Subconjunctival cysticercosis - Is surgery always indicated? Role of medical management-literature review and report of two cases.

Ocular cysticercosis is caused by the larval form of pork tapeworm for which humans and pigs are the intermediate hosts. Intense inflammation secondary to immunological reaction is the hallmark feature of the infection, which can affect almost any tissue of the host. Orbital imaging yields specific features suggestive of the diagnosis. Although medical management is the recommended treatment for extra-ocular and retro-orbital cysticercosis, surgical removal has also been suggested by several authors. Here, we report two cases of subconjunctival cysticercosis, successfully managed with medical treatment alone using oral steroid and albendazole. Surgical excision for subconjunctival cysticercosis is associated with complications which can be observed even with the most experienced hands. Through these two cases, we wish to sensitize the practicing physicians regarding the most common ocular infestation seen in the developing countries along with brief literature review on the management protocols to be followed before any surgical reference.

Expression of p53 and Ki-67 proteins in patients with increasing severity and duration of pterygium.

Purpose: Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis. Methods: Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (<4 years and >4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant. Results: Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in <4 years, and 92.9% positive in >4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in <4 years, and 85.7% positive in >4 years of the duration of pterygium with no statistical significance. Conclusion: Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.

Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic.

PURPOSE: To ascertain ophthalmologist's perceptions about webinars as a method of continued medical education during the COVID-19 pandemic. METHODS: In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16th August 2020 to 31st August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom's taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners. RESULTS: 393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology. CONCLUSION: Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.

Post phacoemulsification wound infection by Nocardia cyriacigeorgica: a rare acid-fast organism.

Tunnel infection is one of the most dreaded infections, post phacoemulsification. Most cases reported till now are caused by Gram-positive and Gram-negative bacteria or fungi and very few cases by the acid-fast organisms. Ocular infections by Nocardia usually have poor prognosis. Here, we report a case of tunnel infection, its management and microbiological identification of cause behind it, that is, Nocardia cyriacigeorgica a rare acid-fast microorganism.

"Pattern of ocular morbidities among pilgrims attending religious mega festive event-'Kumbh Mela 2019' at Prayagraj, India".

BACKGROUND: Globally, ocular morbidities are one of the most underdiagnosed, underreported, and undertreated public health concern. Among estimated 39 billion blind in world, India shares major proportions, with majority of them living in rural population. In India, religious festivals like Kumbh Mela that involve mass gatherings are mainly attended by middle and elderly population who are usually susceptible to various ocular diseases. Therefore, we analyzed the data of our eye camp to document pattern and magnitude of ocular morbidities among pilgrims attending a mega religious festive event. METHODS: In a cross-sectional, descriptive study, we included all those patients who participated in a mega eye camp "Netrakumbh" from January to March 2019 at Kumbh Mela, Prayagraj, India and were attended by voluntary ophthalmologist from All India Institute of Medical Sciences, Rishikesh. Presenting chief complaints and detailed history were collected from all participants. All patients underwent comprehensive eye examination including visual acuity, slit lamp biomicroscopic examination, tonometry, etc., Data were compiled and analyzed utilizing SPSS 22.0. RESULTS: A total of 47142 eyes of 23571 persons of all age groups (range 5 years to 70 years) with approximate equal gender distribution attending the mega eye camp were examined. The most common ocular morbidity noticed after ocular examination was refractive error with underlying cause majorly as presbyopia, followed by cataract, after cataract, convergence insufficiency, lids, and adnexal disease, etc. CONCLUSIONS: This study highlights the changing pattern of common ocular morbidities presently among middle and elderly populations in developing countries like India.

Cryptic Myiasis by Chrysomya bezziana: A Case Report and Literature Review.

Myiasis is the invasion of living animal tissue by fly larvae. Orbital tissue infestation involvement occurs in 5% of all myiasis cases and is potentially destructive. Infection by Chrysomya bezziana is very rare in clinical practice. A 65-year-old woman with history of left eye evisceration presented to the emergency department due to a creeping sensation in the left eye socket and underwent medical and surgical treatment for C. bezziana ophthalmomyiasis. A systematic review was performed to identify ophthalmomyiasis cases caused by C. bezziana published in PubMed and Embase until December 2019. C. bezziana can cause major destruction to both vital and non-vital tissues. It should be treated promptly to prevent extensive damage and life-threatening conditions. This report provides an overview of the epidemiology, causes, risk factors, diagnosis, and treatment options that could assist clinicians in diagnosis and management of this condition.

Accuracy of biometry using automated and manual keratometry for intraocular lens power calculation.

INTRODUCTION: A comparison of precision of intraocular implant power calculation by computing keratometry values by two different methods, namely, the automated and manual keratometry (MK), was done. For checking this accuracy, the parameter taken into consideration was the absolute refractive error which was ascertained postoperatively. SUBJECTS AND METHODS: This study was conducted in the Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore. At a tertiary eye care centre in Central India (Sri Aurobindo Institute of Medical Sciences, Indore). Duration of the study was 18 months. Sample size was 66 individuals who were with cataract (nuclear sclerosis I to III). Although keratometry was done by both methods and implant power derived separately by computing both readings, decision of which power to be implanted in an eye would depend on the group, in which patient would fall. Group A were prospective candidates who would be implanted intraocular lens (IOL) of that power as assessed by computing MK value, whereas Group B were participants who would be implanted IOL of that power as assessed by computing value obtained by automated keratometry (AK). First patient fell in Group A and second in Group B, third again in Group A till 33 patients had been operated in each group. RESULTS: Bland-Altman plot thus obtained showed that the two keratometers are comparable. The postoperative refractive errors for the two Groups (A and B), showed that if an error of ±0.50 D or less is considered, then in Group A 81% of patients achieved this and 87% of patients required this as spectacle aid in Group B. CONCLUSIONS: In this study, we compared the accuracy of AK with that of MK for calculation of implant power. It was concluded from this study that AK is a simple keratometric technique that appeared to be more accurate than MK.

Appraisal of Bleb Using Trio of Intraocular Pressure, Morphology on Slit Lamp, and Gonioscopy.

PURPOSE: The aim of this study was to assess bleb function using Wuerzburg bleb classification score (WBCS) for bleb morphology on slit lamp, intraocular pressure (IOP), and gonioscopy. METHODS: A total of randomly selected 30 eyes posttrabeculectomy were assessed for bleb function with the trio of bleb morphology, IOP, and gonioscopy. Bleb was assessed using the WBCS of 0-12 on slit lamp, IOP was assessed using applanation tonometry, and visualization of inner ostium and iridectomy were assessed using gonioscopy. Postoperative patients of less than six weeks were excluded from the study. RESULTS: The correlation between WBCS and the duration of trabeculectomy was found to be highly significant (P value = 0.029). The correlation of IOP with WBCS was also found to be strongly positive (P = 0.000). IOP was found to be highly associated with peripheral iridectomy (P = 0.000), internal window (P = 0.001), and bleb characteristics.