory detachment height, and pigment epithelial detachment height were recorded at baseline and 3 monthly follow-up. RESULTS: Twenty-three eyes of 23 patients were included (males 14, females 9). Twelve and 11 eyes were included in group 1 and group 2, respectively. Group 1 showed statistically significant improvement in BCVA (P < 0.001) and CSFT (P=0.007) through 3 months compared with baseline. There was significant change in BCVA from baseline at 1st month (P = 0.007), 2nd month (P = 0.002) and 3rd month (P = 0.008). In group 2, there was no significant improvement in BCVA, CSFT, subretinal hyperreflective material height, neurosensory detachment, and pigment epithelial detachment height from baseline through 3 months. CONCLUSIONS: After 3 loading doses, ziv-aflibercept showed efficacy in terms of improved BCVA and reduction of CSFT from baseline whereas aflibercept did not show such improvement. Considering the cost- effectiveness and the proven safety of ziv-aflibercept, it is a viable option for the crucial, initial 3 doses in the treatment of nAMD.

Intravitreal Ziv-Aflibercept : Safety Analysis in Eyes Receiving More Than Ten Intravitreal Injections.

Purpose: To report the ocular and systemic adverse events in eyes receiving ≥10 intravitreal ziv-aflibercept (IVZ) injections.Methods: Medical records of patients who received ≥10 IVZ for various chorioretinal conditions with minimum follow up period of 12 months were retrospectively analysed. These eyes received standard dose of IVZ (1.25 mg/0.05 ml) on pro-re-nata (PRN) or treat and extend (T&E) protocol. The primary study outcome was ocular and systemic adverse events related to IVZ injections whereas secondary outcomes were change in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT) at last visit compared to baseline. Comparison of BCVA and CMT at baseline and final visit was done using paired t-test.Results: A total of 94 eyes which received a mean ± standard deviation (mean±SD = 14.4 ± 4.6) IVZ injections were studied. A total of 41 eyes were treatment naïve whereas 53 eyes received intravitreal injections in the past with last injection at least 3 months prior. Mean (±SD) follow up period was 26.7 ± 8.7 months. Ocular adverse events were limited with a case each of acute iridocyclitis, endophthalmitis, cataract progression and early epiretinal membrane formation. No systemic events were recorded within a month of IVZ injection. There was a significant improvement in BCVA (p = 0.001) and change in CMT (p = 0.001) at last visit.Conclusion: Ocular use of ziv-aflibercept is safe with limited ocular and systemic side effects. Multiple injections of IVZ can be used in various chorioretinal diseases over the long term.

Bilateral advanced (group D or E) intraocular retinoblastoma: outcomes in 72 Asian Indian patients.

PURPOSE: To study the clinical presentation, treatment, and outcomes of patients with bilateral advanced intraocular retinoblastoma. METHODS: Retrospective case series of 72 patients. RESULTS: The mean age at presentation was 19 months. Leukocoria (n = 49, 68%) was the most common presenting complaint. The tumors were classified as groups D (n = 60, 42%) or E (n = 84, 58%) based on the Philadelphia version of International Classification of Retinoblastoma (ICRB); groups D (n = 84, 58%) or E (n = 60, 42%) based on Children's Hospital Los Angeles version of International Classification of Intraocular Retinoblastoma (ICIoR); T2 (n = 116, 81%) or T3 (n = 28, 19%) based on 8th edition American Joint Committee Classification (AJCC). Systemic chemotherapy (n = 138, 96%) was the most common primary treatment modality. The chance of globe salvage was higher for group D based on ICRB (83%; odds ratio (OR) 7.73; 95% confidence interval (CI) 3.45-17.33) or ICIoR (81%; OR 12.75; 95% CI 5.74-28.34) and T2b (73%; OR 5.19; 95% CI 2.51-10.73) based on AJCC. Over a mean follow-up period of 59 months, tumor recurrence was noted in 42 (29%) eyes and globe salvage was achieved in 83 (58%) eyes. Of the 50 eyes where vision was recorded, vision of 20/200 or better was achieved in 24 (48%) eyes. There were events of leukemia (n = 1, 1%), pinealoblastoma (n = 1, 1%), systemic metastasis (n = 3, 4%), and death (n = 4, 6%) during the follow-up period. CONCLUSION: Multimodality treatment allows globe salvage (58%) and vision salvage (48%) in eyes with advanced group D and E intraocular retinoblastoma.

Safety of 5914 intravitreal ziv-aflibercept injections.

PURPOSE: To analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions. METHODS: This was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related. RESULTS: A total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent. CONCLUSION: This constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.

Efficacy of fresh Aloe vera gel against multi-drug resistant bacteria in infected leg ulcers.

BACKGROUND: Infected leg ulcers are major health problems resulting in morbidity and disability and are usually chronic and refractory to antimicrobial treatment. AIMS: The present study is aimed at determining the bacteria involved in leg ulcers and their resistance patterns to commonly used antibiotics as well as to determine whether Aloe Vera has antibacterial activity against multi-drug resistant organisms and promotes wound healing. METHOD: A total of 30 cases with leg ulcers infected with multi-drug resistant organisms were treated with topical aloe vera gel and 30 age and sex-matched controls were treated with topical antibiotics. Culture and sensitivity was done from the wounds on alternate days and the ulcer was clinically and microbiologically assessed after 10 days. The results were compiled and statistically analysed. RESULTS: Cultures of the study group who were using aloe vera dressings showed no growth by the fifth day in 10 (33.3%) cases, seventh day in another 16 (53.3%) and ninth day in two of the remaining four cases (6.7%) while in two (6.7%) cases there was no decrease in the bacterial count. This means that of the 30 cases, 28 showed no growth by the end of 11 days while two cases showed no decrease in bacterial count. Growth of bacteria in study group is decreased from 100% (30 cases) to 6.7% (2 cases) by day 11 with P<0.001. Cultures of the control group did not show any decrease in the bacterial growth by day 11. CONCLUSION: Aloe vera gel preparation is cheap and was effective even against multi-drug resistant organisms as compared to the routinely used topical anti-microbial agents.