Foam Sclerotherapy for Conjunctival Inclusion Cyst Post Evisceration.

Orbital conjunctival epithelial cysts have traditionally been excised, with the risk of leaving behind remnants that may result in recurrences. We present an 18-year-old male who complained of a poorly retained prosthesis three years after a primary evisceration and polymethylmethacrylate (PMMA) ball implant. We performed cyst aspiration and injection foam sclerotherapy for the cyst, which resolved completely in six weeks, allowing the prosthesis to be retained comfortably. Aspiration and injection of sclerosing agents may result in the collapse of the cyst along with fibrosis of their walls with obliteration of the lumen, resulting in complete resolution.

Make in India: Normative data for automated perimetry.

BACKGROUND: The normative data set in authomated perimetry is predominantly of non-Indian origin and hence may not be an accurate basis for visual field analysis in Indian population.This video describes an attempt to create a native normative dataset for automated perimetry, which can then be fed in our machines and be used as the normative database. PURPOSE: To formulate normative data and to increase domain knowledge of normative values for automated perimetry in Indian population of different age groups. SYNOPSIS: Cross-sectional study conducted on patients receiving outpatient care in a span of 3 years, which included 6586 healthy normal patients (13172 eyes) with vision 6/6 unaided or after refractive correction. The patients were tested with 30-2 SITA FAST threshold algorithm on Humphrey Field Analyzer Model no: 745i. Normative data was calculated on basis of age group ranging from 19-75 years categorized to every decade. Normal values were formulated on basis of perimetry performed on normal patients. HIGHLIGHTS: Our work on creating a native normative dataset may add value as well as increase the accuracy of perimetry analysis in Indian eyes. ONLINE VIDEO LINK: https://youtu.be/jqgC2Tn7HIg.

Evaluating Contrast Sensitivity in Asian Indian Pre-Term Infants With and Without Retinopathy of Prematurity.

Purpose: The purpose of this study was to evaluate the contrast threshold in Asian Indian preterm infants with and without retinopathy of prematurity (ROP) using Newborn Contrast Cards measured during the first ROP screening and to correlate with final outcome and visual acuity at 3 months of corrected age. Methods: Preterm infants born ≤ 2000 grams birth weight (BW) and/or ≤ 34 weeks gestational age (GA) undergoing ROP screening were enrolled prospectively. Visual acuity was recorded using Teller Acuity Cards. Contrast threshold was measured with Newborn Contrast Cards at first screening visit and at the end of ROP screening at 40 weeks of postmenstrual age or older. Results: Of the 173 study infants, 134 (77.5%) did not have any stage of ROP. Of the remaining 39 (22.5%), 34 (87%) had type 2 ROP and 5 (13%) had type 1 ROP requiring treatment. The mean contrast threshold at the first visit of the no ROP type 1 and type 2 groups was 0.36 ± 0.07, 0.65 ± 0.19, and 0.46 ± 0.09, respectively (P < 0.001). Contrast threshold had a significant correlation with BW (R = -0.291, P = < 0.001) and gestational age (R = -0.47, P = < 0.001). The contrast threshold at the first visit correlated with visual acuity measured at 3 months of corrected age in logMAR (R = 0.36, P = 0.01). Other than BW and GA, no other systemic risk factors correlated with contrast threshold measured at the first screening visit. Conclusions: Newborn Contrast Cards are a viable tool to test contrast threshold in preterm infants. The association between contrast threshold and ROP, and its correlation with visual acuity, suggest that contrast threshold measurement may help predict the clinical vision outcome among prematurely born infants. Translational Relevance: Contrast threshold measurement may prove to be a useful tool in the estimation of visual potential in preterm infants.

Propensity of aerosol and droplet creation during oculoplastic procedures: A risk assessment with high-speed imaging amidst COVID-19 pandemic.

PURPOSE: The study uses principles of liquid and gas mechanics to verify and quantify the generation of aerosols in oculoplastic procedures, namely surgery using a scalpel, electrosurgical device, and a mechanized drill. METHODS: Surgical techniques were performed ex vivo using the electrosurgical device, scalpel, and mechanized drill on the muscle and bone of commercially available chicken. The liquid and gas dynamics were observed using a high-speed high-resolution Photron SA5 camera (0.125 to 8 ms temporal resolution, 0.016 to 0.054 mm/pixel spatial resolution) and stroboscopic lighting (Veritas 120 E LED Constellation). The analysis was performed using in-house algorithms and ImageJ software. RESULTS: The use of a mechanized drill at 35000 rpm and a 3 mm fluted burr generated aerosol with particle size 50 to 550 microns with a spread of 1.8 m radius. Surgical smoke was generated by an electrosurgical device in both cutting and coagulation modes. Dispersion of the smoke could be controlled significantly by the use of suction, mean smoke spread ratio being 0.065 without suction and 0.002 with use of suction within 2 cm. CONCLUSION: The quantification of the aerosol generation will help surgeons take practical decisions in their surgical techniques in the pandemic era.

Visual morbidity in thyroid eye disease in Asian Indian patients.

Purpose: To describe visual morbidity in thyroid orbitopathy in Asian Indians and the factors influencing its onset. Methods: A retrospective chart review was performed for patients with thyroid related orbitopathy seen between May 2014 and April 2019. Three hundred and one patients were included in the study. Relevant history, clinical findings, investigations, and treatment were documented. Results: Nineteen percent of patients had at least 1 visual morbidity feature such as compressive optic neuropathy, exposure keratopathy or diplopia, requiring intravenous glucocorticoid. Male gender, older age, and diabetes were the significant risk factors for high visual morbidity (all P < 0.05). Systemic thyroid status, degree of proptosis, and duration of disease were not significant. Average dose of intravenous glucocorticoid needed was 3.8 g; 24 (7.9%) patients required orbital decompression, and 13 (4.3%) needed eyelid surgery. At the last follow-up, 97% of patients had vision 6/12 or better in both eyes. Conclusion: There is significant visual morbidity found in Indian patients with TED, even with moderate proptosis and systemic control of thyroid status. This is the first set of data on the subject.

Prevalence and Correlates of HIV Disclosure Among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review.

OBJECTIVE: Disclosure of HIV status among children and adolescents living with HIV has both beneficial and challenging aspects. To address existing knowledge gaps and update the literature on childhood disclosure, we conducted a systematic review on caregivers' perceptions and practices of HIV disclosure in low- and middle-income countries (LMICs). METHODS: Standard databases were searched for studies conducted in LMICs, published in English between 2004 and 2015. Excluded articles were reviews or case reports, and those not reporting childhood disclosure. Data regarding prevalence, correlates and impact of disclosure, were presented as frequencies. RESULTS: Two authors independently screened 982 articles. After applying eligibility criteria, 22 articles representing 12 countries and 2,843 children were reviewed. The proportion of fully disclosed children ranged from 1.7% to 41.0%. Up to 49.5% children were provided "deflected" information (use of a non-HIV-related reason for explaining illness and health care visits). Factors associated with full disclosure included antiretroviral treatment initiation and caregivers' felt need for maintaining optimal adherence. Barriers to disclosure included fear of negative psychological reactions and inadvertent disclosure to others. Caregivers perceived a strong need for active participation from health care providers to aid the process of disclosure. CONCLUSIONS: Full disclosure of HIV status was not common among children and adolescents in LMICs, while the practice of deflected disclosure was prominent. Caregivers perceived the need for support from health care providers during the disclosure process. Evidence-based guidelines incorporating the developmental status of the child, locally prevalent cultures, and caregiver perceptions are prerequisite to enhancing disclosure in these settings.

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications.

INTRODUCTION: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. METHODOLOGY: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. RESULTS: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. CONCLUSIONS: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.