Changes in ocular surface status after phacoemulsification in patients with senile cataract.

AIM: To evaluate the signs and symptoms of dry eye after phacoemulsification; effects on the status of ocular surface using impression cytology; and associated risk factors. METHODS: Prospective study included 50 eyes (50 patients) with no dry eye signs or symptoms, who underwent clear corneal phacoemulsification for senile cataract. Dry eye indices used included Ocular Surface Disease Index scoring, Schirmer I test, tear break up time, tear meniscus height, corneal fluorescein staining, lissamine green staining and goblet cell density (GCD) with the help of impression cytology. Primary outcome measures included post-operative changes in the dry eye indices. Secondary outcome measures included correlation of the dry eye signs and symptoms with various risk factors. RESULTS: Aggravation of both the signs and symptoms of dry eye were noted in immediate post-operative period. The sharp deterioration was followed by a recovering trend towards the end of sixth week. A decrease in GCD was also noted. Risk factors for deterioration include age, duration of exposure to microscope light and effective phacoemulsification time. Diabetic status, socio-economic status and site of incision did not have any effect on dry eye status. CONCLUSION: There is a transient deterioration of "dry eye" status post-phacoemulsification. The patients should be carefully counselled about the evanescent nature of the disease. Incision can be given at the site of high corneal curvature to neutralize astigmatism without any fear of inducing dry eye. Minimum light exposure and ultrasound energy should be used during the surgery.

Indications and graft survival analysis in optical penetrating keratoplasty in a tertiary care center in North India: a 5-year study.

PURPOSE: To study the indications and variables correlating with graft survival in optical penetrating keratoplasty in a tertiary care hospital in north India. PARTICIPANTS: All patients who underwent optical keratoplasty, except those undergoing lamellar grafts, tectonic grafts transplants and penetrating keratoplasty done for therapeutic purposes were included in the study. Patients with follow-up less than 2 years were excluded from the study. MATERIALS AND METHODS: Data were obtained by reviewing the records of 101 patients who underwent optical penetrating keratoplasty from 2008 to 2013 for various indications. RESULTS: Out of 101 patients who underwent optical penetrating keratoplasty, 71 were males and 30 were females. The mean age of the recipient was 48.53 years with range 1-82 years. The main indications were previous failed graft (29.7%), healed keratitis except HSV (15.8%), pseudophakic or aphakic bullous keratopathy (14.8%), corneal dystrophies/degenerations (12.9%), adherent leucoma (9.9%), post-HSV scars (8.9%), and others like anterior staphyloma, congenital corneal opacities, buphthalmos and keratoconus (7.9%). The graft survival rate was 67.33% at 1-year follow-up and 59.4% at 2-year follow-up. The mean survival time of the grafts was 22.42 months. The mean time for graft failure was 7.12 (±0.9) months. CONCLUSION: One- and 2-year survival of grafts at our center is lower as compared to western studies, probably due to higher percentage of poor prognosis indications for surgery and a relative scarcity of excellent-quality donor corneas.

Adult onset retinoblastoma: A diagnostic dilemma.

Retinoblastoma is the most common intraocular tumor of childhood. About 95% of retinoblastoma cases are diagnosed before the age of 5 years. Not more than 30 cases of Adult-onset retinoblastoma have been reported in literature. A 32 year old male presented with a painful blind eye. There was sudden loss of vision accompanied by severe pain and redness in right eye about 1 year ago, for which some surgery was done with neither a gain in vision nor any relief from pain. Then he was put on maximum tolerable medical therapy, later cyclocryotherapy was done. Now he presented to us with complains of extreme pain and bleeding from right eye since 2 days. There is no history of any ocular trauma. Right eye had no perception of light & showed anterior staphyloma with perforation. Right eye evisceration was done & material sent for histopathological examination, which revealed an adult-onset retinoblastoma. CECT scan revealed thickening of optic nerve throughout its entire length with contrast enhancement. He was further taken up for enucleation of residual sclera with maximum optic nerve stump removal to reconfirm the diagnosis. Histopathological examination revealed tumor deposits present in orbital soft tissue, resection margins and optic nerve cut end.Retinoblastoma presenting in adult age creates a diagnostic dilemma because of its low frequency and atypical features. We want to highlight the importance of high clinical suspicion and imaging modalities before taking any patient for evisceration with unexplained vision loss. One should send the eviscerated material for histopathological examination.

Ocular morbidity among school-going children in the Union Territory of Chandigarh.

Schoolchildren in India are susceptible to various types of ocular morbidities. Early detection through regular surveys helps in prompt treatment and prevention of blindness. The aim of this study was to estimate the prevalence of ocular morbidity among schoolchildren aged 6-16 years and to determine their socio-demographic risk factors. This cross-sectional study includes government and private schools in Chandigarh. The study was conducted during August 2010 to December 2010. The World Health Organization 30-cluster sampling technique was used to cover an optimum sample size of 9,067 students in 30 schools from 169 schools in Chandigarh with proportional allocation in different classes. Statistical analysis was done using SPSS version 15.0. Qualitative data was analysed using the Chi squared test. Logistic regression analysis was performed to identify risk factors. Prevalence rates of refractive error, colour-blindness, squint, and vitamin A deficiency were found to be 29.3, 1.2, 0.8 and 0.05 %, respectively, with an overall prevalence of ocular morbidity of 30.4 %. The prevalence of ocular morbidity was significantly higher among female students and among those studying in private schools. The prevalence rate increased significantly with age. A high prevalence of treatable or preventable ocular morbidity was observed among school-going children, and refractive error was the most common problem.

Acrophialophora fusispora as an Agent of Mycotic Keratitis: A Case Report and Review of Literature.

BACKGROUND: Acrophialophora species is an infrequent human opportunistic pathogen. It is widely distributed in temperate as well as tropical regions. Here, we present a rare case of fungal keratitis caused by A. fusispora. CASE PRESENTATION: A 26-year male driver presented with pain, watering, redness, whitish discoloration, and blurring of vision in the left eye for the last 3-4 days. Upon examination, he had a dry-looking corneal ulcer with infiltration and satellite lesions. Corneal scrapings were positive for septate fungal hyphae by Gram staining and KOH mount. After five days, the growth observed was presumptively identified as genus Acrophialophora and finally identified as Acrophialophora fusispora by genetic sequencing. The patient failed to respond medically and was planned for therapeutic keratoplasty. DISCUSSION: To date, four cases of ocular involvement due to Acrophialophora have been described. Amongst which one case was associated with an immunocompromised state. Three of the cases were resolved medically, while one required therapeutic keratoplasty, indicating possible strong pathogenicity to the eye. CONCLUSION: As Acrophialophora seems to have a predilection for eye infections, an early diagnosis with timely appropriate treatment is the best way to restore the normal vision of a patient.

Quality of life following LASIK surgery at a tertiary center in North India.

BACKGROUND AND AIM: Laser-assisted in situ keratomileuses (LASIK) refractive surgery is a cutting-edge and developing area of ophthalmology. Reshaping the cornea during refractive surgery helps patients become less dependent on glasses or contact lenses. The aim of the present study was to evaluate the visual outcome, quality of life, and patient satisfaction following LASIK surgery at a tertiary care center in North India using the National Eye Institute Refractive Error Quality of Life (NEIRQL-42) questionnaire. METHODS: NEI-RQL, a 42-item measure with 13 subscales. The questionnaire was administered to a sample size of 71 patients who underwent LASIK Surgery at a tertiary center in North India. Data were collected pre- and post-surgery (1,3,6 month post-LASIK) for myopic or hyperopic refractive error. Statistical analysis was done using the Friedman test and Wilcoxon signed-rank test. RESULTS: In myopic patients, the mean preoperative spherical equivalent (SE) was -4.19 ± 2.28D in the right eye and -4.26 ± 2.28D in the left eye and post-op SE -0.06±0.29 (p=0.00). The largest improvements (>25 points) on the 0 to 100 possible score range, were seen in activity limitations, dependence on correction, appearance, and satisfaction with correction subscales. The subscale glare showed a statistically significant difference (worsening) whereas a non-significant change (P> 0.05) was recorded only in the sub-optimal correction sub-scale. CONCLUSIONS: The NEIRQL-42 is a responsive tool to evaluate vision-related changes in quality of life after LASIK surgery in the Indian population. The best surgical expectancy and QoL can be expected at 6 months following surgery.

Herpes Zoster Ophthalmicus After COVID-19 Vaccination: Chance Occurrence or More?

ABSTRACT: As the understanding of COVID-19 infection becomes better, it is being recognized as a complex multisystem pathology rather than just affecting the lungs. Several ocular findings have been documented by researchers in individuals infected with COVID-19, and ocular symptoms may even be the first presenting feature of COVID-19 infection in 2.26% individuals. Several countries have started vaccination with inactivated or live vaccines to combat this pandemic, and varied side effects have been reported after vaccination. Few cases of herpes zoster have previously been reported in elderly patients with comorbidities after receiving COVID-19 vaccines. In this article, the authors described 2 interesting cases of herpes zoster ophthalmicus (HZO) after receiving a live COVID-19 vaccine. The first case was a 35-year-old immunocompetent man who developed HZO 3 days postvaccine. The second case was a 40-year-old immunocompetent man who developed HZO 28 days postvaccine. To the best of our knowledge, no literature to date has described HZO after live vaccine.

Total Corneal Melt in Patient with Porphyria Cutanea Tarda in Presence of Another Risk Factor.

Purpose: To report a case of two siblings affected by porphyria cutanea tarda (PCT) presenting with varying severity of ocular disease and evaluation of difference in the presence of risk factors. Methods: Case report Result: A 42-year-old Indian male diagnosed with PCT and history of daily intake of alcohol, presented with sudden decrease in vision of right eye. Examination showed perforated cornea surrounded by rim of 360-degree avascular necrotic sclera, with no evidence of infection. Similar systemic history was present in his elder brother. He did not consume alcohol and presented with mere localized scleral thinning. Since the patient's sibling acted as a natural control for the evaluation of alcohol as an independent risk factor, the difference in severity of disease can be explained on the basis of difference in alcohol intake. Conclusion: In the presence of progression of the disease, other risk factors like intake of alcohol should be evaluated.

Keratomycosis in and around Chandigarh: a five-year study from a north Indian tertiary care hospital.

To find out the prevalence and epidemiological features of keratomycosis in Chandigarh, the present study was carried out jointly by the Departments of Microbiology and Ophthalmology, Government Medical College Hospital, Chandigarh, over a period of 5 years from January 1999 to December 2003. Corneal scrapings were collected from a total of 154 suspected patients of keratomycosis and were processed and identified by standard laboratory techniques. The study revealed that a total of 64 cases (41.55%) were positive for fungal agents. Direct microscopy was positive in 52 cases (76.47%) and culture in 34 cases (53.12%). Most common fungal isolates were Aspergillus species 14 (41.18%), Fusarium species 8 (23.53%), Candida species 3 (8.82%), Curvularia species 2 (5.88%) and Bipolaris species 2 (5.88%). Thus, hyaline filamentous fungi were the most common etiological agents and mechanical trauma with vegetative matter was the most common predisposing factor. Males in age group of 21-50 years were more commonly affected.

Intracorneal Amphotericin B Injection in a Case of Indolent Candidal Keratitis.

Ocular candidiasis is one of the opportunistic infection occurring in human body. Pathogenesis wise, Candida is very virulent and slow growing organism. We report a case of 76-year-old female with left eye candidal stromal abscess, not responding to topical and oral antifungal drugs. Patient was administered intrastromal amphotericin B injection in the affected eye. Four midstromal injections were given in the areas surrounding the corneal abscess. A total of approximately 0.05 mL of amphotericin B, 5 µg per 0.1 mL, was administered. Within next four weeks, the eye became completely quiet with healed epithelial defect and corneal scarring. Intracorneal injection of amphotericin B is a safe and effective treatment option for recurrent and recalcitrant fungal infections.

A Case of Bilateral Corneal Perforation in a Patient with Severe Dry Eye.

Dry eye is a common problem affecting mainly the adult population. In severe cases, it can result in sterile corneal ulcer and perforation. We report a rare case of a 26-year-old male, a known patient of severe dry eye who presented with sterile corneal ulcer with corneal perforation in both the eyes. The patient was managed by applying cyanoacrylate glue and bandage contact lens in both eyes and topical antibiotic, topical cyclosporine and preservative free artificial tears at two hourly intervals. The patient was investigated for the systemic cause of severe dry eye but no cause could be ascertained. On follow up, the patient reported marked relief in photophobia. On examination, both eyes showed sealed perforation with well formed anterior chamber. In conclusion, one should examine a dry eye patient carefully and detect corneal ulcers and perforations in time so as to prevent its sequelae.

Five-Year Retrospective Review of Cases with Benign Essential Blepharospasm and Hemifacial Spasm Presenting in a Tertiary Eye Care Center in North India.

Retrospective analysis of epidemiological and clinical characteristics of patients diagnosed with benign essential blepharospasm and hemifacial spasm who reported to the oculoplasty clinic of a tertiary eye care center in north India between January 2010 and April 2015 was carried out. Dry eye, as well as all the local factors that can cause blepharospasm or hemifacial spasm, was ruled out. Systemic evaluation was done to rule out any neurological disorder. A detailed history was taken to rule out any associated psychiatric disorders as well as use of any medication which could be responsible for dystonic movements. In every patient of hemifacial spasm, magnetic resonance imaging (MRI) of the brain was done for any facial nerve compression or tumor involving posterior fossa. Botulinum type A injections were given after assessing their requirements on the basis of guidelines given by Jankovic et al.

Simple Limbal Epithelial Transplantation in Acid Injury and Severe Dry Eye.

The epithelial cells of cornea constantly undergo renewal and regeneration and the stem cells responsible for renewal resides within basal epithelium at the limbus in palisades of Vogt. Simple limbal epithelial transplantation (SLET) is a simplified technique for limbal stem cell deficiency and it combines the benefits of both conjunctival limbal autografting and cultivated limbal epithelial transplantation by being single-stage and utilizing minimal donor tissue. We will be discussing two cases of ocular surface disorder which were managed successfully by new technique simple limbal epithelial transplantation. Two patients one with unilateral Limbal Stem Cell Deficiency (LSCD) following acid injury and other with bilateral LSCD due to severe dry eye underwent limbal epithelial transplantation using the SLET method after taking prior consent for the procedure. Success was termed complete when a completely epithelialized, avascular and stable corneal surface was seen. The follow up examinations were done on first day, at 1 week, 2 weeks, 4 weeks and at 3 months after the surgery. A completely epithelialised, avascular and stable corneal surface was achieved by 4 weeks in both patients. Simple limbal epithelial transplantation is a new technique which is simple, cheap and easily affordable and it has decreased the dependence on stem cell laboratory.

Unilateral visual loss due to central retinal artery occlusion with total ophthalmoplegia following cervical spine surgery in prone position.

BACKGROUND: Blindness after spinal surgery is a rare complication, but it is serious, irreversible and incurable. Central retinal artery occlusion (CRAO) is rare after spinal surgery and ophthalmoplegia is even rarer. CASE: A 52-year-old male patient complained of loss of vision in right eye immediately after cervical spine surgery. On examination, the patient's visual acuity in right eye was absent perception of light. Right eye pupil was dialated and relative afferent pupillary defect (RAPD) was present. Extraocular movements were absent in all gazes in right eye. Intra-ocular pressure (IOP) was 26 mmHg in right eye and 16 mmHg in the left. Posterior segment examination revealed blurred disc margin with ischemic whitening of retina, thin and attenuated retinal arterioles and a central cherry red spot in right eye. Left eye was essentially normal. OBSERVATIONS: The causal factors of blindness in the patient were likely ischemia of the retina after venous congestion or temporary arterial occlusion resulting from changes in pressure to the tissues of the orbit. Factors including prolonged prone positioning with head end dependent position and possibility of orbital compression by the headrest could have contributed to impaired venous drainage, increase in IOP and reduction in perfusion pressure. CONCLUSION: Loss of vision post spinal surgery is a rarest of complication yet grave and irreversible. Because the problem involves mainly prone positioning of the patient, an appropriate position should be found so that facial and ocular compression can be avoided.

Orbital Cysticercosis - masquerading as preseptal cellulitis with ptosis.

We are sharing a case of orbital cysticercosis,which presented to us initially with simple ptosis and later on with upper lid inflammation and restricted ocular motility in upgaze. Human cysticercosis, a parasitic infection caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium, is a benign infection of the subcutaneous tissues, inter-muscular fascia, muscles and other organs. Though it exists worldwide, it is more prevalent in the developing countries of Latin America, Asia and Africa, especially in areas where under-cooked pork is consumed regularly (Pushker et al, 2001). However, 5 year study of 33 cases of Ocular/Adnexal cysticercosis showed seventy percent of patients were of low socioeconomic group and 70% were strictly vegetarians (Atul et al, 1995). The clinical manifestation of orbital cysticercosis is entirely different from neuro-cysticercosis or cysticercosis of other parts of body. Diagnosis of cysticercosis is mainly based on highly specific radiological signs and history of exposure in endemic areas.

Malignant glaucoma as a complication of Nd:YAG laser posterior capsulotomy.

A 79-year-old woman with pseudophakia who underwent Nd:YAG posterior capsulotomy for posterior capsular opacification in her right eye had increased intraocular pressure associated with a flat anterior chamber. Full-thickness patent iridotomy performed with an Nd:YAG laser did not reduce the intraocular pressure. B-scan ultrasonography showed aqueous pockets in the vitreous, leading to a diagnosis of malignant glaucoma. Medical and surgical therapy normalized the intraocular pressure and resolved the symptoms of malignant glaucoma.

Eye donation awareness among medical and paramedical staff in a medical institute.

INTRODUCTION: Corneal diseases constitute a significant cause of visual impairment and blindness in the developing world. The number of corneal transplants done is far less than required due to the lack of donor cornea. A well informed and motivated medical and paramedical staff can increase the rate of eye donation by counseling grief-stricken relatives of the deceased for eye donation. OBJECTIVE: To assess the awareness of the medical and paramedical staff of a medical institute about eye donation. MATERIALS AND METHODS: This was a cross-sectional study. A self-designed, standardized, single-response type questionnaire on eye donation awareness was prepared and circulated in all the departments of our institute. RESULTS: Of the 395 participants, 317(80.5%) were aware of eye donation, 312(80%) knew that the cornea is used for eye donation and 294(76%) knew that the ideal time for eye donation is within six hours of death. Only 286(72.4%) knew about pledging for eye donation and only 251(65.4%) consented for pledge of their eyes. Of those who did not want to pledge, 12(14.8%) had religious reasons, 9(11.1%) feared disfigurement, 9(11.1%) thought that they might be born blind in their next birth and 51(63%) had some other reasons. CONCLUSION: There is a need for regular eye donation awareness programs not only in the community but even for the medical and paramedical staff in hospitals and medical colleges. This will ultimately enhance the eye donation program in the country to help cope with the backlog in the long term.

Spectrum of fungal keratitis: clinicopathologic study of 44 cases.

AIM: To determine the causative agents of fungal keratitis and study the predisposing factors over a period of ten years in a single tertiary care hospital. METHODS: A retrospective analysis of fungal corneal ulcers was done from 2003-2012. Patients' clinical data were noted from the file records. Correlation of histopathological diagnosis was done with the report on fungal culture. RESULTS: Mycotic keratitis was established in 44 cases by a positive fungal culture. Direct microscopic examination of potassium hydroxide (KOH) mounts revealed fungal elements in 39 cases while 40 cases showed fungus on Gram stained smears. Males (54.55%) were more commonly affected than the females (45.45%). The age ranged from 18 to 82 years. Most common age group to be involved was 41-60 years. Predisposing risk factors were seen in 34 (77.27%) cases. Most common findings on clinical examination were anterior chamber reaction and conjunctival injection seen in all the cases. Other common findings were stromal infiltration and hypopyon seen in 20 (45.45%) and 18 (40.91%) cases respectively. On histopathological examination the fungus was typed, as aspergillus in 34 cases while no definite typing was possible in 10 cases. The predominant isolate was aspergillus flavus (59.09%) followed by fusarium (15.91%). Mixed fungal and bacterial infection was seen in 3 (6.82%) cases. CONCLUSION: Although culture is the gold standard for definitive diagnosis of fungal keratitis, direct microscopic examination of corneal scrapings or histomorphological evaluation of biopsies allow a rapid preliminary diagnosis. Early administration of antifungal treatment helps in preventing dreadful complications.