Central toxic keratopathy leading to epithelial ingrowth following femtosecond LASIK.

We report a case of a woman in her 30s who underwent femtosecond LASIK (laser-assisted in situ keratomileusis) in both eyes to correct her simple myopic astigmatism. After the surgery, both eyes developed diffuse lamellar keratitis, and intensive topical steroids were initiated to control the same. Subsequently, central toxic keratopathy (CTK) developed bilaterally. Three weeks after the surgery, the right eye showed signs of progressive epithelial ingrowth involving the pupillary area. Surgical intervention in the form of flap relift followed by debridement of the epithelial cells and an alcohol interface wash were performed to treat the same. This is the first report of an epithelial ingrowth following CTK after femtosecond LASIK.

Ocular fish hook injuries.

PURPOSE: Fishing stands out as a widely enjoyed leisure pursuit. While ocular fishing injuries are infrequent, they carry the potential for severe ocular trauma, and safe extraction of a fish hook can pose challenges. We here in report a series of 21 cases of penetrating injury to the cornea by fish hook, detailing successful surgical interventions employed for their management. The report not only outlines different techniques for the removal of fish hooks but also provides clarification on terminologies associated with various components of a fish hook. METHODS: This was a retrospective study conducted at tertiary eye care centers in South India. Our hospitals cater to the states of Telangana, Andhra Pradesh, and Odisha. All medical records of patients who attended the emergency department from the period of 2003 to 2023 were evaluated and all patients with fish hook injury were included in the study. This is the longest and largest study in India. RESULTS: Twenty-one cases of ocular fish-hook injuries were presented to the emergency room between 2003 and 2023. Patients were between the ages of 9 and 59 years (mean, 29.4 years), and 90.4 % (19 out of 21) were males. Patient demographics, injury characteristics, surgical interventions, and visual outcomes were meticulously documented. Out of 21 cases, three cases (14.3 %) had blunt trauma, 17 cases (80.9 %) had penetrating injury and one case had lid laceration. Patients had better visual outcomes after the second surgery. Out of 21 cases, 7 (33.3 %) had post-operative visual acuity (VA) between 20/20 and 20/40. Three (14.3 %) had post-operative VA between 20/60 and 20/125. Five (23.8 %) had post-operative VA between 20/200 and 20/600. Six cases (28.6 %) had poor visual outcomes of which two had no perception of light (NPL), two had Hand movements and the other two had the perception of light present and projection of rays inaccurate CONCLUSION: This extensive case series underscores the complexity of ocular injuries caused by fish hooks and emphasizes significance of tailored surgical approaches for optimal visual outcomes. The hook can be successfully removed with minimal trauma to ocular structures by understanding structure of fish hook and by employing appropriate method of extraction.

Maximizing surgical safety: Approaches to prevent intraoperative complications in manual small incision cataract surgery (MSICS).

BACKGROUND: In manual small incision cataract surgery (MSICS), the occurrence of intraoperative complications is a recognized concern that can impact both surgical outcomes and patient safety. MSICS is widely practiced as a cost-effective alternative for cataract extraction, especially in resource-limited settings where access to phacoemulsification may be limited. However, it is important to acknowledge that MSICS is not entirely risk-free. Complications during the surgery can arise due to factors such as surgeon experience, surgical technique, instrument handling, and patient-specific anatomical variations. Common complications encountered in MSICS include posterior capsule rupture, corneal burns, iris trauma, wound-related issues, vitreous loss, and anterior chamber hemorrhage. It is crucial for surgeons to have a comprehensive understanding of the background and potential risks associated with these complications. This knowledge allows them to proactively implement preventive strategies, optimize surgical outcomes, and prioritize patient safety during MSICS procedures. Ongoing efforts in the field of cataract surgery aim to improve outcomes by advancing surgical techniques, refining equipment, and enhancing postoperative care. Through research and innovation, the goal is to minimize complications and achieve optimal visual outcomes for individuals undergoing cataract surgery. PURPOSE: This video discusses the possible complications and provides practical strategies to minimize the same at each step of the MSICS procedure. SYNOPSIS: The video demonstrates the potential complications that can occur intraoperatively during MSICS and highlights the significance of careful technique and practical strategies for prevention. HIGHLIGHTS: In resource-poor settings, MSICS is widely used as the predominant technique for cataract surgeries. Despite being a cost-effective alternative, MSICS offers comparable visual outcomes to phacoemulsification with low complication rates. This video emphasizes the importance of proactive measures and careful technique in preventing complications, thereby improving patient safety and outcomes in MSICS. VIDEO LINK: https://youtu.be/hOAMJpC67C0.

Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India.

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.

Prognostic factors of open-globe injuries: A review.

Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.

Conventional-based contact lens fitting in pure microphthalmia associated with irregular cornea.

In this case, a female teenager presented to the clinic with blurring of vision at a distance in both eyes since 2 years. All preliminary examinations were recorded. Retinoscopy revealed split reflex in both eyes. Both anterior and posterior segment findings seem to be within normal limits except for the microcornea. Topography depicts an asymmetric bow tie with superior steeping in both eyes. This case was diagnosed as pure microphthalmos associated with irregular corneal curvature, suggestive of keratoconus without corneal thinning with the help of topography and biometric measurements. Contact lens trial was advised to improve the visual potential. Fitting this patient in RGP lenses has been a challenging task because of narrow palpebral fissure height and small cornea.

Incidence of re-surgery after manual small-incision cataract surgery at a tertiary eye-care center in South India.

Purpose: To study the incidence of re-surgery after manual small-incision cataract surgery (MSICS) at a tertiary eye-care center in South India and to compare the re-surgery rate between trainees and experts. Methods: A retrospective study was conducted at a tertiary eye-care center in Andhra Pradesh state of South India, which included 19,515 patients who underwent MSICS between 2012 and 2022 with 369 eyes of 369 patients who underwent re-surgery within 1 week of primary surgery. Factors included demographic data, type of re-surgery, that is, wound re-suturing, IOL repositioning, cortical wash, as well as anterior chamber (AC) wash. Results: 19,515 eyes from the year 2012-2022 were analyzed. Most of the patients undergoing re-surgery belonged to the age group of 61-70 years (40.3%). Wound re-suturing was the more frequently performed re-surgery (47.6%). Wound re-suturing rates were comparable between the trainees and experts, whereas IOL repositioning, cortical wash, and AC wash were higher in the cases performed by trainees though statistically not significant. Conclusion: Careful pre-operative assessment, training under supervision, and other measures can be taken to reduce the re-surgery rates. Timely diagnosis and early treatment can give better outcomes and prevent devastating complications like endophthalmitis.

Penetrating injury of the cornea by a barbed fish hook and its surgical management by "Cut-it out technique".

Fishing is a worldwide pastime enjoyed by millions of people. Ocular fishing injuries though uncommon may cause potentially devastating ocular trauma. We report a rare case of penetrating injury of the cornea by a barbed fish hook and its successful surgical management by "cut-it out technique". We are discussing the various techniques available for removal of fish hooks. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the appropriate method of extraction.

Impact of COVID-19 related national lockdown on care of corneal transplantation patients at a tertiary eye care centre in India.

PURPOSE: To study impact of COVID-19 related national lockdown on care of corneal transplantation patients at a tertiary eye centre in Andhra Pradesh state of South India. METHODS: Cross-sectional questionnaire-based study conducted at tertiary eye care centre in Andhra Pradesh state of South India, included 109 patients who underwent keratoplasty(full thickness or partial thickness) at our centre and who came for follow-up visit after lockdown. Factors such as type, indication, number of keratoplasties in the operated eye, and unusual clinical outcomes identified during visit after the lockdown, were studied. Uncorrected visual acuity, best corrected visual acuity, clarity of graft, graft-host junction apposition, intactness of sutures, intraocular pressure and disc status were compared on visits made before and after lockdown. RESULTS: During lockdown, 77.1% patients were properly using medications that was significantly (P = 0.0003) lower than that of before the lockdown (90.8%). After the lockdown, 82.3% patients were using medications properly that was comparable (P = 0.11) to that of during the lockdown (77.1%). The proportion of eyes with clear grafts and intact sutures decreased significantly after lockdown. The unusual outcomes observed after the lockdown were graft failure (36.7%), graft edema (11%), graft infiltrate(5.5%), phthysis bulbi (1.85%) and edematous graft cleared in eyes 3.7% eyes. CONCLUSION: We noted significant drop in usage of medications from 91% before lockdown to 77% during lockdown and maintained at 83% after lockdown. Edematous grafts increased from 41% before lockdown to 54% after the lockdown. Intactness of sutures decreased from 82% before lockdown to 69% after lockdown.

Changing trend in the morphology of cataracts at a tertiary eye care centre in South India due to COVID-19-pandemic related national lockdown.

Purpose: To study the changing trends in the morphology of cataracts at a tertiary eye care center in South India due to COVID-19 pandemic-related national lockdown. Methods: A retrospective study conducted at a tertiary eye care center in Andhra Pradesh state of South India, which included 1724 patients (1753 eyes) who underwent cataract surgery at our center during April 2019-July 2019 (1298 eyes of 1271 patients) and April 2020-July 2020 (455 eyes of 453 patients). Factors studied included preoperative lens status, associated phacodonesis or subluxation, pupil size, other eye lens status, associated retinal problems, glaucoma, and complications during surgery. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal clarity, intraocular pressure (IOP), and disc status at postoperative day 1, 1 week, and 1-month visits were compared. Results: A significantly lower proportion of nuclear sclerosis (decreased from 83.2% in last year before lockdown to 55.2% during lockdown) and significantly higher proportions of mature, brown, or black cataract and phacomorphic, phacolytic, or Morgagnian cataract (increased from 15.5% in last year before lockdown to 43.8% during lockdown) were observed. The proportion of small-incision cataract surgery decreased significantly (from 63.2% to 57.4%), whereas the proportion of phacoemulsification increased significantly (from 35.9% to 41.5%) during lockdown as compared to last year. A significantly higher proportion of eyes with small pupils and association with retinal pathology were also observed during the lockdown. Conclusion: During the national lockdown, there was a shift from nuclear sclerosis grade toward mature, brown, black grade of cataracts. In addition, the proportion of small-incision cataract surgery decreased significantly whereas the proportion of phacoemulsification increased significantly during the lockdown. More number of cataracts with small pupils and associated retinal pathology were observed during the lockdown.

Visual outcomes of sterile corneal infiltrates after photorefractive keratectomy.

PURPOSE: Sterile infiltrates following laser refractive surgery is an uncommon complication. This study was undertaken to analyze the visual outcomes of sterile infiltrates following photorefractive keratectomy (PRK). METHODS: This retrospective study included 14 eyes that developed sterile infiltrates following PRK out of a total of 6280 eyes that underwent PRK between 2014 and 2017. Medical records of these patients, including patient demographics, characteristics of the infiltrate, presenting visual acuity, and treatment outcomes were recorded and analyzed. RESULTS: The incidence of sterile corneal infiltrates post-PRK in our study was 0.22% (14/6280). The mean age of the patients was 27.42 ± 4.87 years. The uncorrected visual acuity (UCVA) at presentation was 0.49 ± 0.13 log MAR units. The mean size of the infiltrate was 3.22 ± 2.85 mm2. All cases were successfully managed medically with topical steroids. The mean UCVA and best-corrected visual acuity (BCVA) at the last follow-up visit were 0.08 ± 0.08 and 0.05 ± 0.07 log MAR units, respectively. The mean time taken for resolution of the infiltrate was 8.91 ± 4.57 days. CONCLUSION: Sterile infiltrates following PRK can be effectively treated with aggressive topical steroids. The outcome is generally favorable and does not require surgical intervention if treatment is instituted early.

Outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.

Purpose: To study the outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty (DSEK) or Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods: From 2260 eyes that underwent DSEK or DSAEK from July 2008 to June 2015, 80 eyes of 80 patients developed graft detachment and were retrospectively reviewed. Host-related, surgery-related and donor-related factors that have a bearing on graft adhesion were looked at retrospectively, and eventual outcomes after rebubbling procedure were studied. Results: Successful attachment was observed in 77 (96.25%) eyes and clear grafts were achieved in 55 (68.75%) eyes, while 25 (31.25%) eyes had graft failure. The uncorrected and best-corrected distance visual acuities significantly improved from 1 month to 3 months post-operatively and remained stable till 12 months of follow-up. Three lenticules that failed to attach with the first rebubbling procedure underwent a second rebubbling, two underwent a repeat DSEK with good outcomes and four underwent penetrating keratoplasty. On evaluating possible risk factors for graft failure, lower donor endothelial cell density was found to be a significant factor (P = 0.03). The median graft survival following rebubbling was 30 months. Conclusion: Rebubbling procedure in detached grafts after DSEK or DSAEK can reattach the lenticule in 96% of eyes in immediate post-operative period and the majority of the grafts remained clear on long-term follow-up with a median graft survival period of 2.5 years.

Self-medication complicating pseudo membranous conjunctivitis.

We aim to highlight the prevalence of using local medications for curing eye ailments in a rural population and the harmful consequence of resultant disease, ranging from something as mild as conjunctivitis to sight-threatening conditions. This case report will address one such incidence where in a local village, the doctor known as a registered medical practitioner) in the rural community, uses local remedies for his conjunctivitis and ends up in a condition where he cannot see anything beyond perceiving light. The membrane removal and treatment with topical antibiotic cured his infection, restoring complete recovery of vision. This incidence inspired the local village doctor to become an eye health educator. He was motivated to spread awareness about the ill effects of self-medication on eye health. He is also determined to bring all blind people and others who need eye care from his remote village to our centre.

The sting of a honey bee: An unusual subconjunctival foreign body.

Ocular foreign bodies (FBs) are often encountered in clinical practices. However, there are cases in which the presence of the FB is difficult to diagnose based on mere history taking and/or clinical examination. We herein present a case of unusual subconjunctival foreign body in the form of the sting of a honey bee in a 63-year-old farmer. This was removed from the superior forniceal subconjunctival space in toto with forceps under a microscope in the operation theater. This case emphasizes the need to elicit a complete history and a careful ocular examination with double eversion of the eyelid to avoid missing any foreign body lodged in the fornices and subconjunctival space in patients who complained of foreign body sensation.

Visual outcome and complications of various techniques of secondary intraocular lens.

BACKGROUND/AIMS: The purpose of this study was to compare and evaluate the visual outcome and complications of various techniques of secondary intraocular lens (IOL) (i.e., anterior chamber IOL [ACIOL], suture-fixated posterior chamber IOL [PCIOL], and glue-fixated PCIOL). STUDY DESIGN AND SETTING: This was a randomized, prospective, interventional, comparative, clinical trial study. SUBJECTS AND METHODS: Patients of either sex having aphakia and lacking posterior capsular support were included in the study, and patients having corneal or scleral pathology, optic atrophy, uncontrolled glaucoma, retinal detachment, and other retinal pathology were excluded from the study. The patients were divided into three groups after comprehensive ophthalmological examination - Group A (secondary ACIOL) included 44 patients, Group B (secondary scleral-fixated sutured PCIOL) included 32 patients, and Group C (fibrin glue-fixated sutured PCIOL) included 34 patients. RESULTS: A total of 110 patients were included in this study, of which 59 (53.63%) were males and 51 (46.37%) were females. The best-corrected visual acuity (VA) after 6 weeks was in the range of 20/60-20/40 in 36.4% of Group A and 40.6% of Group B patients. In Group C, 52.9% of patients had best-corrected VA in the range of 20/30-20/20. The overall complications were less in glued PCIOL group. CONCLUSION: It can be concluded that fibrin glue-assisted PCIOL implantation provides better visual outcome with minimal complications in eyes with deficient capsular support.

Isolated abscess in superior rectus muscle in a child.

Pyomyositis is a primary bacterial infection of striated muscles nearly always caused by Staphylococcus aureus. Development of the intramuscular abscess involving the extra-ocular muscles (EOMs) remains an extremely rare process. We herein present a case of isolated EOM pyomyositis involving superior rectus muscle in a 2-year male child who was referred with complaints of swelling in left eye (LE) and inability to open LE since last 1-month. Orbital computed tomography (CT) scan showed a well-defined, hypo-dense, peripheral rim-enhancing lesion in relation to left superior rectus muscle suggestive of left superior rectus abscess. The abscess was drained through skin approach. We concluded that pyomyositis of EOM should be considered in any patient presenting with acute onset of orbital inflammation and characteristic CT or magnetic resonance imaging features. Management consists of incision and drainage coupled with antibiotic therapy.

Visual impairment and blindness among the students of blind schools in Allahabad and its vicinity: A causal assessment.

BACKGROUND/AIMS: Information on eye diseases in blind school children in Allahabad is rare and sketchy. A cross-sectional study was performed to identify causes of blindness (BL) in blind school children with an aim to gather information on ocular morbidity in the blind schools in Allahabad and in its vicinity. STUDY DESIGN AND SETTING: A cross-sectional study was carried out in all the four blind schools in Allahabad and its vicinity. MATERIALS AND METHODS: The students in the blind schools visited were included in the study and informed consents from parents were obtained. Relevant ocular history and basic ocular examinations were carried out on the students of the blind schools. RESULTS: A total of 90 students were examined in four schools of the blind in Allahabad and in the vicinity. The main causes of severe visual impairment and BL in the better eye of students were microphthalmos (34.44%), corneal scar (22.23%), anophthalmos (14.45%), pseudophakia (6.67%), optic nerve atrophy (6.67%), buphthalmos/glaucoma (3.33%), cryptophthalmos (2.22%), staphyloma (2.22%), cataract (2.22%), retinal dystrophy (2.22%), aphakia (1.11%), coloboma (1.11%), retinal detachment (1.11%), etc. Of these, 22 (24.44%) students had preventable causes of BL and another 12 (13.33%) students had treatable causes of BL. CONCLUSION: It was found that hereditary diseases, corneal scar, glaucoma and cataract were the prominent causes of BL among the students of blind schools. Almost 38% of the students had preventable or treatable causes, indicating the need of genetical counseling and focused intervention.