Epithelial barrier dysfunction in ocular allergy.

The epithelial barrier is the first line of defense that forms a protective barrier against pathogens, pollutants, and allergens. Epithelial barrier dysfunction has been recently implicated in the development of allergic diseases such as asthma, atopic dermatitis, food allergy, and rhinitis. However, there is limited knowledge on epithelial barrier dysfunction in ocular allergy (OA). Since the ocular surface is directly exposed to the environment, it is important to understand the role of ocular epithelia and their dysfunction in OA. Impaired epithelial barrier enhances allergen uptake, which lead to activation of immune responses and development of chronic inflammation as seen in allergies. Abnormal expression of tight junction proteins that helps to maintain epithelial integrity has been reported in OA but sufficient data not available in chronic atopic (AKC) and vernal keratoconjunctivitis (VKC), the pathophysiology of which is not just complex, but also the current treatments are not completely effective. This review provides an overview of studies, which indicates the role of barrier dysfunction in OA, and highlights how ocular barrier dysfunction possibly contributes to the disease pathogenesis. The review also explores the potential of ocular epithelial barrier repair strategies as preventive and therapeutic approach.

Comparison of Corneal Tissue Profile of Pseudophakic and Phakic Donors.

PURPOSE: To compare the endothelial quality of corneas obtained from pseudophakic donors with age-matched phakic controls. METHODS: Retrospective analysis of 100 corneas each from pseudophakic and phakic eyes with donor age ≥60 years in both the groups was performed. The endothelial cell density, coefficient of variation, and percentage of hexagonal cells obtained by specular microscopy were compared between the two groups. The cut-off level of endothelial cell density (ECD) taken for optical keratoplasty was 2,000 cells/mm2. RESULTS: The male and female donors constituted 60% (n=120) and 40% (n=80), respectively. The mean age of the donors was 66.9±7.3 years in the phakic group and 69.9±7.7 years in pseudophakic group. The mean ECD in the phakic group was 2757.6±328.5 cells/mm2 and that in the pseudophakic group was 2225.5±471.9 cells/mm2 (P<0.0001). The mean coefficient of variation in the phakic group was 37.1±5.0 and that in the pseudophakic group was 38.6±11.1 (P=0.234). The mean percentage of hexagonality in the phakic group and the pseudophakic group was 52.0±6.4% and 51.2±7.2%, respectively (P=0.414). Both in univariate and multivariate linear regression analysis, age of the donor was found to be negatively associated in predicting ECD (P=0.002 and P=0.003, respectively). Sixty-nine and thirty-three corneas from the phakic and pseudophakic donor pool were used respectively. CONCLUSION: Difference in ECD between the phakic and the pseudophakic donor group was found to be statistically significant. The ECD in the pseudophakic group was found to be above the cut-off limit required for keratoplasty. Hence, pseudophakic corneas may also be used for transplantation.

Outcome of four-point fixated open loop polymethyl methacrylate anterior chamber intraocular lens.

PURPOSE: To study long-term visual and refractive outcomes and complications in eyes with anterior chamber intraocular lens (ACIOL) implantation. METHODS: Data of patients who underwent primary and secondary ACIOL implantation at L V Prasad Eye Institute, Bhubaneswar between 2011 and 2020 was collected, including details of post-operative visits. For analysis, sample was divided into: group Ia (primary ACIOL in cases without risk factors, n = 104); group Ib (primary ACIOL in cases with pre-existing risk factors, n = 49); and group II (secondary ACIOL, n = 40). RESULTS: A total of 193 eyes of 192 patients were included. Mean post-operative follow-up in groups I and II were 8.6 and 11.51 months, respectively. Mean pre-operative and last visit corrected distance visual acuity were 1.73 ± 0.11 and 0.42 ± 0.05 logMAR units in group Ia (p < 0.001), and 1.53 ± 0.14 and 0.49 ± 0.10 logMAR units in group Ib (p < 0.001). The mean spherical equivalent (MSE) for last refraction was -0.37 ± 0.18 diopters (D) and -0.15 ± 0.51 D in groups I and II, respectively. Of 76 eyes in which addition of 2.5 D (over the near emmetropic posterior chamber intraocular lens power) was taken for ACIOL, 40 (52.6%) had MSE within ± 0.5 D. Most common complications were transient corneal edema and anterior chamber reaction. Eyes on anti-glaucoma medications at last visit were eight (7.7%), 15 (30.6%), and two (5.0%) in groups Ia, Ib, and II, respectively. CONCLUSION: We observed that ACIOLs have good visual and refractive outcomes. Raised IOP is a concern in eyes with pseudoexfoliation, but can be managed with close monitoring. Hence ACIOL can be a good option for managing aphakia after cataract surgery.

Comparative profile of ocular surface microbiome in vernal keratoconjunctivitis patients and healthy subjects.

PURPOSE: To compare ocular surface microbiome and its antibiotic sensitivity in vernal keratoconjunctivitis (VKC) with normal ocular surface. METHODS: In this case-control study, thirty patients each with clinical diagnosis of VKC and age-matched controls with normal ocular surface were enrolled. Tear film samples were collected from each group and subjected to microbial evaluation with microscopy, conventional culture methods, and polymerase chain reaction (PCR). Microbial diversity and antibiotic sensitivity patterns were analyzed. RESULTS: Most patients (67%) belonged to severe grades (3 and 4) of VKC, and allergic history could be elicited in 20%. On culture, bacteria were isolated in 50% of VKC patients and 47% of control group. Staphylococcus species were identified in 70% VKC group and 57% control group. S. aureus growth was seen in 52% and 21% of VKC patients and controls, respectively. S. pneumoniae was isolated only in controls (29%) (p<0.05). Confluent colonies (≥10 colonies/µl) were seen in 70% of VKC patients and 14% of controls (p<0.05). Fluoroquinolone resistance was more among higher grades of VKC (50%) (p<0.01) and was observed in 46% of VKC patients and 23% of control group (p<0.01). Both groups were negative for HSV-1 DNA and fungal growth. CONCLUSION: Staphylococcus, the most common ocular surface flora, was predominant in VKC patients. Microbial analysis revealed similar microbial diversity in both groups. However, bacterial load was higher in VKC. Increased fluoroquinolone resistance was observed in VKC patients with more resistance among higher grades. Fungi and HSV-1 were not seen in VKC or normal ocular surface.

Mast cells contribute to the induction of ocular mucosal alloimmunity.

Beyond their historical role as the effector cells in allergic disorders, mast cells have been implicated in regulating both innate and adaptive immune responses. Possessing considerable functional plasticity, mast cells are abundant at mucosal surfaces, where the host and external environments interface. The purpose of this study was to evaluate the contribution of mast cells to allograft rejection at the ocular surface. Using a well-characterized murine model of corneal transplantation, we report that mast cells promote allosensitization. Our data show mast cell frequencies and activation are increased following transplantation. We demonstrate that mast cell inhibition (a) limits the infiltration of inflammatory cells and APC maturation at the graft site; (b) reduces allosensitization and the generation of Th1 cells in draining lymphoid tissues; (c) decreases graft infiltration of alloimmune-inflammatory cells; and (d) prolongs allograft survival. Our data demonstrate a novel function of mast cells in promoting allosensitization at the ocular surface.

Mesenchymal Stem Cells Modulate Differentiation of Myeloid Progenitor Cells During Inflammation.

Mesenchymal stem cells (MSCs) possess distinct immunomodulatory properties and have tremendous potential for use in therapeutic applications in various inflammatory diseases. MSCs have been shown to regulate pathogenic functions of mature myeloid inflammatory cells, such as macrophages and neutrophils. Intriguingly, the capacity of MSCs to modulate differentiation of myeloid progenitors (MPs) to mature inflammatory cells remains unknown to date. Here, we report the novel finding that MSCs inhibit the expression of differentiation markers on MPs under inflammatory conditions. We demonstrate that the inhibitory effect of MSCs is dependent on direct cell-cell contact and that this intercellular contact is mediated through interaction of CD200 expressed by MSCs and CD200R1 expressed by MPs. Furthermore, using an injury model of sterile inflammation, we show that MSCs promote MP frequencies and suppress infiltration of inflammatory cells in the inflamed tissue. We also find that downregulation of CD200 in MSCs correlates with abrogation of their immunoregulatory function. Collectively, our study provides unequivocal evidence that MSCs inhibit differentiation of MPs in the inflammatory environment via CD200-CD200R1 interaction. Stem Cells 2017;35:1532-1541.

Fusarium keratitis at a tertiary eye care centre in India.

The aim of the study was to report the clinical and microbiological profiles of Fusarium keratitis. In this single-centre, retrospective, non-comparative case series, 47 laboratory-confirmed cases of keratitis caused by Fusarium species treated at the L V Prasad Eye Institute, Bhubaneswar, India, between November 2006 and October 2009, were reviewed. The analysis included predisposing factors, clinical characteristics, microbiological findings, treatment and outcome. Forty-seven samples of 47 patients were included in the study. The mean age of the 47 patients was 46 ± 17 years. Twelve eyes had a history of injury. Corneal scraping could not be done in one of the cases due to large perforation. Fungal filaments were detected in corneal scraping in 41 cases, and in three cases microconidia were observed in microscopy. Fusarium solani was the most common species (44.7 %). All three cases where microconidia were present in smear were identified as F. solani in culture. The mean time to positive culture was 2.4 ± 1.5 days. Twenty-three patients underwent adjunctive surgical procedure. Visual acuity of <20/200 at presentation and final follow-up was noted in 80.9 and 51.4 % patients, respectively. One-half (23/47) of the patients had improvement in visual acuity. Fusarium keratitis may present after trauma without any satellite lesion, and the response to medical therapy is generally poor. Rapid diagnosis can be made by smear examination of corneal scrapings in a majority of the cases and confirmed by culture within 2-3 days. Presence of microconidia in smear examination may be suggestive of F. solani.

The role of corneal biopsy in the management of microbial keratitis.

PURPOSE: Corneal biopsy helps in diagnosing deep-seated or recalcitrant lesions of microbial keratitis (MK). We aim to analyze its role in managing these challenging cases. METHODS: This is a retrospective review of 22 cases of corneal biopsy at our institute from January 2010 to December 2021. Data were retrospectively collected using the electronic medical record (EMR) system. Those cases of indolent, progressive MK or deep-seated lesions where cornea scraping was not possible were considered for corneal biopsy to establish the microbiological diagnosis. The primary aims of our study were to analyze the indications, success rates, and outcomes for biopsy patients in our series. Additional outcomes that were analyzed included the average time from presentation to biopsy, the type of causative organism isolated from the biopsy by either histopathological or microbiological method, and the frequency and outcome of surgical interventions performed. Descriptive statistics using mean (±standard deviation) and median (±range) were used to interpret the demographic data. RESULTS: Overall, 15 of 22 patients (68%) had a positive corneal biopsy after microbiological or histopathological examinations. The most identified organism was microsporidia (n = 4,30.7%), followed by mycobacteria (n = 2,15.4%), gram-negative bacilli (n = 2,15.4%), acid-fast bacilli (n = 1,7.6%), fungus (n = 2,15.4%), gram-positive cocci (n = 1,7.6%), and mixed bacterial infection (n = 1,7.6%). CONCLUSION: Corneal biopsy should be considered a diagnostic modality for patients with deep-seated or unresponsive MK. It can improve the treatment for MK, ensuring targeted therapy.

Ring infiltrate in staphylococcal keratitis.

Smear and culture tests of corneal scrapings from a patient with a ring infiltrate confirmed significant growth of a Staphylococcus species resistant to fluoroquinolones. Because of nonresponse to medical management, the patient underwent therapeutic penetrating keratoplasty. Staphylococcal infection of the cornea may appear as a ring-like infiltrate that is recalcitrant to medical management.

Past, present, and prospects in microsporidial keratoconjunctivitis- A review.

Ocular microsporidiosis comprises two entirely different spectra of disease as keratoconjunctivitis and stromal keratitis. Microsporidial keratoconjunctivitis (MKC) has been increasingly reported in the past two decades, probably due to raised awareness, simpler diagnostic procedures, and a better understanding of the clinical presentation. It is characterized by the presence of raised, coarse, punctate, multifocal, round to oval, greyish-white corneal epithelial lesions which usually evolve into nummular scars before resolution. Conjunctivitis seen is non-purulent and of mild-moderate intensity, with mixed papillary-follicular reaction. The mode of transmission and pathogenesis is poorly understood. Despite lack of inflammatory response, uncommon associations reported were- endotheliitis, corneal edema, limbitis, uveitis, and sub-epithelial infiltrates. There has been no consensus on the management of MKC. It varies from the use of multiple antimicrobial agents to simple lubricants. The majority of the disease goes underdiagnosed or misdiagnosed and treated as adenoviral keratoconjunctivitis, with topical steroids or anti-virals empirically. Changing trends have been noticed in the pattern of infection, possibly with increasing evidence of Vittaforma corneae as causative organisms, previously reported to cause stromal keratitis. An elaborate review of the past and present literature on MKC is provided in this review article, along with gaps in knowledge, and future directions of research.

Multidrug-resistant keratitis: challenging yet manageable.

PURPOSE: To study the incidence, clinical features and outcomes of multidrug-resistant (MDR) bacterial keratitis. METHODS: All cases of MDR-bacterial keratitis presenting to our institute over a period of 2 years were retrospectively analysed. Details of risk factors, size and depth of infiltrate, treatment, and outcome were noted. Antibiotic susceptibility tests were done on the ocular isolates from the culture of samples obtained from ocular infections, and resistance or sensitivity of the organisms to the commonly used antibiotics was studied. RESULTS: Forty patients were diagnosed with MDR-bacterial keratitis in the study period. The mean age of patients was 50.9±25.4 years. Most common risk factors were vegetative trauma (n=12, 30.0%), followed by corneal transplantation (n=7, 17.5%) and systemic comorbidities (n=7, 17.5%). Infiltrate was small (<6 mm) in 22 (55%) and large (>6 mm) in 18 (45%) patients. It involved the superficial, mid and deep stroma in 11 (27.5%), 9 (22.5%) and 15 (37.5%) cases, respectively. Gram-negative bacilli (n=18, 45%) were the maximum, among which Pseudomonas aeruginosa (15%) was the most common. Resistance to 3 (n=17, 42.5%) and 4 (n=17, 42.5%) classes of antibiotics was the most commonly observed. One (2.5%) patient showed resistance to all seven classes of drugs tested. Complete resolution of infection was seen in 15 (37.5%) MDR patients on medical management alone. Five (12.5%) patients underwent therapeutic penetrating keratoplasty. Size of the infiltrate was found to have a significant correlation with the outcome (p=0.002). CONCLUSION: MDR keratitis, despite being a challenge to treat, can be successfully managed by medical therapy alone, if appropriate therapy is started early in the clinical course.

Demographic profile and clinical characteristics of Fuchs' endothelial corneal dystrophy in a tertiary eye care center.

Purpose: This study was performed to determine the demographic profile and clinical characteristics in patients with Fuchs' endothelial corneal dystrophy (FECD) reporting to a tertiary eye care center in India. It is a retrospective, single-center, observational study. Methods: The study included 280 patients (559 eyes) diagnosed with FECD presenting between January 2013 and December 2020. The data was collected from the electronic medical record system of the institute. Patient data included demographic features, clinical characteristics, investigations, and surgical interventions. Results: The mean age of the patients was 62 years. Late-onset FECD (95.7%) was more common than early-onset FECD (4.3%). Male: female ratio for late-onset FECD and early-onset FECD was 1:1.65 and 3:1, respectively. More than one-third of the patients had associated systemic history. Preexisting ocular diseases were seen in 5.9% of eyes. Blurring of vision was seen in 383 eyes (68.5%), 13 eyes (2.1%) had glare, and 163 eyes (29.2%) were asymptomatic. A total of 113 surgical interventions were done in 108 eyes (including repeat transplants). Only cataract surgery was done in 40 (7.2%) eyes, whereas penetrating keratoplasty, Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty without or with cataract surgery (sequential or triple procedure) were done in 12 (2.1%), 47 (8.4%), and 14 (2.5%) eyes, respectively. Conclusion: Patients with FECD present mostly during the sixth decade. Posterior lamellar keratoplasty is the most common transplant procedure being performed on FECD patients.

Factors affecting the epithelial integrity of human donor corneas.

Purpose: To evaluate various factors affecting the integrity of human donor corneal epithelium. Methods: Donor corneal buttons were evaluated for epithelial defect (ED) and exposure. The slit-lamp photographs were taken on day 01, and the data such as age and gender of the donor, cause of death, refrigeration of cadavers, death-to-preservation time (DPT), experience of technician, and distance from site of collection to eye bank were collected. Results: A total of 100 consecutive corneal buttons belonging to 56 donors were evaluated. The median age of donors was 50 years. Males constituted 45 (80.4%). The mean DPT was 9.7 ± 5.3 hours. After death, 34 donors (60.7%) were refrigerated before the collection/retrieval. Most of the corneas (80%) were recovered by technicians having an experience of 0-5 years. Thirty-one donors (55.3%) were located at 1-50 km from the eye bank. The mean area of exposure was 15 ± 4.3 mm2. The mean area of ED was 28.7 ± 5.9 mm2. ED was significantly associated with refrigeration of cadavers and longer DPT. On multivariate analysis, only DPT was found to be significantly associated (P = 0.006; odds ratio [OR] = 1.54 ± 0.24) with the presence of ED. After transplantation, only two corneas had persistent epithelial defects and were treated successfully using various interventions. Conclusion: Integrity of donor corneal epithelium is mainly influenced by the refrigeration of cadavers and DPT.

Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India.

Purpose: To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011-2020) in a tertiary eye care center of eastern India. Methods: A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Results: Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full-thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full-thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). Conclusion: With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full-thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period.

Microsporidia-induced stromal keratitis: a new cause of presumed immune stromal (interstitial) keratitis.

BACKGROUND AND OBJECTIVE: To describe the clinical features, diagnosis and management of immune stromal keratitis/interstitial keratitis (IK) associated with microsporidial epithelial keratitis. METHODS: Between October 2020 and January 2021, medical records of IK patients microbiologically proven as microsporidia from samples collected from corneal epithelium on smear examination, and/ or molecular analysis were reviewed. Demography, clinical profile and treatment were analysed. Real-time PCR (RT-PCR) for adenovirus (ADV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) was done. RESULTS: Twenty of 152 (13%) microbiologically proven cases of microsporidial keratitis were diagnosed as IK during the study period, the mean age and duration of symptoms were 35.7±11.4 years and 46.3±27.7 days, respectively. Half had predisposing risk factors, like trauma; and 30% had prior recurrences. One-fourth of patients were using antivirals on presentation. Characteristic presentations included disciform keratitis(n=12), incomplete/complete ring(n=5), and combination(n=3), along with variable subepithelial infiltrates (n=14). All cases had stromal oedema, with an intact epithelium and fine pigment dusting on endothelium. Corneal epithelial scrapings had scanty microsporidia spores in smears of 17/20 (85%), and pan-microsporidial DNA was identified in 14/20 (70%), with Vittaforma corneae by sequencing in 11/20 (55%). Other viruses detected were ADV (14,70%), VZV (2,10%), EBV (1,5%) and HSV (1,5%). Rapid resolution of inflammation and oedema within 2 weeks of starting steroids was seen in all cases. CONCLUSION: Microsporidia epithelial keratitis induced stromal inflammatory keratitis; is distinguished from microsporidial keratoconjunctivitis and stromal keratitis, by characteristic clinical features, and response to topical steroids.

Microsporidia-Associated Anterior Uveitis After Keratoconjunctivitis.

OBJECTIVE: The aim of this study was to describe the clinical features and management of uveitis associated with microsporidial keratoconjunctivitis (MKC). METHODS: The medical records of clinically diagnosed or microbiologically proven patients with MKC between July 2016 and August 2021 were reviewed. Patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells were analyzed for their demography, clinical features, and treatment. Patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis were excluded from the study. RESULTS: Of the 2212 patients reviewed within the study period 171 of 172 eyes (7.7%) had documented evidence of KPs and/or anterior chamber cells. The patients' mean age was 43.8 ± 13.8 years, and there were more men (n = 120). The mean duration of appearance of KPs was 6.9 ± 5.5 days, and 28% (n = 48 of 171) appeared on the day of presentation. Superficial punctate keratitis was central and diffuse in 48 and 49 patients, respectively. The treatment was either lubricant alone (45.3%; 78 eyes) or combined with topical steroids (54.7%; 94 eyes). The mean duration of the resolution was longer in the "corticosteroid" than "no corticosteroid" group: KPs: 15.3 ± 6.5 days versus 12.3 ± 5.8 days ( P = 0.007) and superficial punctate keratitises: 15.4 ± 9.4 days versus 11.7 ± 6.2 days ( P = 0.01). The presenting visual acuity with a pinhole was 0.26 ± 0.26 (logMAR) and it improved to 0.03 ± 0.07 on resolution ( P < 0.0001, paired t test). CONCLUSIONS: Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions.

Assessment of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during COVID-19 pandemic.

Purpose: : To determine the presence of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during the COVID-19 pandemic. Methods: This observational, cross-sectional study was conducted in clinically diagnosed patients with conjunctivitis attending the outpatient services of our institute from July 2021 to December 2021. The tear samples were collected from patients using Schirmer's strips or capillary tubes to detect the presence of SARS-CoV-2 by real-time PCR assay. COVID-19 vaccination and infection status, visual acuity, and clinical features were documented in all cases. Results: A total of 111 patients with symptoms of conjunctivitis were included during the study period. The mean age was 41.1 ± 13.1 years, and the mean duration of symptoms was 7.1 ± 4.4 days, with 74% males. Conjunctival congestion was mild in 69 (62.1%) patients, moderate in 30 (27%) patients, and severe in 12 (10.8%) patients. All except four had superficial punctate keratitis (SPK). Five (4.3%) patients were positive for SARS-CoV-2 RNA in their tear samples. All had mild-moderate conjunctival congestions with variable papiliofollicular reaction and SPKs, superficial hemorrhages were seen in three and pseudomembrane in one patient. They were followed up with telemedicine and three of them developed mild COVID-19-related symptoms and recovered after in-home quarantine. None of them had a previous history of COVID-19 infection and all had received COVID-19 vaccination within 2 weeks to 2 months. Conclusion: SARS-CoV-2 transmission through ocular secretion of conjunctivitis patients cannot be ignored and appropriate COVID-19-preventive behavior should be followed in ocular settings.

Sequelae of carbide-related thermo-chemical injury: A retrospective analysis.

Purpose: To describe the outcomes of eyes with calcium carbide (CaC2)-related thermo-chemical injury. Methods: This study included 28 eyes of 23 patients who presented with calcium carbide-related ocular burns. Only patients with more than three months of follow-up were included. Group A included 16 eyes with Dua's Grade I-III burns, while Group B included 12 eyes with Grade IV-VI burns. Electronic medical records were reviewed to provide data on the etiology of burn, presenting clinical signs and visual acuity, sequelae, and surgical interventions performed, both in the acute and chronic phases. Results: The overall mean age was 28.48 ± 11.8 years. Fifteen patients were injured while using carbide to create an explosion to scare away animals on farms. The median presenting BCVA (best-corrected visual acuity) in Group A (20/160) was significantly better than in Group B [(20/2000) (P = 0.002)]. Five eyes in Group A and one eye in Group B underwent medical management. There was no difference in the duration of follow-up for both groups (P = 0.24). The median final BCVA in Group A (20/32) was significantly better than in Group B [(20/200) (P = 0.02)]. Two eyes in Group A and nine eyes in Group B developed LSCD. Two eyes in Group B were phthisical at the last visit. Conclusion: Calcium carbide-related ocular injuries can result in significant visual morbidity in young adults. Early presentation and management may improve outcomes. Prevention of these injuries by increasing awareness and increasing advocacy efforts is necessary.

Keratitis following descemet's stripping endothelial keratoplasty (DSEK): Clinical features and outcome in early vs late presentation.

OBJECTIVE: To compare the clinical presentation, risk factors, causative organisms, and final outcome of early- and late- onset microbial keratitis following Descemet's Stripping Endothelial Keratoplasty (DSEK). MATERIALS AND METHODS: In a retrospective, comparative, case series, twenty-three (10 early-onset keratitis, 13 late-onset keratitis) cases were included for analysis from a single centre tertiary eye care setup. Data about demography, indication, clinical features, and outcome were collected for both the groups. Comparison of clinical presentation, risk factors, microbiology and final outcome were carried out. RESULTS: The most common indication was failed graft. While all patients with late-onset keratitis presented with ulcerative keratitis, 60% of early-onset keratitis presented with ulcerative keratitis. Four patients in the early-onset group had interface keratitis. Associated endophthalmitis was more in the early-onset compared to the late-onset group. Early-onset interface keratitis cases are mostly associated with donor-related infection. Gram-positive bacteria were the most common organisms isolated from both early- and late- onset infection. Major surgical procedures in both early- and late- onset keratitis included lenticule removal (n = 4) and therapeutic penetrating keratoplasty (n = 5). CONCLUSIONS: Failed graft is a major risk factor in post-DSEK keratitis. Interface keratitis and endophthalmitis are commonly observed in early-onset keratitis. A majority of the patients need surgical intervention.

Preservation of donor corneal epithelium in McCarey-Kaufman medium.

Purpose: To evaluate the role of McCarey-Kaufman (MK) medium in maintaining the integrity of donor corneal epithelium. Methods: Nineteen corneal buttons were harvested and stored in MK media at 2°C-8°C for four days. Serial photographs were done every day till the 3rd day, and images were then analyzed with ImageJ software (LOCI, University of Wisconsin, USA). The area of exposure and epithelial defect (ED) was calculated every day for each corneal button. Results: The average age of the donors was 56.5 ± 22.7 years and mean time from death to preservation of the corneal buttons was 7.7 ± 3.1 hours. The average corneal area was 145.6 ± 18.8 mm2. The total mean area of exposure was 3.6 ± 4.8, 7.2 ± 9.2, and 9.0 ± 11.9 mm2, and ED was 1.7 ± 4.6, 2.8 ± 5.3, and 3.3 ± 5.9 mm2 on days 1, 2, and 3, respectively. The percentage of increase in the area of exposure and ED in MK media was 3.71% and 1.1% from day 1 to day 3, respectively. Six out of 19 corneal buttons (31.57%) were utilized for keratoplasties, of which two were utilized in house and four were distributed outside. Of the two utilized corneas, none had epithelial defect on postoperative day 1. Rest 13 corneas were either used for training and research purposes, stored in glycerol media, or discarded. Conclusion: Since the percentage change in area of exposure/ED is not much at the end of day 3, corneas stored in MK media can be safely used even after three days of storage. Hence, MK medium serves as an excellent medium in maintaining the integrity of donor corneal epithelium.