Viral Keratitis, Surgical Intervention in Viral Keratitis, Challenges in Diagnosis and Treatment of Viral Keratitis, HSV, HZV.

Viral keratitis is a significant cause of ocular morbidity and visual impairment worldwide. In recent years, there has been a growing understanding of the pathogenesis, clinical manifestations, and diagnostic modalities for viral keratitis. The most common viral pathogens associated with this condition are adenovirus, herpes simplex (HSV), and varicella-zoster virus (VZV). However, emerging viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Vaccinia virus can also cause keratitis. Non-surgical interventions are the mainstay of treatment for viral keratitis. Antiviral agents such as Acyclovir, Ganciclovir, and trifluridine have effectively reduced viral replication and improved clinical outcomes. Additionally, adjunctive measures such as lubrication, corticosteroids, and immunomodulatory agents have alleviated symptoms by reducing inflammation and facilitating tissue repair. Despite these conservative approaches, some cases of viral keratitis may progress to severe forms, leading to corneal scarring, thinning, or perforation. In such instances, surgical intervention becomes necessary to restore corneal integrity and visual function. This review article aims to provide an overview of the current perspectives and surgical interventions in managing viral keratitis. The choice of surgical technique depends on the extent and severity of corneal involvement. As highlighted in this article, on-going research and advancements in surgical interventions hold promise for further improving outcomes in patients with viral keratitis.

Therapeutic contact lens-related infection by a novel pathogenic fungus Coniochaeta hoffmannii-a case report.

This study aims to report a rare instance of corneal decompensation brought on by Coniochaeta hoffmannii fungus invasion of a bandage contact lens (BCL). A 71-year-old man with pseudophakic bullous keratopathy (PBK) had BCL treatment for four months to symptomatically reduce pain and itching in his right eye. However, the patient unexpectedly lost his vision. The slit-lamp examination revealed an edematous cornea; the extensive direct inspection raised suspicion of BCL. For morphological characterization, the BCL extracted was inoculated onto 5% sheep blood agar and PDA. By Sanger sequencing method the isolate's genomic DNA was molecularly identified as C. hoffmannii.

Single-arm tool for assessment of anomalous head posture.

Background: Anomalous head posture (AHP) measurement is crucial in the management of nystagmus and incomitant strabismus and also during follow-up assessments. The types of AHP include chin posture, head tilt, and face turn. Goniometer is a low-cost tool widely used to measure head posture. This has two arms: one reference arm and one measuring arm. The drawback of this device is that the examiner has to maintain the reference arm exactly parallel or perpendicular to the floor and the other arm has to align the AHP. Since not all the examiners are comfortable in aligning both the arms simultaneously, the measurements obtained by a goniometer end up being less accurate. A device named cervical range of motion (CROM) is more reliable but expensive. There is an iOS application created for the purpose of head posture assessment, but an iPhone is expensive. Purpose: To demonstrate a low-cost, innovative, reliable single-arm tool (SAT) for assessment of AHP. Synopsis: A clinometer is a device that is used to measure the heights of buildings. In this device, the gravitational force of the earth determines the reference line. We have modified a clinometer into a SAT by incorporating a long plastic arm to it, which is used to measure head tilt and chin up/down measurements. For the purpose of face-turn measurement, we modified a compass for direction into another type of SAT by fitting a yoke dial and a long plastic arm to measure face turn. Here, the principle is to have the line of direction as a reference. The direction of the patient's seating arrangement is determined and taken as the reference direction. The amount of the patient's face turn is measured by finding out the angle between reference direction and direction of the nose. Highlights: This video shows the method of making SAT in a do-it-yourself manner and also demonstrates the method of measuring AHP. SAT is a reliable and low-cost device. Online Video Link: https://youtu.be/UwoHARok85c.

Technique of using Cionni capsular tension ring in the management of of ectopia lentis cases.

BACKGROUND: Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus. PURPOSE: Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children. SYNOPSIS: This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs - right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases. HIGHLIGHTS: Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon's choice and not based on the type of subluxation. VIDEO LINK: https://youtu.be/zbdpP0lhykw.

Novel device to contain aerosols during phacoemulsification.

We herein describe a novel device to contain droplets and aerosols during phacoemulsification. We modified the silicon phaco test chamber into an aerosol containment chamber (ACC) by shortening the chamber and making a pear-shaped opening at one aspect of its tip. The ACC was fitted over phaco tip such that 4-5 mm of phaco tip and sleeve was exposed. When the phaco tip and irrigation port are inside the anterior chamber during phacoemulsification, the portion of the modified chamber remains around the clear corneal tunnel in an enclosing manner that contains aerosols and droplets.

Fungal Keratitis Caused by Exserohilum, An Emerging Pathogen.

PURPOSE: To determine the epidemiology, risk factors, clinical features, and prognosis of fungal keratitis caused by Exserohilum. METHODS: All culture-proven cases of keratomycosis caused by Exserohilum presented from January 2012 to December 2014 were retrospectively analyzed using a computerized database. RESULTS: Among 1542 cases of keratomycosis, 47 (3%) were due to Exserohilum. The mean age of presentation was 50.4 years. Males (n = 32; 68%) were more commonly affected than females (n = 15; 32%). A history of trauma was present in most of the cases (n = 38; 80.9%). The mean time of the first visit to the hospital was 6.2 days after onset of symptoms. Most of the patients (n = 24; 72.3%) had central or paracentral ulcers. The infiltrate was confined to the superficial one-third of the stroma in 39 patients (83%). Most of the patients (89.4%) responded well to topical treatment (natamycin 5% for ulcers <5 mm; voriconazole 1% was added for ulcers >5 mm or with hypopyon); 4 patients (8.5%) required therapeutic penetrating keratoplasty and 1 patient (2.1%) progressed to endophthalmitis, requiring evisceration. The mean best-corrected visual acuity in the medically treated patients improved from 0.89 (logMAR) at presentation to 0.77 at the completion of treatment (P = 0.015). CONCLUSIONS: This study signifies the importance of this new emerging pathogen that was generally regarded as rare in the past. The infection seems to be more prevalent than previously thought, especially in hot and humid areas. Vision is likely to improve if the infection is diagnosed and appropriate topical treatment is started early.