Langerhans cell disease of the eyelids masquerading as blepharochalasis.

Langerhans cell disease (LCD) occurring as an isolated tumor of the eyelids has been described infrequently. Moreover, none of the reported cases had associated systemic involvement. We present an unusual case of LCD of the eyelids masquerading as blepharochalasis with central diabetes insipidus (CDI).

Effect of ageing and cataract formation on the Raman spectroscopic profile of human lens: An observational study.

PURPOSE: To observe the spectroscopic profile of human lens in different age groups and varying grades of cataract and to use the data to arrive at differentiating molecular biology. DESIGN: An observational cross-sectional study. METHODS: The study enrolled 30 patients (30 eyes) with a mean age of 59.6 years diagnosed with immature senile cataracts. The patients underwent small incision cataract surgery, and the harvested lens nuclei were examined under a Raman spectroscope for studying their molecular composition. The relative intensities of the peaks in the Raman spectra were evaluated and compared among different age groups and grades of cataract. A correlation of tyrosine doublet ratio with grade of cataract and age of the subject was calculated. RESULT: Several Raman spectral peaks were observed in the range of 600 cm-1 to 1800 cm-1 with correspondence to tyrosine, phenylalanine, tryptophan, and amides I and III. A strong negative correlation between the grade of cataract and the ratio of tyrosine doublet was seen (r = -0.805). Also, a negative correlation between age and tyrosine ratio was seen (r = -0.62). The wavenumber/spectral peak of tryptophan was observed only in one sample, and amides I and III were identified, but the intensity of the peak for amide II was very small or absent. CONCLUSION: It was observed that the buried conformation of tyrosine was predominant in cases with a higher age or grade of cataract. The buried conformation of tryptophan became less in the higher grades of cataract.

Comparison of effective phacoemulsification time and corneal endothelial cell loss using three different ultrasound frequencies: A randomized controlled trial.

Purpose: Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer. Methods: A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6-6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28-kHz frequency, group II with 42-kHz frequency, and group III with 53-kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months. Results: The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperatively. Conclusion: Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts.

Comparison of effective phacoemulsification time and corneal endothelial cell loss using 2 ultrasound frequencies.

PURPOSE: To compare 2 ultrasound (US) frequencies for phacoemulsification for moderate to hard cataract to determine a frequency that makes phacoemulsification safer and more efficacious. SETTING: Post Graduate Institute of Medical Education and Research, New Delhi, India. DESIGN: Randomized controlled trial. METHODS: Patients with grade 4.0 to 6.9 senile cataract were randomized to 2 groups. Group A had lower frequency (28 kHz) phacoemulsification, and Group B had higher frequency (42 kHz) phacoemulsification. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial parameters were assessed over 1 year. RESULTS: Both groups comprised 80 patients. The groups were matched for age (P = .533), sex (P = .263), and nuclear grade (nuclear color, P = .496; nuclear opalescence, P = .622). Group B had significant reductions in EPT (P = .008) and EFU (P = .004) compared with Group A. Postoperatively, the endothelial cell density (ECD) was significantly higher in Group B at 1 month (P = .004), 3 months (P = .003), 6 months (P = .004), 9 months (P = .002), and 1 year (P = .003). The percentages of ECD loss were also significantly lower in Group B; the difference was statistically significant up to 1 year postoperatively even after adjustments for age, grade of cataract, EPT, and EFU. CONCLUSION: Higher frequency phacoemulsification was associated with a lower EPT and EFU as well as better endothelial preservation than a lower frequency.

Intralesional Triamcinolone Acetonide (TA) Versus Incision and Curettage (I & C) for Medium and Large Size Chalazia.

INTRODUCTION: Chalazion is a common inflammatory mass lesion of eyelid. Incision and curettage is a conventional treatment but intralesional steroid is also a safe option for multiple chalazia and chalazion near lacrimal drainage system. So, we conducted an interventional study to compare the treatment outcomes of injection triamcinolone acetonide (TA) versus incision and curettage (I&C) in medium and large sized primary chalazion. OBJECTIVE: To compare the success rate of intralesional TA versus I&C for the treatment of medium and large sized primary chalazia. MATERIALS AND METHODS: An interventional study was carried out in 118 patients with primary chalazion. The patients were divided equally into two groups A and B of medium sized (3-7mm) and large sized chalazia (>7mm) respectively. Treatment modality either I&C or TA was decided in each group by randomization Cytological evaluation was done for each case and diagnosis other than chalazion was excluded. Main outcome measure was resolution in size more than 80%. Secondary outcome measure was correlation of cytological features with size, duration, success rate and complications. CONCLUSION: Intralesional TA was found to be as effective as I&C in both the groups. In cytological analysis, we found that in large sized chalazia I&C is superior to TA in suppurating granuloma.

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification.

BACKGROUND: To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months. METHODS: One hundred and twenty six consenting patients of grade 4.0-6.9 senile cataract were randomized into three groups for phacoemulsification: Group A (n = 42): Gravity fed infusion system and 450 Kelman miniflared ABS phaco tip; Group B (n = 42): intraocular pressure (IOP) based infusion system and 450 Kelman miniflared ABS phaco tip; Group C (n = 42): IOP based infusion system and 450 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months. RESULTS: The three arms were matched for age (p = 0.525), gender (p = 0.96) and grade of cataract (p = 0.177). Group C was associated with significant reductions in CDE (p = 0.001), EFU (p < 0.0005) as well as TAT (p = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density (p = 0.876) and central corneal thickness (p = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups. CONCLUSIONS: Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip. TRIAL REGISTRATION: Trial registration No.: CTRI/2016/06/007022.

Cilium incarnatum externum.

A 25-year-old woman presented with a history of a cosmetically bothersome bulge over her left eyelid. She was diagnosed with cilium incarnatum externum. The subcutaneous cilium was surgically removed and examined.

Epiphora and proptosis as a presenting complaint in acromegaly: Report of two cases with review of literature.

Acromegaly is an endocrine disorder characterized by the excess of growth hormone leading to bony and soft-tissue enlargement. Eye involvement due to extraocular muscle enlargement has been described rarely in these patients. Epiphora has been described only once earlier in a patient with acromegaly. Here, we describe two females with acromegaly who presented with the complaints of watering from the eye and proptosis.

Orbital tuberculoma extending into the cranium.

Orbital tuberculoma is not uncommon in the developing countries, but intracranial extension of orbital tuberculoma is extremely rare. Our case, a 14-year-old girl, presented with proptosis and progressive painless diminution of vision eventually leading to loss of vision. MRI showed a mass with peripheral enhancement of contrast, separate from the optic nerve and extending into the cranium through the optic foramen. Early decompression and chemotherapy resulted in marked visual recovery. Histopathology of the excised lesion confirmed tuberculosis. The case is reported to highlight both the rare presentation as well as remarkable visual recovery in a patient with orbital tuberculosis.