Scleral Abscess of the Infusion Port Site Following Pars Plana Vitrectomy and its Management.

INTRODUCTION: Mycotic scleral abscess after pars plana vitrectomy (PPV) is a rare entity and a scleral abscess caused by Aspergillus flavus following PPV has not been reported in the literature. We describe the clinical presentation, complication and management outcome in a patient, who developed a mycotic scleral abscess at the infusion port site after 20 gauge pars plana vitrectomy. CASE: Two weeks after pars plana vitrectomy, a patient presented with a scleral abscess at the site of infusion port. He was a known diabetic, had a history of pulmonary tuberculosis and was using steroid eye drop at the time of presentation. Surgical debridement of the abscess was performed and he was treated with topical and systemic antifungal drugs. After three days of incubation, Sabouraud dextrose agar identified growth of Aspergillus flavus. After showing initial resolution, at 4 weeks follow up, the scleral abscess was noted to have progressed to involve the adjacent cornea. Corneoscleral patch graft was performed and treatment with topical and systemic antifungal was continued, which led to complete resolution of the corneoscleral abscess with corneal opacity and scar formation, over a period of eight weeks. CONCLUSION: Scleral abscess is a rare complication after pars plana vitrectomy and requires early and appropriate treatment to decrease the ocular morbidity. Dissemination of the infection to involve the cornea can be managed with corneo scleral patch graft and appropriate antifungal medications to salvage the eye.

Incidence of Glaucoma after Combined Descemet's Stripping Endothelial Keratoplasty and Retropupillary Fixated Iris-Claw Lens.

Purpose: To assess the incidence of glaucoma after combined Descemet's stripping endothelial keratoplasty (DSEK) and retropupillary fixated iris-claw intraocular lens (IOL) implantation in the patients with bullous keratopathy (BK) who required secondary IOL or IOL exchange. Methods: In this retrospective case series, medical records of 22 patients who underwent combined DSEK and retropupillary fixated iris-claw IOL implantation were evaluated. Preoperative vision, intraocular pressure (IOP), postoperative IOP at different time periods, and intraoperative and postoperative complications were analyzed. Results: A total of 22 eyes of 22 patients (7 females and 15 males) were analyzed. The median age was 62 years, and the median duration of the postoperative follow-up was 106.5 days. The corrected distance visual acuity improved from a median of 1.85 logMAR to 1.68 logMAR. None of the patients had intraoperative complications. Three patients (13.6%) had dislocation of the donor tissue on the 1st postoperative day and were successfully rebubbled. Six eyes (27.3%) had graft failure and required penetrating keratoplasty. Eleven eyes (50%) had a sustained rise in the IOP, of which 2 (9.09%) had ocular hypertension and 9 eyes (40.9%) progressed to glaucoma. Conclusions: DSEK combined with retropupillary fixated iris-claw lens is a good surgical option for the management of aphakic/pseudophakic BK in patients who require secondary IOL or IOL exchange. Regular IOP monitoring after the surgery is an essential, as there is a risk of IOP rise and glaucoma in the postoperative period. Clinicians should be vigilant and control the IOP to prevent glaucoma progression.

Simple and novel technique of using lampblack soot as a corneal tattoo for disfiguring corneal opacities.

The aim of this study was to report a series of corneal tattooing in three eyes of three patients with disfiguring corneal scar and no visual potential, which underwent the procedure using the lampblack prepared in the operating room (OR), and to describe the novel technique of lampblack preparation for the surgery. The depth of corneal opacity was carefully assessed and a superficial lamellar pocket was made by lamellar separation using corneal dissectors, following which the prepared lampblack soot using materials available in the OR was deposited in the pocket. At a mean follow-up of 6 months, all the eyes had a stable corneal surface with an acceptable cosmetic outcome. Corneal tattoo using lampblack gives a satisfactory cosmetic result with good patient satisfaction and improved quality of life in the eyes with disfiguring corneal scar.

Effect of pupil size on posterior chamber phakic intraocular lens vault measurements.

PURPOSE: The aim of this study was to measure the implantable collamer lens (ICL) vault changes with anterior segment optical coherence tomography (AS-OCT) after the implantation of the Visian posterior chamber phakic ICL with a central hole (V4c) in relation to the pupil size. METHODS: This retrospective observational pilot study included 32 eyes of 16 patients, who underwent V4c ICL implantation. ICL vault was measured with AS-OCT in undilated and fully dilate state of the pupil. Primary outcome measure was the change in the vault of V4c ICL at the maximum and minimum pupil size. RESULTS: Median (IQR) undilated and post-dilated vault measurement was 393.00 (335.50-493.50) microns and 421.00 (338.50-503.75) microns, respectively, which was not statistically significant (P = 0.44). CONCLUSION: No statistically significant difference was observed between the undilated and post-dilated ICL vault measurements. Hence, the postoperative vault can be measured either in resting, undilated state or fully dilated state of the pupil and would be similar irrespective of the pupil size.

"Separate the Wheat from the Chaff" - Descemet's Stripping Endothelial Keratoplasty Graft Failure due to Accidental Implantation of Full-Thickness Precut Tissue.

We present an interesting case of failed Descemet's stripping endothelial keratoplasty (DSEK) graft, due to accidental implantation of a full-thickness precut tissue. A repeat DSEK was planned, and during the surgery along with the DSEK graft, an extra thick corneal tissue was also retrieved. Careful evaluation of both the explanted tissues revealed that the primary surgeon failed to separate a precut DSEK graft and implanted the entire full-thickness tissue. After the repeat DSEK, there was improvement in corneal edema and visual acuity.

A simplified ex vivo model to learn the correct orientation of Descemet membrane endothelial graft.

We describe a simple, endoilluminator-assisted technique, which enables an easy identification of the descemet membrane endothelial keratoplasty graft orientation, as well as provides its good visualization in the anterior chamber, during all the steps of surgery in the wet lab.

Zinsser-Engman-Cole Syndrome Presenting as Partial Limbal Stem Cell Deficiency.

PURPOSE: To report a case of partial limbal stem cell deficiency and characteristic mucocutaneous triad in an 11-year-old boy. METHODS: Systemic features along with ocular features are described in this case report. RESULTS: Ophthalmic evaluation showed bilateral partial limbal stem cell deficiency (LSCD) and systemic examination revealed characteristic mucocutaneous triad of oral leukoplakia, skin hypopigmentation, and nail dystrophy suggestive of the Zinsser-Engman-Cole syndrome or dyskeratosis congenita. CONCLUSIONS: Thorough ocular and systemic evaluation can help in clinching the diagnosis of this rare condition. Timely referral to a dermatologist and hemato-oncologist would help in the management of life-threatening complications like malignancy or progressive bone marrow failure.

Management of anisocoria and high vault in an eye with implantable collamer lens.

A young lady presented with very high vault and fixed dilated pupil along with optic capture of the implantable collamer lens (ICL). After thorough evaluation and ruling out the ICL sizing error, the optic capture was relieved and the ICL was rotated into vertical position. Single-pass four throw pupilloplasty was performed for the fixed dilated pupil. Postoperatively the ICL vault and the pupil size decreased and patient was asymptomatic. This case highlights a successful outcome of rotation of a nontoric ICL to reduce the high vaulting and optic capture along with single-pass four throw pupilloplasty.

Dematiaceous Fungal Colonization of the Bandage Contact Lens in a Patient Lost to Follow-up During the COVID-19 Crisis.

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.