Penetrating keratoplasty and glaucoma valve surgery in recurrent Mooren's disease: A multidisciplinary approach.

INTRODUCTION AND IMPORTANCE: The case report highlights the challenges in managing recurrent Mooren's ulcer, a rare and severe form of peripheral ulcerative keratitis. CASE PRESENTATION: A 49-year-old male, with bilateral Mooren's disease who underwent multiple surgical interventions for visual rehabilitation but developed disease recurrence in the left eye despite being on systemic and topical immunosuppression. The authors report successful long-term visual rehabilitation following a large-graft penetrating keratoplasty and Ahmed glaucoma valve implantation performed under immunosuppressive cover after adequate control of inflammation with intravenous Rituximab. CLINICAL DISCUSSION: We discuss the traditionally poor survival of penetrating keratoplasty in refractory Mooren's disease due to the recurrence of the disease in the graft. Occurrence of secondary glaucoma is commonly seen in these eyes, which often requires combined filtration surgery and medical management. The first and second line systemic immunosuppression may be insufficient in adequately controlling the disease, and that intravenous monoclonal antibodies, such as Rituximab, may be a promising treatment modality in refractory Mooren's disease prior to embarking on any surgical intervention. CONCLUSION: Overall, the case report highlights the importance of adequate control of inflammation and the use of immunosuppressive cover in achieving successful outcomes of PK and AGV surgery in Mooren's ulcer. The authors suggest that intravenous Rituximab may be a valuable addition to the management of refractory Mooren's disease, particularly prior to surgical intervention. However, as with any case report, the findings should be interpreted with caution and further research is needed to validate the efficacy of this treatment modality.

A cross-sectional study to compare the normal corneal epithelial thickness in various age groups of Indian population using 9 mm wide optical coherence tomography scans.

PURPOSE: To compare the corneal epithelial thickness among various age groups of normal Indians with 9-mm-wide optical coherence tomography scans. METHODS: This cross sectional, observational study recruited patients in the age groups of 5-20 years (group 1), 21-35 years (group 2), 36-50 years (group 3), and more than 51 years (group 4). They underwent a detailed ophthalmic examination and were excluded if found to have any ocular surface or intraocular disease (except cataract and refractive error), undergone any ophthalmic surgery, corneal topography changes suggestive of corneal ectasias, or been continuously using any topical medication in either eye for a period of 3 months or more with the last instillation being within 1 month of inclusion in the study. Corneal epithelial thickness (CET) was measured using anterior segment optical coherence tomography (AS-OCT). The CET data from 25 sectors in each eye were analyzed for each age group. RESULTS: There were 71 subjects in group 1, 76 subjects in group 2, 59 subjects in group 3, and 57 subjects in group 4. The mean (± standard deviation) ages in the groups 1, 2, 3, and 4 were 14.04 ± 5.10, 26.63 ± 4.71, 42.66 ± 3.92, and 61.65 ± 7.47 years, respectively. The central corneal thickness in all age groups was comparable. Maximum variance in CET parameters was seen in superior cornea. CONCLUSION: Central corneal thickness remains fairly stable over various age groups. The maximum variance in CET over age is seen in superior cornea. The findings from the Indian population correlate well with racially and geographically distinct subjects.

Presumed herpes simplex virus ulcerative nodular episcleritis treated by topical acyclovir alone.

A 7-year-old female child was referred to the cornea clinic with a painless, ulcerated, and inflamed nodule near the limbus which did not respond to 1-week antibiotic therapy and worsened on starting topical steroids. Clinical examination showed ulcerative nodular episcleritis and raised a suspicion of herpes simplex virus etiology. The patient responded well and resolved completely on topical antiviral therapy alone.

A cross-sectional study to determine the normal corneal epithelial thickness in Indian population using 9-mm wide optical coherence tomography scans.

PURPOSE: To study the corneal epithelial thickness with 9-mm scans of optical coherence tomography in normal Indians with appropriate representation of all age groups. METHODS: This was a cross-sectional observational study. 263 patients were divided into the age groups 5-20 years, 21-35 years, 36-50 years and more than 51 years were recruited for the study. All patients underwent a detailed ophthalmic examination. Patients found to have any ocular surface or intraocular disease condition (except cataract and refractive error), or who had undergone any ophthalmic surgery in the past, or had corneal topography changes suggestive of corneal ectasias (screened in patients with astigmatism more than 3 diopters) or had been continuously using any topical medication in either eye for a period of 3 months or more with the last instillation being within 1 month of inclusion in the study were excluded. All subjects underwent corneal epithelial thickness measurement with anterior segment optical coherence tomography (AS-OCT) on the Avanti OCT (Model RTVueXR1002, Optovue, USA). The corneal epithelial thickness (CET) data from 25 sectors in each eye were analyzed. RESULTS: 263 right and left eyes of 263 patients were analyzed in the study. Mean CETs in the central 2 mm zone were 54.13 ± 4.51 µm and 54.37 ± 3.75 µm for the right and left eyes, respectively. The superior peripheral sectors and inferior paracentral sectors were the thinnest and the thickest sectors, respectively, in both eyes. CONCLUSION: CET parameters for Indian eyes are comparable to those reported from racially distinct and geographically distant study subjects.

A Case Report of An Iris Epithelial Cyst Masquerading As Iris Cysticercosis.

INTRODUCTION: Iris cysts can be primary or secondary. It is common to mistake a parasitic cyst for a benign pigment epithelial cyst. However, we report a case where a benign cyst was mistaken for a parasitic cyst. CASE: A 50-year-old gentleman was seen in our OPD with gradual, progressive, painless diminution of vision in the right eye over past 5 Months. He was found to have a cystic lesion in the iris encroaching upon the pupil. OBSERVATIONS: Ultrasound biomicroscopy showed features characteristic of cysticercosis. In-toto excision of the cyst was done and was sent for histopathological examination. Histopathology failed to reveal features consistent with cysticercosis and instead showed characteristics of epithelial cyst of the iris. CONCLUSION: Histopathological examination should be done for all cystic lesions of the iris to confirm diagnosis.

Comparison of higher order aberrations in amblyopic and non-amblyopic eyes in pediatric patients with anisometropic amblyopia.

Purpose: To compare the ocular higher order aberrations (HOAs) for the physiologic pupil size in amblyopic and non-amblyopic eyes of patients with anisometropic amblyopia in pediatric age group. Methods: Children between 5 and 15 years age having treatment naïve anisometropic amblyopia; after a detailed examination by a pediatric ophthalmologist; underwent assessment of wavefront aberrations for both amblyopic and non-amblyopic eyes at their physiologic pupil sizes using i-Trace ray tracing wavefront aberrometer. The axial lengths were also measured using IOL Master 500. The RMS values of the total ocular higher order aberrations (HOAs) and those arising from internal and corneal components of the two eyes were tabulated and compared to look for differences. Comparison of total ocular aberrations for pre-determined refractive error groups was also done for amblyopic and non-amblyopic eyes separately. Results: Eighty-eight eyes of 44 subjects were included for analysis. Mean pupil size was comparable in between amblyopic and non-amblyopic eyes (3.98 mm vs. 4.07 mm, P = 0.346). The mean axial lengths of the two eyes were comparable (amblyopic eyes 23.13 mm vs. non-amblyopic eyes 22.88 mm, P = 0.419). Significant differences in total HOAs and those arising from the internal optics (except spherical aberrations) of the eye were noted between the two eyes. There were no differences in the corneal HOAs. The total HOAs were comparable amongst the various refractive error groups for amblyopic and non-amblyopic eyes individually. Conclusion: There are significant differences in ocular HOAs between amblyopic and non-amblyopic eyes in children with anisometropic amblyopia.

Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt.

A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.