PRESENTATIONS AND FACTORS AFFECTING OUTCOME OF RHEGMATOGENOUS RETINAL DETACHMENT WITH CHOROIDAL DETACHMENT: An Indo-Taiwanese Study.

PURPOSE: To report the clinical settings, management, and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment. METHODS: Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan. RESULTS: Overall 303 eyes were included. Mean age was 43.72 ± 20.64 years (median 46). Best-corrected presenting visual acuity was 1.79 ± 0.92 logMAR (median 2.10) (Snellen 20/1,233). Forty-four patients (17.91%) received preoperative steroids. Final visual acuity was 1.33 ± 0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%), whereas favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (odds ratio [OR] 2.76), absence of proliferative vitreoretinopathy worse than Grade A (OR 7.69), use of preoperative steroids (OR 4.50), and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of proliferative vitreoretinopathy worse than Grade A (OR 10.41), and use of preoperative steroids (OR 7.24). CONCLUSION: Administration of preoperative steroids, use of an encircling band during surgery, and pseudophakic status of the eye were found to have better outcomes in rhegmatogenous retinal detachment with concurrent choroidal detachment.

Differentiating Occult Neuroretinitis and Non-Arteritic Anterior Ischaemic Optic Neuropathy: Clinical and Optical Coherence Tomography Characteristics.

We report clinical and optical coherence tomography (OCT) differences among patients with occult neuroretinitis and non-arteritic anterior ischaemic optic neuropathy (NAAION). We retrospectively reviewed records of patients with a final diagnosis of occult neuroretinitis and NAAION seen at our institute. Data were collected regarding patient demographics, clinical features, concomitant systemic risk factors, visual function, and optical coherence tomography (OCT) findings at presentation and subsequent follow-up. Fourteen and 16 patients were diagnosed to have occult neuroretinitis and NAAION, respectively. Patients with NAAION were slightly older (median age 49, inter-quartile range [IQR]: 45-54 years, versus 41, IQR: 31-50 years) than patients with neuroretinitis. Seventy-five per cent of patients with NAAION were male versus 43% with neuroretinitis (p = 0.07). Systemic risk factors were present in 87.5% of patients with NAAION versus 21.4% in patients with neuroretinitis (p = 0.001). At presentation, all patients presented with blurred vision, had similar visual function, and had optic disc oedema. In addition, none of the patients had evident retinitis lesions, but 10 (71%) showed evident retinitis lesion at follow-up. Neuroretinitis patients had more often vitreous cells (64% versus 6%, p = 0.001), and subretinal fluid (78.6% versus 37.5%, p = 0.03) than the patients with NAAION. In summary, NAAION patients tended to be slightly older, more often male, and had associated systemic diseases more often than those with neuroretinitis. Neuroretinitis patients more often had posterior vitreous cells and subretinal fluid on OCT. However, larger prospective studies are needed.

CULTURE POSITIVITY RATES OF DEEP VITREOUS BIOPSY UNDER AIR VIS-À-VIS CONVENTIONAL ANTERIOR VITREOUS BIOPSY IN ENDOGENOUS ENDOPHTHALMITIS.

PURPOSE: To describe the comparison of the culture positivity rates of deep vitreous biopsy under air and conventional anterior vitreous biopsy in endogenous endophthalmitis. MATERIALS: A retrospective, consecutive, comparative series including cases of endogenous endophthalmitis from January 2014 to January 2021. They were divided into those where conventional anterior vitreous biopsy was taken and those where a deep biopsy was taken under air (DBA group). The culture positivity rate among the two groups was compared, and factors affecting the same were analyzed by a regression analysis. RESULTS: There were 140 eyes in the conventional anterior vitreous biopsy group and 44 eyes in the DBA group. Sex, age, duration of symptoms, underlying systemic illness, presenting vision in logMAR, and total number of vitreous interventions were comparable between the two groups. Visual outcome was better in patients undergoing DBA as compared with those who underwent conventional anterior vitreous biopsy , (1.28 ± 1.01 logMAR, 20/380 vs. 1.88 ± 1.33 logMAR, 20/1,500, P = 0.03). No case in the DBA group developed retinal detachment or any complication attributable to the technique. In the conventional anterior vitreous biopsy group, the culture positivity was seen in 43/140 samples (30.71%), and in the DBA group, it was noted in 29/44 samples (65.9%). Taking a DBA was the only factor that was significant both in bivariate (odds ratio 4.36, 95% confidence interval 2.12-8.95, P < 0.0001) and multivariate analysis (odds ratio 4.02, 95% confidence interval 3.1-7.43, P < 0.0001). CONCLUSION: Vitreous sampling can be performed from the deep vitreous cavity in endogenous endophthalmitis safely and effectively under air infusion, improving the culture positivity rates.

CLINICAL PRESENTATIONS, MICROBIOLOGY, AND FACTORS AFFECTING MANAGEMENT OUTCOMES IN LENS ABSCESS WITH CONCURRENT ENDOPHTHALMITIS.

PURPOSE: To describe the clinical presentations, microbiology, and factors affecting management outcomes in lens abscess with concurrent endophthalmitis. MATERIALS: A retrospective, consecutive, noncomparative series including cases of endophthalmitis with concurrent lens abscess from January 2017 to May 2021. RESULTS: This study included 102 eyes, predominantly male (71.6%). All cases were posttrauma. The mean age noted was 30.47 ± 19.51 years. Presenting vision was logMAR 3.02 ± 0.74 (median 3.5, Snellen 20/63245). A favorable anatomical outcome was seen in 63 eyes (61.8%), while a final favorable functional outcome was seen in 51 eyes (50%). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Final vision was logMAR 2.13 ± 1.32 (median 2.7, Snellen 20/10023) (P < 0.0001). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Increasing age (OR 1.04, P = 0.02), female sex (OR 7.91, P = 0.007), initial intervention of vitrectomy instead of limited vitreous biopsy (OR 11.72, P = 0.009), and a negative vitreous culture (OR 14.28, P = 0.0004) predicted a favorable anatomical outcome. Absence of a corneal infiltrate (OR 11.11, P = 0.003) and initial intervention of vitrectomy instead of a limited vitreous biopsy (OR 21.96, P < 0.0001) predicted a favorable functional outcome. Culture positivity was seen in 56.9% of the cases. Gram-positive organisms were predominant (n = 41) followed by Gram-negative organisms (n = 12) and fungi (n = 10). CONCLUSION: Lens abscess can present concurrently with traumatic endophthalmitis. Management should involve the complete removal of the crystalline lens along with a pars plana vitrectomy for optimal outcomes.

CLINICAL PREDICTORS OF TUBERCULAR RETINAL VASCULITIS IN A HIGH-ENDEMIC COUNTRY.

PURPOSE: To determine clinical signs suggestive of tubercular etiology in retinal vasculitis. METHODS: A retrospective comparative study of patients who presented with retinal vasculitis at three tertiary care centers in India. All patients underwent detailed clinical evaluation and tailored laboratory investigations for etiological diagnosis. Tubercular etiology was diagnosed on basis on the presence of retinal periphlebitis in association with ancillary evidence of systemic tuberculosis and exclusion of nontuberculosis entities. Patients with tubercular (Group A) and nontubercular (Group B) etiology were compared for demographic characteristics, supportive diagnostic evidence, and specific ocular signs. Statistical analysis was performed at 5% confidence levels. RESULTS: Of the 114 patients diagnosed with retinal vasculitis, Group A had 69 patients (100 eyes) and Group B had 45 patients (75 eyes). Active or healed subvascular lesions (P ≤ 0.0001), focal vascular tortuosity (P ≤ 0.0001), and occlusive vasculitis (P = 0.002) were significantly more common in Group A patients than in Group B patients. All three were independent predictors of tubercular etiology on multivariate regression analysis. CONCLUSION: The presence of healed or active subvascular lesions, focal vascular tortuosity, and occlusive vasculitis could be predictive of tubercular etiology in retinal vasculitis.

Management of Endophthalmitis with and without Topical Antibiotics: A Case-Control Study.

PURPOSE: The aim of this study was to compare the management outcome of endophthalmitis with and without the use of topical antibiotics. METHODS: A retrospective comparative chart review of 2 cohorts of endophthalmitis (other than those associated with open-globe injury, keratitis, or wound site infection), one managed with topical antibiotics (TA group) and one without (NTA group), was performed. RESULTS: The study included a total of 270 eyes of 270 patients. Of these, 169 eyes were in the TA group and 101 were in the NTA group. Post-cataract surgery was the most common etiology, accounting for 81.06 and 78.2% of cases, respectively (p = 0.57). A favorable functional outcome at the last visit was seen in 37.5 and 39.6% of eyes (p = 0.73), and a favorable anatomic outcome was noted in 61.2 and 49.5% of eyes (p = 0.06), respectively. The median follow-up was 3.5 and 9 months, respectively (p < 0.0001). Susceptibilities to the common antibiotics used (vancomycin, ceftazidime, and amikacin) were comparable, with the exception of imipenem, for which the susceptibility noted was 95 and 66%, respectively (p = 0.01). Culture positivity in the TA group was seen in 72 out of 169 eyes (42.6%), while in the NTA group it was seen in 98 out of 101 eyes (97.02%; p < 0.0001). CONCLUSION: Topical antibiotics do not give any added advantage in the management of endophthalmitis otherwise being treated with intravitreal antibiotics and standard vitrectomy techniques.

CLINICAL PRESENTATIONS, DIAGNOSIS, AND MANAGEMENT OUTCOMES OF CURVULARIA ENDOPHTHALMITIS AND A REVIEW OF LITERATURE.

PURPOSE: To describe the clinical presentation and management of Curvularia endophthalmitis and compare with previous published literature. METHODS: Retrospective interventional comparative case series and literature review. Eight cases with culture-proven Curvularia endophthalmitis from January 2000 to March 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures as appropriate. The undiluted vitreous biopsy was subjected to microbiologic evaluation. Pre-existing literature was reviewed, and the current outcomes were compared with them. The mean age at presentation, etiology, number of interventions, interval between inciting event and presentation, type of intravitreal antifungal used, anatomical, and the functional outcomes were reported and compared with pre-existing literature. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. RESULTS: In the current series, there were 4 men and 4 women. Mean age at presentation was 34.5 ± 13.51 years (median 30 years). Inciting event was open-globe injury in five cases and cataract surgery, trabeculectomy, and endogenous cause in one case each. Presenting visual acuity was ≥20/400 in 3 cases at presentation and 5 cases at the last visit. One case with staphyloma and endophthalmitis underwent evisceration for a painful blind eye. The patients in the current series were much younger than those described previously. CONCLUSION: Presentation and diagnosis of Curvularia can be delayed especially in postoperative cases. Early and appropriate management with multiple interventions can result in an acceptable visual and anatomical outcome.

ENTEROCOCCUS ENDOPHTHALMITIS: Clinical Settings, Antimicrobial Susceptibility, and Management Outcomes.

PURPOSE: To report the clinical presentation and management outcome of patients with endophthalmitis caused by Enterococcus species and to report the susceptibility profile of the isolates. METHODS: Twenty-nine cases with culture-proven Enterococcus endophthalmitis from January 2005 to May 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Favorable visual outcome was final visual acuity ≥20/400. RESULTS: There were 24 men (82.8%). Mean age at presentation was 32.89 ± 25.25 years (median 24 years). Inciting event was open globe injury in 18 (62%), endogenous in 5 (17.24%), postcataract surgery in 3 (10.34%), postscleral buckling in 2 (6.89%), and postkeratoplasty in 1 (3.44%). Enterococcus casseliflavus was the commonest species isolated (14/29, 48.27%) followed by E. faecalis (9/29, 31%). Susceptibility to vancomycin was seen in 27/29 isolates (93%). Visual acuity was ≤20/400 in all eyes at presentation and ≥20/400 in 10/29 cases (34.48%) at final visit. Anatomical success was seen in 18/29 eyes (62%). Corneal involvement was high at 24/29 eyes (82.75%). CONCLUSION: Enterococcus is not an uncommon organism in the setting of endophthalmitis after open globe injury. Resistance to vancomycin is rare. Multidrug resistance pattern is restricted to E. faecalis. Visual outcome is poor despite early and appropriate therapy due to inherent organism virulence.

CLINICAL PRESENTATION, MICROBIOLOGIC PROFILE AND FACTORS PREDICTING OUTCOMES IN BACILLUS ENDOPHTHALMITIS.

PURPOSE: To describe the clinical presentation, microbiologic profile, and factors predicting outcomes in Bacillus endophthalmitis. METHODS: Retrospective interventional case series. Eighty-six patients with culture-proven Bacillus endophthalmitis, from January 2001 to December 2015, underwent vitrectomy/vitreous biopsy and intravitreal antibiotic with or without steroid as appropriate. The undiluted vitreous biopsy was subjected to microbiologic evaluation. The duration of symptoms, presenting visual acuity, organisms isolated, influence of intravitreal dexamethasone with intravitreal antibiotics, and type of initial intervention were examined for any clinical and statistical correlation in terms of odds ratio with the final visual outcome. RESULTS: Trauma was the commonest etiology (n = 75; 87.2%). Mixed infection with other bacteria was seen in 11 patients. All Bacillus species were sensitive to gentamicin followed by ciprofloxacin (n = 85; 98.83%) and vancomycin (n = 81; 94.18%). Odds in favor of a favorable visual outcome were seen with clinical treatment within 48 hours of the symptoms (OR 25.47, 95% CI 2.45-254.16, P = 0.006), better presenting vision (OR 31.21, 95% CI 2.96-323.64, P = 0.004), and absence of polymicrobial infection (OR 18.03, 95% CI 0.9-344.4, P = 0.05). Only 20% of all treated patients regained ambulatory vision, and one fifth of all of them developed phthisis. CONCLUSION: Patients diagnosed with Bacillus endophthalmitis merit aggressive vitreous intervention guided by the culture-sensitivity report. Despite early and appropriate treat ment, the outcomes are generally poor.

Clinical presentations, risk factors and outcomes of ceftazidime-resistant Gram-negative endophthalmitis.

BACKGROUND: To describe the clinical features and outcomes of patients diagnosed with ceftazidime-resistant Gram-negative endophthalmitis and the role of intravitreal imipenem in these cases. DESIGN: Retrospective consecutive interventional case series at a tertiary eye care centre in South India. PARTICIPANTS: Consecutive cases of ceftazidime-resistant Gram-negative endophthalmitis from April 2010 to December 2014. Fifty-six cases diagnosed during this time period were included. METHODS: All cases were managed with vitreous biopsy/vitrectomy, microscopy and undiluted vitreous culture, antimicrobial susceptibility of bacterial isolates and received intravitreal antibiotics. MAIN OUTCOME MEASURES: Anatomic and visual outcome of these cases, antimicrobial susceptibility pattern of intravitreal imipenem and outcome of cases injected with it. RESULTS: Commonest presentation was acute endophthalmitis following cataract surgery (27 eyes, 48.21%). Pseudomonas aeruginosa was isolated in 33 eyes (58.93%; 95% CI 46.05-71.81%). Nineteen eyes (34%; 95% CI 21.59-46.41%) developed phthisis; 14 eyes (25%; 95% CI 13.66-36.34%) had vision <20/200; 17 eyes (30.35%; 95% CI 18.31-42.39%) eyes had an ambulatory vision >20/200 (logMAR 1); 6 eyes (10.71%; 95% CI 2.61-18.81%) had a reading vision >20/40 (logMAR 0.3). Trend was towards better anatomic (72.73% vs. 40%) (P = 0.05) and visual improvement in the imipenem group (logMAR 3.94 + 0.21 to 2.43 + 1.4; P = 0.002), as compared with non-imipenem group (logMAR 2.99 + 1.3 to 2.55 + 1.4; P = 0.13). CONCLUSIONS: Outcome of ceftazidime-resistant Gram-negative endophthalmitis is poor. P. aeruginosa is the commonest isolated organism. All cases were sensitive to imipenem. There was a trend towards better anatomic outcome in imipenem-treated eyes.

CLINICAL PRESENTATIONS AND OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN RETINITIS PIGMENTOSA.

PURPOSE: To describe the clinical presentations and outcomes of rhegmatogenous retinal detachments (RRD) in eyes with retinitis pigmentosa. METHODS: A retrospective review of all patients of retinitis pigmentosa with RRD from January 1990 to December 2013 at a tertiary eye care institute. RESULTS: Of total 28,622 patients of retinitis pigmentosa over a 23-year period, 17 eyes of 17 patients had RRD. Mean age at presentation was 34.53 ± 16.42 years (median 32 years). Median duration of decreased vision attributed to RRD was 6 months. Ten eyes (59%) had cataract and 3 eyes (18%) had history of cataract surgery. Thirteen eyes (76%) had inferior retinal detachment; 9 eyes (53%) had lattice with retinal holes; and 8 eyes (47%) had atrophic retinal holes. There were no horse-shoe tears, giant retinal tears, dialysis, and macular holes related RRD. Majority (82%) of retinal breaks were in the inferotemporal quadrant. Only 3 eyes (18%) had proliferative vitreoretinopathy at presentation. Twelve eyes at presentation had best-corrected visual acuity <20/200 and 6 eyes had only light perception. The macula was involved by the detachment in all cases. Mean preoperative visual acuity was 1.4 ± 0.88 logarithm of the minimum angle of resolution (median 1.3, range 3-0.1; 20/502). Surgery was not advised in 6 eyes (35% patients); 5 eyes (30%) underwent scleral buckling and 6 eyes (35%) underwent vitrectomy. Median follow-up was 5 months. Reattachment rate at last follow-up was 91% (15 eyes). Mean postoperative best-corrected visual acuity recorded was 1.06 ± 0.8 (median 1, range 3-0.1; 20/229) (P = 0.15). Eight eyes at last visit had best-corrected visual acuity <20/200. Of the 11 eyes operated, 4 improved in vision and 7 retained the preoperative vision. CONCLUSION: The incidence of RRD in retinitis pigmentosa is very low. Presentation, although delayed, is at a younger age. Horse-shoe tears and proliferative vitreoretinopathy are uncommon; cataract is a common coexisting pathology. Surgical reattachment rates appear high and recurrent RRD is uncommon. However, visual gain is limited by the underlying retinal degenerative condition.

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature.

To report the clinical and microbiological characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (B-K-Pro) implantation. Retrospective analysis of 45 eyes that received a B-K-Pro type 1 between 2009 and 2012 was performed. Five eyes with a diagnosis of exogenous endophthalmitis after B-K-pro type 1 were identified and information about demographic data, indication for K-Pro, post-operative bandage contact lens use, post-operative prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid and preoperative and post-operative visual acuity were collected. The incidence of endophthalmitis was 11.1 % (5 of 45 eyes) and average time to develop endophthalmitis was 5.62 months (range 2 days to 8 months). Mean patient age was 31.4 years (5 to 65 years). The surgical indications included corneal injury due to chemical burns (n = 2), multiple failed grafts secondary to microbial keratitis (n = 2) and congenital glaucoma with congenital herpetic keratitis (n = 1). Post-Boston K-Pro, the visual acuity ranged from light perception (LP) to 20/50. K-pro was explanted in 4 patients. There was bacterial and fungal growth in two patients each and one vitreous did not grow anything. All the eyes were phthisical at last visit. Infectious endophthalmitis after K-Pro implantation in our study had a higher incidence, early onset and extremely poor visual outcome compared with post-cataract surgery endophthalmitis, as reported in literature. Not only bacterial but also fungal infections are an important etiology for infectious endophthalmitis in these cases.

Asymptomatic Ophthalmomyiasis Interna Posterior with Central Pigment Accumulation in the Inner Retina.

PURPOSE: To report a case of ophthalmomyiasis interna posterior which was asymptomatic and had pigment clumps in the inner retina at the macula. METHODS: Single-centre, observational, retrospective case report. RESULTS: A routine refractive error check-up for an asymptomatic 52-year-old Asian Indian woman, who had relied on glasses for 8 years, unfolded a captivating narrative within her retina. This coloured fundus photo unveils mid-peripheral retinal disease with multiple outer retinal atrophic tracts, circumlinear patterns, and intricately intertwined RPE atrophic tracts. These were hyper-autofluorescent on blue autofluorescence. The inferonasal periphery had two-disc diameters of pigmented retinal-choroidal atrophic scar. The macula revealed a collection of black intraretinal pigments in parafoveal areas. The distinct clinical presentation, marked by multiple tracts and unilateral manifestation without disc pallor, hinted at the intriguing possibility of self-resolved "Ophthalmomyiasis interna posterior." CONCLUSION: The course of disease in ophthalmomyiasis interna posterior can be self-limiting and asymptomatic. The presence of inner retinal pigments at foveal and parafoveal areas, possibly due to pigment migration from the peripheral outer retinal tracts, is a rare presentation.

Experience of focused workshop intervention in presentation skills - Importance of foundational skills for ophthalmologists in training.

Background: The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training. Methods: A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1-10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results: Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention. Conclusions: Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

Analysing the effectiveness of Just-A-Minute Optometry Clinical Pearls: a micro-learning tool in continuing optometry education.

CLINICAL RELEVANCE: Just-A-Minute Clinical Pearls as a microlearning concept may be beneficial in enhancing optometry and ophthalmology practice globally. BACKGROUND: Medical education often witnesses a gap in effectively translating the learnings into clinical practice, pointing to the complex and traditional teaching methods as hindrances. The present work studied the usefulness and acceptability of Just-A-Minute Optometry Clinical Pearls, a micro-learning tool, among optometrists and ophthalmologists. METHODS: Just-A-Minute Optometry clinical pearls were developed by the optometry team of LV Prasad Eye Institute and shared (via email) among optometrists and ophthalmologists on a daily basis between June 2021 to May 2022. In the middle of the project, the recipients were invited to participate in an online survey. The variables studied included frequency of checking clinical pearls, simplicity of their content, grasping speed, most used subspeciality pearls, knowledge gain and retention, practice applicability, overall learning experience, and the likelihood of recommending it to a friend. RESULTS: Among 150 respondents, 103 (68.7%) were ophthalmologists, and 46 (30.7%) were optometrists. The majority were from private (n = 64, 42.7%) and institutional (n = 48, 32%) practices, with 102 (68.4%) having more than five years and 21 (14%) having 2-5 years of experience. About 115 (77%) respondents checked clinical pearls every day, 147 (99%) found the format easy, and 131 (88%) could grasp the content within one minute. They felt that JAM-OCP 'always' enhanced clinical knowledge (n = 108, 72%) and clinical applicability (n = 82, 55%) and helped in knowledge retention (n = 123, 84%). The responses to the clinical application significantly varied (Chi-square tests) among subgroups of education qualification (p < 0.001) and practice types (p < 0.03). CONCLUSIONS: The Just-A-Minute Optometry Clinical Pearls were beneficial to optometrists and ophthalmologists in their practices. This, as a tele-education tool, supports continuing optometry education across the globe.

Surgical approach to endophthalmitis: an overview.

Endophthalmitis is one of the most severe ocular emergencies faced by ophthalmologists worldwide. Without prompt treatment significant visual loss is inevitable. With increased understanding of the science of endophthalmitis, recent studies have shown a clear role of early and more definitive surgery to achieve better visual and anatomic outcomes. Surgery in endophthalmitis encompasses a whole gamut of interventions. There are diagnostic procedures like anterior chamber tap and vitreous biopsy or therapeutic procedures like complete pars plana vitrectomy and retinal detachment repair. Current literature is deficient on a detailed description of the spectrum of surgical interventions in endophthalmitis. In the current communication, we summarize the studies based on various surgical interventions in endophthalmitis. We also elaborate in detail on each surgical maneuver, taking the reader through the nuances of each surgery via an exhaustive description and appropriate photos and surgical video clips.

Macular Punctate Lesions Presenting as a Primary Manifestation of Ocular Toxoplasmosis.

PURPOSE: To study clinical features and outcomes of primary ocular Toxoplasmosis (OT) cases presenting as macular punctate lesions. METHODS: Retrospective review of three cases of OT with positive Toxoplasma serology. RESULTS: We describe three cases presenting as primary OT with no evidence of old retinochoroidal scar in either eye. All the cases had multiple foveal or extrafoveal, punctate, inner/outer, or combined lesions at macula with minimal vitreous reaction. During the first/primary episode, all the lesions resolved with 1. retinal atrophy, thinning (n = 1) or 2. Progressed to limited full-thickness retinitis lesions (n = 2). Recurrence as typical retinochoroiditis was seen in one eye. More than four-fold IgG positivity was seen in all cases while IgM positivity was seen in two cases. CONCLUSIONS: Macular punctate lesions (inner/outer/combination) can be the primary manifestation of ocular toxoplasmosis in the absence of old retinochoroiditis scars in either eye.

Anterior Non-Necrotizing Scleritis with Active Uveitis in Cases of Ocular Syphilis.

PURPOSE: To study clinical characteristics and management outcomes of cases of ocular syphilis co-presenting with scleritis and active uveitis. METHODS: A retrospective analysis of cases diagnosed with ocular syphilis between January 2020 and December 2023 was conducted at a tertiary eye care centre. Clinical records, investigations, and outcomes were reviewed to identify cases with scleritis with active uveitis. Demographic data, clinical features, treatment modalities, and resolution patterns were analyzed. RESULTS: Among the 135 eyes of 95 cases of ocular syphilis studied, scleritis with uveitis was observed in 3.70% of eyes (five eyes). All cases with scleritis and uveitis were unilateral and male, with ages ranging from 32 to 61 years. Concurrent features included placoid chorioretinitis, retinal vasculitis, and anterior uveitis. Misdiagnosis with subsequent oral steroid therapy precipitated scleritis as an exacerbation in two cases. Three cases, which were previously undiagnosed, were found to be HIV-positive. Scleritis manifested as anterior, non-necrotizing inflammation, often accompanied by chemosis, and responded rapidly to antibiotic and non-steroidal anti-inflammatory therapy. Scleritis resolution preceded that of chorioretinitis and retinal vasculitis. CONCLUSIONS: Non-necrotizing anterior scleritis with chemosis can be a rare presentation of active syphilitic uveitis. Large placoid chorioretinitis lesions, preceding inadvertent oral steroid and/or undiagnosed HIV status were the possible risk factors for the development of concurrent scleritis.