Multimodal analysis of the COVID-19-associated mucormycosis outbreak in Delhi, India indicates the convergence of clinical and environmental risk factors.

BACKGROUND: The aetiology of the major outbreak of COVID-19-associated mucormycosis (CAM) in India in spring 2021 remains incompletely understood. Herein, we provide a multifaceted and multi-institutional analysis of clinical, pathogen-related, environmental and healthcare-related factors during CAM outbreak in the metropolitan New Delhi area. METHODS: We reviewed medical records of all patients diagnosed with biopsy-proven CAM (n = 50) at 7 hospitals in the New Delhi, and NCR area in April-June 2021. Two multivariate logistic regression models were used to compare clinical characteristics of CAM cases with COVID-19-hospitalised contemporary patients as controls (n = 69). Additionally, meteorological parameters and mould spore concentrations in outdoor air were analysed. Selected hospital fomites were cultured. Mucorales isolates from CAM patients were analysed by ITS sequencing and whole-genome sequencing (WGS). RESULTS: Independent risk factors for CAM identified by multivariate analysis were previously or newly diagnosed diabetes mellitus, active cancer and severe COVID-19 infection. Supplemental oxygen, remdesivir therapy and ICU admission for COVID-19 were associated with reduced CAM risk. The CAM incidence peak was preceded by an uptick in environmental spore concentrations in the preceding 3-4 weeks that correlated with increasing temperature, high evaporation and decreasing relative humidity. Rhizopus was the most common genus isolated, but we also identified two cases of the uncommon Mucorales, Lichtheimia ornata. WGS found no clonal population of patient isolates. No Mucorales were cultured from hospital fomites. CONCLUSIONS: An intersection of host and environmental factors contributed to the emergence of CAM. Surrogates of access to advanced COVID-19 treatment were associated with lower CAM risk.

Novel Application of Predictive Modeling: A Tailored Approach to Promoting HCC Surveillance in Patients With Cirrhosis.

OBJECTIVE: There has been increased interest in interventions to promote hepatocellular carcinoma (HCC) surveillance given low utilization and high proportions of late stage detection. Accurate prediction of patients likely versus unlikely to respond to interventions could allow a cost-effective approach to outreach and facilitate targeting more intensive interventions to likely non-responders. DESIGN: We conducted a secondary analysis of a randomized clinical trial evaluating a mailed outreach strategy to promote HCC surveillance among 1200 cirrhosis patients at a safety-net health system between December 2014 and March 2017. We developed regularized logistic regression (RLR) and gradient boosting machine (GBM) algorithm models to predict surveillance completion during each of the 3 screening rounds in a training set (n = 960). Model performance was assessed using multiple performance metrics in an independent test set (n = 240). RESULTS: Among 1200 patients, surveillance was completed in 41-47% of patients over the three rounds. The RLR and GBM models demonstrated good discriminatory accuracy, with area under receiver operating characteristic (AUROC) curves of 0.67 and 0.66 respectively in the first surveillance round and improved to 0.77 by the third surveillance round after incorporating prior screening behavior as a feature. Additional performance characteristics including the Brier score, Hosmer-Lemeshow test and reliability diagrams were also evaluated. The most important variables for the predictive model were prior screening completion status and past primary care contact. CONCLUSIONS: Predictive models can help stratify patients' likelihood to respond to surveillance outreach invitations, facilitating tailored strategies to maximize effectiveness and cost-effectiveness of HCC surveillance population health programs.

Labial mucosa grafting for lid margin, anterior lamellar, and posterior lamellar correction in recurrent cicatricial entropion.

PURPOSE: To report a novel modified technique for severe recurrent cicatricial entropion correction based on anterior lamellar recession (ALR) and grafting. METHODS: Six eyelids of five patients (9-48 years; three females) with severe cicatricial entropion (three upper and three lower eyelids) had surgical correction using ALR and labial mucosal grafting for spacing the ciliary margin away from the lid margin and reconstruction of the lid margin and posterior lamella. The modified technique included using mucous membrane as a single unit for anterior lamella, lid margin, and posterior lamella reconstruction employing a different suturing technique. RESULTS: The indications for surgery included Stevens-Johnson syndrome (3), chemical injury (2), and post-surgical scarring in congenital distichiasis with lymphedema (1). Entropion resolved in all patients with restoration of eyelid margin and reduction in ocular discomfort. Trichiasis was present in all six eyelids (100%) preoperatively and resolved completely in all but one case (83% success rate) with three residual focal trichiatic lashes in the temporal area, which was successfully managed with radiofrequency ablation. There were no recurrences of trichiatic or distichiatic lashes at a median follow-up duration of 16 months (range, 12-18 months). CONCLUSION: Successful resolution of the recurrent cicatricial entropion can be achieved with the use of labial mucosa as one solution for spacing the anterior lamella and reconstruction of the lid margin and posterior lamella with minimal recurrence rate.

Ocular surface squamous neoplasia in a setting of fungal keratitis: a rare co-occurrence.

PURPOSE: To describe a rare co-occurrence of ocular surface squamous neoplasia (OSSN) in a patient with microbial keratitis. METHODS: Case report. RESULTS: We describe a 68-years female who developed ocular surface squamous neoplasia (OSSN) in an eye with culture proven severe fungal keratitis of 5 months duration, which progressed to endophthalmitis. She was managed with extended enucleation for left eye. Histopathology examination was consistent with squamous cell carcinoma of ocular surface with no corneal stromal/scleral/anterior chamber involvement. She received adjuvant chemotherapy with topical Interferon alpha2b (3 cycles) for positive margins. Six months after treatment, she is completely tumor free. CONCLUSION: Co-occurrence of OSSN and chronic fungal keratitis is rare. We recommend that patients with chronic ocular infections should be examined and followed closely for abnormally thickened limbal areas.

Utility of intraocular endoscope for lacrimal canaliculi and sac examination.

PURPOSE: Intraocular endoscope was used as a dacryoendoscope, and its observations and performance in lacrimal drainage system (LDS) are reported. METHODS: The Endo Optiks (Little Silver, New Jersey, USA), an intraocular endoscope (modified with customized sheath), was used for LDS visualization in ten normal adults and five patients with lacrimal disorders. RESULTS: We were able to capture high-definition images of lacrimal canaliculi and sac in all normal adults. Smooth whitish canalicular mucosa with lumen could be appreciated in all normal individuals. Common canaliculus showed variable folds among individuals and reddish lacrimal sac mucosa could be appreciated with great details. In patients with canalicular obstruction, site of obstruction was presented as whitish gray area with no visible lumen, which could be opened up precisely with trephination. No false passage was formed in any of the cases. One of the cases had membranous canalicular obstruction, which was opened with probe itself. Nasolacrimal duct could not be examined due to the shorter length of the probe. CONCLUSION: Intraocular endoscope can be used as high-resolution dacryoendoscope for visualization of lacrimal canaliculi and sac.

Ethylene-co-Vinyl Acetate/MWCNTs/Hectorite Elastomeric Nanocomposites: Characterization and Electrical Properties.

MWCNTs/hectorite 3D hybrid filler was prepared from the 1:1 combination by weight of constituent MWCNTs (1D) and hectorite (2D) through simple dry grinding method. The resulting hybrid filler was subsequently utilized for the preparation of Ethylene-co-vinyl acetate (EVA)/MWCNTs/hectorite nanocomposites by solution intercalation method. Transmission electron microscopy and X-ray diffraction studies of the nanocomposites confirm homogeneous dispersion of the fillers in the polymer matrix. Mechanical, thermal and dielectric properties of neat EVA are significantly enhanced with increase in filler content. The improvement in tensile properties observed at 4 wt.% filler content are: 243% in tensile strength (1.78 MPa to 6.11 MPa), 105% in elongation at break (366% to 750%) and 426% in toughness (3.36 MPa to 17.67 MPa) without significant change (1.12 MPa to 1.31 MPa) in Young's modulus. Differential scanning calorimetry confirms significant increase in crystallinity, crystallisation temperature (Tc) and crystallite melting temperature (Tm) of the nanocomposites vis-a-vis neat EVA. Observed shift in Tc by more than 10 °C (~87 to ~98 °C) and Tm by more than 30 °C (~118 to ~151 °C) are really significant confirming the improved thermal stability of the nanocomposites. Maximum improvements in dielectric constant and AC conductivity observed at 5 wt.% hybrid filler content are ~25% and ~50% respectively. Superior mechanical properties of the nanocomposites combined with enhanced thermal stability and dielectric properties make it a prospective material for flexible dielectric applications. Properties attained can be attributed to improved polymer-filler interaction on account of homogeneous dispersion.

Tailored electrical conductivity, electromagnetic shielding and thermal transport in polymeric blends with graphene sheets decorated with nickel nanoparticles.

Electromagnetic interference shielding (EMI) materials were designed using PC (polycarbonate)/SAN [poly(styrene-co-acrylonitrile)] blends containing few-layered graphene nanosheets decorated with nickel nanoparticles (G-Ni). The graphene nanosheets were decorated with nickel nanoparticles via the uniform nucleation of the metal salt precursor on graphene sheets as the substrate. In order to localize the nanoparticles in the PC phase of the PC/SAN blends, a two-step mixing protocol was adopted. In the first step, graphene sheets were mixed with PC in solution and casted into a film, followed by dilution of these PC master batch films with SAN in the subsequent melt extrusion step. The dynamic mechanical properties, ac electrical conductivity, EMI shielding effectiveness and thermal conductivity of the composites were evaluated. The G-Ni nanoparticles significantly improved the electrical and thermal conductivity in the blends. In addition, a total shielding effectiveness (SET) of -29.4 dB at 18 GHz was achieved with G-Ni nanoparticles. Moreover, the blends with G-Ni exhibited an impressive 276% higher thermal conductivity and 29.2% higher elastic modulus with respect to the neat blends.

In situ determination and imaging of physical properties of soft organic materials by analytical transmission electron microscopy.

Analytical transmission electron microscopy (ATEM) offers great flexibility in identification of the structural-chemical organization of soft materials at the level of individual macromolecules. However, the determination of mechanical characteristics such as hardness/elasticity of the amorphous and polycrystalline organic substances by ATEM has been problematic so far. Here, we show that energy filtered TEM (EFTEM) measurements enable direct identification and study of mechanical properties in complex (bio-)polymer systems of relevance for different industrial and (bio-)medical applications. We experimentally demonstrate strong correlations between hardness/elasticity of different polymers (polycaprolactone, polylactid, polyethelene, etc.) and their volume plasmon energy. Thickness and anisotropy effects, which substantially mask the material contrast in EFTEM bulk plasmon images, can be adequately removed by normalizing the latter by carbon elemental map. EFTEM data has been validated using atomic force microscopy phase images, where phase shift related to the hardness and elastic modulus of the materials.

Outcomes of Simple Limbal Epithelial Transplantation Without Amniotic Membrane Grafting in Unilateral Limbal Stem Cell Deficiency: A Case Series of 6 Patients.

PURPOSE: This study describes the technique of simple limbal epithelial transplantation (SLET) without amniotic membrane grafting (AMG) in limbal stem cell deficiency (LSCD). METHODS: Retrospective, interventional case series of 6 patients who underwent SLET without AMG were included. The procedure followed the standard technique, involving limbal biopsy from the healthy eye, resection of symblephera, and pannus dissection in the affected eye. Following host bed preparation, limbal explants were placed on the bare cornea and secured with fibrin glue. A large-diameter bandage contact lens was applied post surgery. No amniotic membrane was used. Preoperative data, including age, gender, cause of LSCD, best-corrected visual acuity, and previous ocular surgeries, were recorded. Postoperative clinical information, such as the duration of follow-up and recurrence of LSCD, best-corrected visual acuity, and other ocular examination findings, was recorded in an excel sheet. RESULTS: Preoperatively, 2 patients had total LSCD (secondary to a firecracker injury and excision biopsy for ocular surface squamous neoplasia). 4 patients had partial LSCD (3 chemical injuries, 1 firecracker injury). The mean age of participants was 30.67 ± 15.91 years, with a mean follow-up duration of 9.33 ± 8.04 months. Intraoperatively, all patients exhibited a smooth corneal surface after pannus removal. Postoperatively, all limbal explants remained securely attached, with complete corneal epithelialization achieved within 2 to 3 weeks. The ocular surface remained stable throughout, and no recurrence of LSCD was observed in any patient. No loss of explants was seen. CONCLUSIONS: The present series suggests that AMG may not be a necessary step for performing SLET.

Design and simulation of 4 kW solar power-based hybrid EV charging station.

Electric vehicles (EVs) have become an attractive alternative to IC engine cars due to the increased interest in lowering the consumption of fossil fuels and pollution. This paper presents the design and simulation of a 4 kW solar power-based hybrid EV charging station. With the increasing demand for electric vehicles and the strain they pose on the electrical grid, particularly at fast and superfast charging stations, the development of sustainable and efficient charging infrastructure is crucial. The proposed hybrid charging station integrates solar power and battery energy storage to provide uninterrupted power for EVs, reducing reliance on fossil fuels and minimizing grid overload. The system operates using a three-stage charging strategy, with the PV array, battery bank, and grid electricity ensuring continuous power supply for EVs. Additionally, the system can export surplus solar energy to the grid, reducing the load demand. The paper also discusses the use of MPPT techniques, PV cell modeling, and charge controller algorithms to optimize the performance of the hybrid charging station.

COVID-19 detection in lung CT slices using Brownian-butterfly-algorithm optimized lightweight deep features.

Several deep-learning assisted disease assessment schemes (DAS) have been proposed to enhance accurate detection of COVID-19, a critical medical emergency, through the analysis of clinical data. Lung imaging, particularly from CT scans, plays a pivotal role in identifying and assessing the severity of COVID-19 infections. Existing automated methods leveraging deep learning contribute significantly to reducing the diagnostic burden associated with this process. This research aims in developing a simple DAS for COVID-19 detection using the pre-trained lightweight deep learning methods (LDMs) applied to lung CT slices. The use of LDMs contributes to a less complex yet highly accurate detection system. The key stages of the developed DAS include image collection and initial processing using Shannon's thresholding, deep-feature mining supported by LDMs, feature optimization utilizing the Brownian Butterfly Algorithm (BBA), and binary classification through three-fold cross-validation. The performance evaluation of the proposed scheme involves assessing individual, fused, and ensemble features. The investigation reveals that the developed DAS achieves a detection accuracy of 93.80% with individual features, 96% accuracy with fused features, and an impressive 99.10% accuracy with ensemble features. These outcomes affirm the effectiveness of the proposed scheme in significantly enhancing COVID-19 detection accuracy in the chosen lung CT database.

Midperipheral mini-capsulorhexis as an additional step for safe phacoemulsification in white intumescent cataracts.

The present article describes a novel surgical technique of a primary mini-capsulorhexis in midperiphery to minimize surgical complications in white intumescent cataracts. Patients with white mature cataracts with a convex anterior capsule or swollen lens fibers were selected. An initial puncture was made 3-4 mm away from the center, in the midperipheral anterior capsule, with a conventional cystitome. A mini-capsulorhexis (2-2.5 mm) was created. Loose cortical matter and fluidic contents were aspirated to reduce the intralenticular pressure. Two cuts were made at the margin of the mini-capsulorhexis, and an adequately sized secondary rhexis was completed, after which phacoemulsification was done. A circular curvilinear capsulorhexis was successfully achieved in all cases, including those with a small pupil. Rhexis could be completed in a patient where an initial extension occurred due to head movement. This refined technique aims to enhance the safety and precision of capsulorhexis in intumescent cataracts, thereby reducing the risk of complications such as the Argentinian flag sign. Further exploration and validation of this approach through clinical trials are warranted to establish its efficacy and safety profile.

Mask region-based convolutional neural network and VGG-16 inspired brain tumor segmentation.

The process of brain tumour segmentation entails locating the tumour precisely in images. Magnetic Resonance Imaging (MRI) is typically used by doctors to find any brain tumours or tissue abnormalities. With the use of region-based Convolutional Neural Network (R-CNN) masks, Grad-CAM and transfer learning, this work offers an effective method for the detection of brain tumours. Helping doctors make extremely accurate diagnoses is the goal. A transfer learning-based model has been suggested that offers high sensitivity and accuracy scores for brain tumour detection when segmentation is done using R-CNN masks. To train the model, the Inception V3, VGG-16, and ResNet-50 architectures were utilised. The Brain MRI Images for Brain Tumour Detection dataset was utilised to develop this method. This work's performance is evaluated and reported in terms of recall, specificity, sensitivity, accuracy, precision, and F1 score. A thorough analysis has been done comparing the proposed model operating with three distinct architectures: VGG-16, Inception V3, and Resnet-50. Comparing the proposed model, which was influenced by the VGG-16, to related works also revealed its performance. Achieving high sensitivity and accuracy percentages was the main goal. Using this approach, an accuracy and sensitivity of around 99% were obtained, which was much greater than current efforts.

Harnessing Generalizable Real-World Ophthalmic Big Data: Descriptive Analysis of the Bodhya Eye Consortium Model for Collaborative Research.

BACKGROUND: Eye care organizations and professionals worldwide are increasingly focusing on bridging the gap between population health and medical practice. Recent advances in genomics and anthropology have revealed that most Indian groups trace their ancestry to a blend of 2 genetically distinct populations: Ancestral North Indians, who share genetic affinities with Central Asians, Middle Easterners, Caucasians, and Europeans; and Ancestral South Indians, genetically distinct from groups outside the Indian subcontinent. Studies conducted among North Indian populations can therefore offer insights that are potentially applicable to these diverse global populations, underscoring significant implications for global health. OBJECTIVE: The Bodhya Eye Consortium is a collaboration among 8 high-volume nonprofit eyecare organizations from across North India. The consortium aims to harness real-world data consistently and with assured quality for collaborative research. This paper outlines the formation of the consortium as a proposed model for controlled collaborative research among the leading eyecare organizations of North India. METHODS: We detail the creation and effective implementation of a consortium following a structured road map that included planning and assessment, establishing an exploratory task force, defining specialty areas, setting objectives and priorities, and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Central to this process was a comprehensive data audit aimed at standardizing data collection across all participating organizations. RESULTS: The consortium currently comprises 9 organizations, each represented in the governance structure by the Governing Council. Scientific standards for published research are established and overseen by the Scientific Committee, while the Conflict Resolution Committee manages any unresolved disputes. The consortium's working groups, organized by various eyecare specialties, collaborate on research projects through virtual interactions. A foundational step in this process was the organizationwide data audit, which revealed that most organizations complied with accurate and standardized data collection practices. Organizations with deficiencies in data completeness developed action plans to address them. Subsequently, the consortium adopted data collection proformas, contributing to the publication of high-quality manuscripts characterized by low dropout rates. CONCLUSIONS: The collaborative research conducted by the Bodhya Eye Consortium-a group of high-volume eyecare organizations primarily from North India-offers a unique opportunity to contribute to scientific knowledge across various domains of eyecare. By leveraging the established heterogeneity of anthropological and genomic origins within the population, the findings can be generalizable, to some extent, to European, Middle Eastern, and European American populations. This access to potentially invaluable, generalizable data has significant global health implications and opens possibilities for broader collaboration. The model outlined in this descriptive paper can serve as a blueprint for other health care organizations looking to develop similar collaborations for research and knowledge sharing.

Late-life mental health education for workforce development: brain versus heart?

PURPOSE: There is a shortage of mental health professionals to care for a growing geriatric population. Though not mutually exclusive, clinical and didactic educational experiences promote cognition, whereas affective knowledge (attitude) is promoted through nonclinical exposure to seniors. This study evaluates the relative impact of cognition and attitude on career interests among healthcare students. METHODS: We developed 13 interactive, video documentary "lessons" on late-life mental health presenting didactic material along with stories of actual patients and families. Four of these lessons were viewed at 1-week intervals by 42 students from medical school and graduate programs of social work, psychology, and nursing. Knowledge, attitudes, and inclinations toward working with seniors were assessed. RESULTS: Both cognition and attitudes toward seniors improved. Linear regression shows that change in attitude, not cognition, predicts interest in working with seniors. CONCLUSION: Educational experiences that promote affective learning may enhance interest in geriatric careers among healthcare students.

An analytical technique to extract surface information of negatively stained or heavy-metal shadowed organic materials within the TEM.

Using a series of uranyl acetate stained or platinum-palladium shadowed organic samples, an empirical analytical method to extract surface information from energy-filtered transmission electron microscopy (EFTEM) images is described. The distribution of uranium or platinum-palladium atoms, which replicate the sample surface topography, have been mathematically extracted by dividing the image acquired in the valence bulk plasmon energy region (between 20 and 30 eV) by the image acquired at the carbon K ionization edge (between 284 and 300 eV). The resulting plasmon-to-carbon ratio (PCR) image may be interpreted as a precise metal replica of the sample surface. In contrast to conventional EFTEM elemental mapping, including an absolute quantification approach, this technique can be applied to 200-600 nm thick organic samples. A combination of conventional TEM and PCR imaging allows one to detect complementary transmission and topographical information with nanometer precision of the same area of carbon-based samples. The advantages and limitations of PCR imaging are highlighted.

Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism.

We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.

Outcomes of topography-guided PRK/CXL in keratoconus using the NIDEK CXIII system-"Bharat Protocol" (Pilot study).

Purpose: Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software-"Bharat Protocol." Methods: Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany). Results: At a minimum follow-up of 6 months (range 6.2-13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen. Conclusions: The "Bharat" Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.

Surgical application of Ong speculum in simple limbal epithelial transplantation and pterygium surgery.

Ong speculum is used in glaucoma surgeries such as trabeculectomy to expose the superior part of the globe. The large inferior blade pushes the inferior conjunctival fornix, due to which the eyeball rotates downwards. It has not been used in other anterior segment surgeries before. We used this speculum in simple limbal epithelial transplantation (SLET) and pterygium surgery to expose superior bulbar conjunctiva for harvesting limbal and conjunctival grafts, respectively. As the superior conjunctiva and sclera become exposed, it facilitates the steps of harvesting limbal biopsy and conjunctival graft in SLET and pterygium surgery. This eliminated the need for a superior rectus suture or an assistant who would keep the globe rotated downwards. Its position could also be maneuvered to adjust the site of exposure when dissecting the area of pannus in SLET. Thus, it makes the superior conjunctiva more accessible.

Partial-thickness compression sutures without descemetopexy for management of acute hydrops in keratoconus: A novel surgical technique.

This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.