Successful management of persistent macular hole after macular hole surgery with intravitreal triamcinolone acetonide: A case report.

We present a case of persistent macular hole (MH) having an apical diameter of 140 microns and a basal diameter of 530 microns following a combined phacoemulsification and MH surgery. Considering post-operative cystoid macular edema (CME) as the possible reason for the failure of the initial surgery, a trial of IVTA was given. The synergistic effect of mechanical plugging of the hole by TA, coupled with resolution of cystoid changes and falling back of the macular hole resulted in the successful closure of the persistent macular hole with improvement in vision from 20/250 to 20/63.

Pars-plana vitrectomy with phacofragmentation for hyperdense cataracts in eyes with severe microcornea and chorio-retinal coloboma: A novel approach.

Purpose: To report the outcomes of pars-plana approach for the management of brunescent cataract in eyes with severe microcornea and associated chorio-retinal coloboma. Methods: This was a retrospective, single center, interventional case series performed in a tertiary eyecare center in central Medical records of consecutive cases of microcornea with coloboma who underwent pars-plana vitrectomy with phacofragmentation (PF) between January 2015 and December 2017 were reviewed. Results: The study group comprised of 30 eyes of 30 patients, of which 18 (60%) were males and 12 (40%) were females. The mean age of the patients was 41.9 years (range of 17-70 years). The mean corneal diameter was 6.7 mm with a range of 4-8 mm and all the eyes had dense cataract with nuclear sclerosis of grade 4 or more. The mean preoperative visual acuity was 1.97 (+/-0.067) Log MAR and the mean postoperative vision at 1 month was 1.6 (+/-0.39) Log MAR. Postoperatively, 21 patients (70%) gained ambulatory vision. The visual gain in all the patients was maintained over a mean follow-up period of 15.5 months. Conclusion: Pars-plana vitrectomy with PF can be considered in eyes with severe microcornea and brunescent cataracts, where cataract surgery through the limbal (anterior) approach is not only difficult but at times impossible due to anatomical restraints.

Ocular filariasis: "Dancing sensation in the anterior chamber".

We report a case of ocular filariasis in a 28-year-old male who presented with a 2-month history of irritated acute red eye. Examination revealed a living and active large worm dancing in the anterior chamber of the left eye causing acute iridocyclitis, leading to drop in vision to 6/36. The worm whose size was approximately 33 mm in length was extracted under local anesthesia in toto using viscoelastics without damaging the ocular structures. Microscopic examination confirmed adult Wuchereria bancrofti.

A cluster of central retinal artery occlusions following cataract surgery.

Purpose: To report a series of central retinal artery occlusions (CRAO) following cataract surgery complicated by posterior capsular rupture (PCR). Methods: Data from 14 patients with acute CRAO following cataract surgery was collected for this study including subject demographics, initial and final best-corrected visual acuity, systemic investigations, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings. Results: Mean subject age was 59.9 ± 12.1 years. Male: Female ratio was 1:1. All patients were operated between October and November 2015 and presented with acute vision loss 1 to 4 days after surgery. All the patients underwent cataract surgery under peribulbar anesthesia and had PCR for which anterior vitrectomy (AV) was done. In all the cases Ethylene oxide (ETO) sterilized vitrectomy probe was used for AV. Clinical picture of CRAO was noted in all the cases during the immediate postoperative period. OCT showed inner retinal layer hyperreflectivity while FFA was normal in all the cases. The final visual acuity was poor in all the eyes. This paper discusses the possible mechanisms of CRAO in these cases. Conclusion: CRAO is a potential complication of peribulbar anesthesia for intraocular surgery in patients with vascular risk factors and hence any substance that can aggravate the vasospasm in such patients should be used cautiously. Vasospasm could be caused by ETO as residual ETO could be present in the vitrectomy machine tubing causing toxicity. It is recommended to be cautious while using ETO sterilized instruments for cataract surgery.

Spectral-domain optical coherence tomography and fundus autofluorescence features in a case of typical retinocytoma.

PURPOSE: To report spectral-domain optical coherence tomography (OCT) and fundus autofluorescence (FAF) features observed in a case of typical retinocytoma. METHODS: Case report. RESULTS: A 17-year-old girl on routine ophthalmologic evaluation for headache had an elevated translucent lesion with peripheral pigmentation and adjacent chorioretinal atrophy close to the disc in the nasal retinal quadrant of the left eye. The lesion was confirmed to be retinocytoma on fluorescein angiography. Optical coherence tomography revealed a hyperreflective layer akin to preserved nerve fiber layer overlying the lesion in most of the scans. Symmetrical hyporeflective spaces in the underlying choroid and at places sudden disruption of choroid was also observed in the area of choroidal atrophy. Fundus autofluorescence revealed areas of hyperfluorescence, isofluorescence, and hypofluorescence in the different regions of the lesion. These features on FAF were consistent with posttreatment regressed retinoblastoma. Scleral hyperreflectivity on OCT as well as unmasked hyperfluorescence on FAF was observed in areas of chorioretinal atrophy. CONCLUSIONS: We report novel findings of superficial hyperreflective layer presumed to be preserved nerve fiber layer in a case of typical retinocytoma as well as FAF features consistent with regressed retinoblastoma.